Question 1

In which of these methods of transmitting claims can employees key standard data elements using an Internet-based service?

Accepted Answer

Direct data entry allows employees to input standard data elements directly into an Internet-based service for claims transmission.

Question 2

What is the payer's responsibility sequence number for the payer of last resort?

Accepted Answer

D

Question 3

What item is not included in the patient information section lines 1-13 of the CMS-1500?

Accepted Answer

The CMS-1500 form's patient information section (lines 1-13) includes details about the health plan, the insured, and the patient, but not the diagnosis. The diagnosis is entered in a different section of the form.

Question 4

What are the five sections on a claim?

Accepted Answer

The answer of What are the five sections on a...

Question 5

A HIPAA-mandated electronic transaction for claims may also be called

Accepted Answer

HIPAA X12 837 Health Care Claim is the correct term for a HIPAA-mandated electronic transaction for claims. This standard format allows healthcare institutions to submit claims electronically, ensuring consistency and efficiency in the processing of healthcare claims.

Question 6

Choose the editing software programs used to check claims for error correction.

Accepted Answer

Claim scrubbers are software programs specifically designed to check medical claims for errors and ensure they meet payer requirements before submission.

Question 7

Name the electronic format that practices use to ask payers about claims.

Accepted Answer

The HIPAA X12 276/277 transaction set is specifically designed for healthcare providers to inquire about the status of a health care claim or encounter to a payer. This electronic format allows for efficient communication regarding claims between healthcare practices and insurance companies or payers.

Question 8

Claims that are acceptable for adjudication by payers are called

Accepted Answer

Clean claims are those that meet the required standards for processing and payment by payers, without any issues that would cause a delay.

Question 9

The physician who actually provided the service is the

Accepted Answer

The rendering provider is the physician or healthcare professional who actually provided the service to the patient.

Question 10

For the release of information to be permissible, signature on file must have been obtained

Accepted Answer

A signature on file for the release of information is typically required to be obtained within 12 months to ensure that the consent is current and reflects the patient's most recent intentions.

Question 11

You are working for a practice and need to include a data element on a claim because it is required by the contract with the payer. Determine which of the following data element types needs to be included in this situation.

Accepted Answer

The answer of You are working for a practice and...

Question 12

Which qualifier would be reported in Item Number 15 to indicate the date being reported is last x-ray?

Accepted Answer

The answer of Which qualifier would be reported in Item...

Question 13

What entity is the destination payer?

Accepted Answer

The answer of What entity is the destination payer?
...

Question 14

Identify the claim filing indicator code that is used to indicate that the health plan is Medicaid.

Accepted Answer

The claim filing indicator code "MC" is used to indicate that the health plan is Medicaid.

Question 15

Assume that three providers are indicated for a claim for lab services. A clearinghouse is the billing provider and the physician practice is the pay-to provider. What type of provider is the laboratory?

Accepted Answer

The laboratory is the rendering provider because it is the entity that actually performs or renders the lab services.

Question 16

A billing service sending a claim is likely to be the

Accepted Answer

The billing provider is the entity responsible for sending a claim to the destination payer, which is typically an insurance company. This term refers to the healthcare provider or entity that has provided a service and is billing for reimbursement.

Question 17

What is sent as additional data to support a claim?

Accepted Answer

Attachments are often sent as additional data to support a claim, providing evidence or detailed information necessary for the claim's processing or approval.

Question 18

Name the function of the carrier block.

Accepted Answer

The carrier block is designed to accommodate a four-line address for the payer, ensuring that billing documents and correspondence are correctly addressed and sent to the appropriate entity responsible for payment.

Question 19

You are working at a practice and need to submit a claim, but cannot reach a patient to obtain his or her address, which is not on file. What should you do?

Accepted Answer

The patient's address is required information for submitting a claim. If the patient's address is not available, the claim cannot be submitted.

Question 20

Under HIPAA, payers may not

Accepted Answer

Under HIPAA, payers are required to accept standard transactions. This provision ensures that there is a uniform process for the electronic exchange of healthcare information, which helps in streamlining billing and payments, and improving efficiency in the healthcare system.

Quiz 7: Health Care Claim Preparation and Transmission