Health Insurance chapter 5 Multiple choice

The health insurance claims process is typically an interaction between the healthcare provider and

an insurance company

The paper claim form approved by the AMA Council on Medical Services, which was subsequently adopted by all government healthcare programs.

HCFA-1500

A very significant piece of legislation passed by Congress in 1996 that impacted healthcare and medical billing was the

HIPAA

ASCA has identified that providers with 25 or fewer full-time employees (FTEs) and physicians, practitioners, and suppliers with 10 or fewer FTEs should be referred to as

small providers

According to HIPAA, which of the following code sets is acceptable for the electronic transmission of healthcare date?

CPT-4 procedure codes

The most common format used for computer text files on the internet is

ASCII

Services or supplies that are appropriate and necessary for the symptoms, diagnosis, and treatment of the medical condition and meet the standards of good medical practice is the definition for

medical necessity

Examples of technological advancements in enrollee verification include all, EXCEPT the following

OCR systems

Medicare claims must be submitted electronically, unless the HHS Secretary grants a/an

Waiver

One category that may be exempt from mandatory electronic claim submission is a/an

small provider

Documents needed to generate an insurance claim include all of the following, EXCEPT a

patient's driver's license

The multipurpose billing document used by many providers is called a/an

superbill, encounter form and patient service slip

The document on which patients' record their demographic and insurance information is the

patient information form

The two basic methods to submit claims electronically are

clearinghouse and direct to insurer

A business entity that specialized in consolidating claims received from providers and transmitting them in batches to each respective third-party payer

Clearinghouse

For entities that choose to transmit claims electronically,_____________ or a clearinghouse is necessary to handle the conversion of data to meet HIPAA requirements.

practice management software

Submitting insurance claims straight to a third-party payer is called

direct claims submission

A claim that has no errors or omissions and can be processed without delays is called a ___ claim

clean

Supplemental documents that provide additional information to the claims processor that normally cannot be included with in the electronic claim format are called

claim attachments

The nine-digit federal tax identification number is commonly referred to as the

EIN

Which of the following is a function included in most practice management software that allows reports to be generated showing outstanding claims by date, by carrier, or by some other sorting function?

Claims tracking

Covered entities were required by law to conform to version 5010, which replaced the HIPAA ASC X12 4010/4010A1 EDI transaction standard, as of

January 1, 2012

One of the recent technological advances that makes verification of patient insurance eligibility easier and faster is the

interactive voice response (IVR)

CMS has published its rules for making electronic claims attachments in the

Federal Register

The primary objective of a health insurance professional is to

submit "clean" claims

HIPAA Standards Verison ______ addresses many of the limitations in the former version and supports the reposrting of national provider identifiers (NPI) and the new ICD-10 codes.

5010

Identify which of the following is considered a HIPAA-covered entity

Healthcare plans, healthcare providers, healthcare clearinghouses

The standard unique identifier that was adopted to identify all healthcare providers and health plans is the

NPI

After January 2012, a new version of the HIPAA standards was implemented called

version 5010

The new HIPAA standards version addreaea many of the deficiencies in the former version and accommodates the reporting of

NPI and the new ICD-10 codes

After the paper form has been completed according to the applicable payer guidelines, it should be __ ______ to check for errors.

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