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The exchange of data in a standardized format through computer systems is known as electronic data interchange
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A disadvantage of electronic claims submission is more time spent processing claims, which requires additional staffing.
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IHMO

IHMO Chapter test 8

QuestionAnswer
The exchange of data in a standardized format through computer systems is known as electronic data interchange True
A disadvantage of electronic claims submission is more time spent processing claims, which requires additional staffing. False
the objective of HIPAA Transaction and Code Set regulations was to standardize code sets, claim forms, and processes used in health care facilities which would reduce administrative costs. True
Any provider who submits claims to Medicare is considered a covered entity. False
The American Medical Association (AMA) developed the standards for electronic data exchange. False
The National Provider Identifier identifies each individual health plan and is required on all claims as of May 23, 2007 False
Encounter form's procedure and diagnostic codes should be audited annually to determine if code changes have been made and if the form needs to updated accordingly. True
Health care providers must comply with electronic fund transfer rules by January 1, 2014 True
Clearinghouses always charge a flat fee for claim processing. False
Confidential data should be stored only in the computer's hard drive. False
Insurance claims transmitted electronically are usually paid in? 2 weeks or less
A clearinghouse is a(n) entity that receives transmission of insurance claims, separates the claims, and sends each one electronically to the correct insurance payer
A provider is not considered a covered entity under HIPAA under which of the following circumstances? The provider has fewer than 10 employees and submits claims only on paper to Medicare.
Supplemental documents that provide additional medical information to a claim are referred to as claim attachments
The most important function of a practice management system is accounts receivable
Back-and-forth communication between user and computer that occurs during online real time is called interactive transaction
When a medical practice has its own computer and transmits claims electronically directly to the insurance carrier, this system is known as carrier-direct
The HIPAA security rule addresses security of electronic PHI in which of the following areas? All of the above
The most common type of physical access control to limit access to areas where medical charts are kept is locks on doors
To ensure that data have been effectively backed up on the practice management system, verification of original records to stored information should be performed weekly
Batch, scrub, edit, and transmit claims daily or weekly
make follow up calls to resolve reasons for rejections weekly
correct rejections and resubmit claims daily
research unpaid claims weekly
The implementation of standard formats, procedures and data content into the electronic data interchange process is the result of __________ regulations. HIPAA
Under HIPAA, if a provider submits claims to Medicare and has 10 or more employees, they are considered a(n) __________ and must comply with electronic transmission requirements to Medicare. Covered entity
Medical data that are compiled and produced in the specific format used throughout the health care industry ad sent in electronic files are HIPAA ___________ transactions. Standard
HIPAA requires employers to obtain ______ Numbers to identify themselves during the enrollment process for employees into a health plan. EIN
A(n) ___________ is a preprinted document used by the provider to circle procedural and diagnostic codes that are then passed on to the insurance billing specialist and used to enter information into the computer system. Encounter form
For assignment of benefits, each patient's ________ must be obtained. Signature
Created by: Yukonclif348
 

 



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