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chapter 8 insurance

Question	Answer
exchange of data in a standardized format through computer connections is known as electronic data interchange	false
encrypted data often look like gibberish to unauthorized users	true
even if the physician's office does not bill Medicare and dose not submit transactions electronically, directly, or through a third party, the practice is still subject to HIPAA transaction rules	false
when submitting a claim to medicare, the name of the insured is required, not situational	false
a Medicare claim must include standard code sets, such as CPT and ICD-9-CM Codes	True
Confidential data should be stored only in the computer's hard drive	false
practice management systems can be rented from practice management systems over the internet	true
for insurance claims to be submitted electronically, a signed agreement by the physician with the carriers involved is necessary	true
clearinghouses always charge a flat fee for claim processing	false
a group of insurance claims sent at the same time from one facility is known as a	batch
a clearinghouse is an	entity that receives transmission of insurance claims, separates the claims, and sends each one electronically to the correct insurance payer
Insurance claims transmitted electronically are usually paid in	2 weeks or less
the most important function of a practice management system is	accounts receivable
the employer's identification number is assigned by the	IRS
a clearinghouse	transmit claims to the insurance payer, performs software edits, and separates claims by carrier
insurance claims form data are gathered	before the service is rendered, during the time the service is rendered, and after the service is rendered
back up copies of office records should be stored	away from the office
when a medical practice has its own computer and transmits claims electronically directly to the insurance carrier, this system is known as	carrier direct
a computer printout that is used to look for errors before an insurance claim is transmitted electronically is called	an insurance billing worksheet
back and forth communication between user and computer that occurs during online real time is called	interactive transaction
assigning a code to represent data is known as	encryption
a combination of letters, numbers, or symbols that each individual is assigned to access the computer system is called a	password
when keying data, it is wise to back up	frequently to save information
an online transaction concerning the status of an insurance claim is called an	electronic remittance advice
employees who have access to patients' medical records must have a high degree of	responsibility and accountability
a status report of claims is usually received	electronically
for assignment of benefits, each patient's ______ must obtained	signature
a screen prompt is a	question field
an internal audit that reviews who has access to PHI is an	administrative safeguard or security measure
an automatic logoff that prevents unauthorized users form accessing a computer is an	technical safeguard
how the physician's office handles the retention, removal, and disposal of paper records is an	physical safeguard
Post payments in practice management system	daily or weekly
note any problematic claims and resolve outstanding files	weekly
batch scrub edit and transmit claims	daily or weekly
review all claim rejection reports	end of month
audit claims batched and transmitted with confirmation reports	daily
make follow-up calls to resolve reasons for rejections	weekly
review clearinghouse payer transmission reports	daily
correct rejections and resubmit claims	daily
update practice management system with payer information	end of month
research unpaid claims	weekly
name 3 advantages of using a clearinghouse to bill insurance companies	1. reduction in time of claims preparation 2. cost-effective method through loss prevention 3, fewer claim rejections
list 3 additional names for an encounter form	charge slip, multipurpose billing form and a patients service slip
what are the 3 kinds for information system safeguards security measures	administrative, physical and technical
list the 3 ways in which clearinghouses are paid	1. a flat fee per claim 2. recoup the expense from the payer 3. a vendor agreement between business associate agreement or trading partner agreement
Medicaid, medicare, and Tricare use which system to eliminate the need for a clearinghouse	they use a carrier-direct system
what does an electronic remittance advice (RA) do	it is the status of a claim, tells you what has been paid or not
what is an encoder	it is add-on software to practice management systems that reduce time researching a claim before batching
what are medical code sets	it stream-lines the old system into a more efficient and cost effective system
why was the HIPAA Transaction Code Set developed	to achieve a higher quality of health care and reduce administrative costs
the numerous software programs formerly used by Medicare have been replaced by which single system	Medicare Transaction System

Created by: hudsondrummerman

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