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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