Question 1

What is the HIPAA X12 837 Health Care Claim: Professional commonly called? 

A. UB-04 
B. CMS-1450 
C. 837P 
D. EOB

Accepted Answer

C. 837P

Question 2

The CMS-1500 form is primarily used for 

A. hospital inpatient billing. 
B. physician service claims. 
C. dental insurance claims. 
D. pharmacy billing.

Accepted Answer

B. physician service claims.

Question 3

Wh organization is responsible for claim content on the CMS-1500? 

A. HIPAA 
B. CMS 
C. NUCC 
D. OSHA

Accepted Answer

C. NUCC

Question 4

The 5010A1 version was updated mainly to 

A. remove diagnosis codes. 
B. allow handwritten claims. 
C. provide more room for ICD-10 codes. 
D. eliminate payer information.

Accepted Answer

C. provide more room for ICD-10 codes.

Question 5

The carrier block on the CMS-1500 is located 

A. at the bottom left of the form. 
B. in the upper right portion of the form. 
C. in the center of the form. 
D. on the back of the form.

Accepted Answer

B. in the upper right portion of the form.

Question 6

Which item on the CMS-1500 contains the patient’s name? 

A. Item 1 
B. Item 2 
C. Item 7 
D. Item 12

Accepted Answer

B. Item 2

Question 7

What information is reported in Item 6 of the CMS-1500? 

A. Insurance plan name 
B. Referring provider 
C. Patient relationship to insured 
D. Patient diagnosis

Accepted Answer

C. Patient relationship to insured

Question 8

Which provider is the healthcare professional who actually treated the patient? 

A. Billing provider 
B. Pay-to provider 
C. Referring provider 
D. Rendering provider

Accepted Answer

D. Rendering provider

Question 9

Which provider receives payment for services on a claim? 

A. Rendering provider 
B. Pay-to provider 
C. Referring provider 
D. Ordering provider

Accepted Answer

B. Pay-to provider

Question 10

Which section of the CMS-1500 reports procedures performed for the patient? 

A. Section 12 
B. Section 18 
C. Section 24 
D. Section 33

Accepted Answer

C. Section 24

Question 11

A Healthcare Provider Taxonomy Code represents the provider’s 

A. insurance group number. 
B. payer identification. 
C. medical specialty. 
D. claim control number.

Accepted Answer

C. medical specialty.

Question 12

A data element is defined as 

A. a denied claim. 
B. the smallest unit of information in a HIPAA transaction. 
C. a paper attachment. 
D. a type of insurance plan.

Accepted Answer

B. the smallest unit of information in a HIPAA transaction.

Question 13

Which type of data element must always be supplied on an electronic claim? 

A. Optional 
B. Situational 
C. Required 
D. Conditional

Accepted Answer

C. Required

Question 14

Which of the following is NOT one of the five major sections of the HIPAA 837P claim? 

A. Provider information 
B. Claim information 
C. Pharmacy information 
D. Subscriber information

Accepted Answer

C. Pharmacy information

Question 15

In the HIPAA 837P claim, the term “subscriber” refers to the 

A. physician. 
B. insurance policyholder. 
C. claims processor. 
D. clearinghouse employee.

Accepted Answer

B. insurance policyholder.

Question 16

What is a clean claim? 

A. A handwritten claim 
B. A claim with no diagnosis codes 
C. A claim accepted by a health plan for adjudication 
D. A claim paid in cash

Accepted Answer

C. A claim accepted by a health plan for adjudication

Question 17

Which of the following is a common claim error? 

A. Complete payer information 
B. Valid procedure codes 
C. Missing patient date of birth 
D. Correct service facility information

Accepted Answer

C. Missing patient date of birth

Question 18

Which method of claim transmission is used by most providers? 

A. Direct data entry only 
B. Paper mailing 
C. Clearinghouses 
D. Fax transmission

Accepted Answer

C. Clearinghouses

Question 19

Online direct data entry into a payer’s system is called 

A. EFT 
B. DDE 
C. NPI 
D. EOB

Accepted Answer

B. DDE

Question 20

Which of the following may be sent as a claim attachment? 

A. Grocery receipts 
B. Driver’s license 
C. Lab results 
D. Utility bills

Accepted Answer

C. Lab results

Question 21

HIPAA requires most healthcare claims to be transmitted 

A. by fax only. 
B. electronically. 
C. through handwritten forms. 
D. through certified mail.

Accepted Answer

B. electronically.

Question 22

Which practices are generally exempt from HIPAA’s electronic claim transmission 

requirement? 
A. Practices with fewer than 10 full-time equivalent employees that do not send electronic 
transactions 
B. Hospital systems 
C. Insurance companies 
D. Pharmacies only

Accepted Answer

A. Practices with fewer than 10 full-time equivalent employees that do not send electronic

Question 23

Which item on the CMS-1500 indicates whether another health benefit plan exists? 

A. Item 10d 
B. Item 11d 
C. Item 21 
D. Item 27

Accepted Answer

B. Item 11d

Question 24

Which item on the CMS-1500 contains diagnosis codes? 

A. Item 17 
B. Item 20 
C. Item 21 
D. Item 33

Accepted Answer

C. Item 21

Question 25

The payer to whom a claim is sent is called the 

A. rendering provider. 
B. destination payer. 
C. clearinghouse. 
D. subscriber.

Accepted Answer

B. destination payer.

Question 26

A unique number assigned by the sender to each claim is called the 

A. taxonomy code. 
B. diagnosis pointer. 
C. claim control number. 
D. NPI number.

Accepted Answer

C. claim control number.

Question 27

Which of the following is an example of a situational data 
element? 
A. Data that is never required 
B. Information required only in certain situations 
C. A handwritten signature 
D. A denied claim code

Accepted Answer

B. Information required only in certain situations

Question 28

Which section of the HIPAA 837P claim contains information related to accidents and 

diagnoses? 
A. Claim information 
B. Provider information 
C. Subscriber information 
D. Payer information

Accepted Answer

A. Claim information

Question 29

Electronic funds transfer (EFT) is associated with 

A. paper claim mailing. 
B. claim denial only. 
C. electronic payment processing. 
D. handwritten claims.

Accepted Answer

C. electronic payment processing

Question 30

Which of the following is one advantage of using clearinghouses? 

A. They eliminate all coding requirements. 
B. They help transmit claims in the correct EDI format. 
C. They replace health insurance plans. 
D. They remove the need for NPIs.

Accepted Answer

B. They help transmit claims in the correct EDI format.

MED112 CODE/BILL

MED112 PRACTICE QUIZ CH 07

Question	Answer
MED112 PRACTICE QUIZ CH 7
What is the HIPAA X12 837 Health Care Claim: Professional commonly called? A. UB-04 B. CMS-1450 C. 837P D. EOB	C. 837P
The CMS-1500 form is primarily used for A. hospital inpatient billing. B. physician service claims. C. dental insurance claims. D. pharmacy billing.	B. physician service claims.
Wh organization is responsible for claim content on the CMS-1500? A. HIPAA B. CMS C. NUCC D. OSHA	C. NUCC
The 5010A1 version was updated mainly to A. remove diagnosis codes. B. allow handwritten claims. C. provide more room for ICD-10 codes. D. eliminate payer information.	C. provide more room for ICD-10 codes.
The carrier block on the CMS-1500 is located A. at the bottom left of the form. B. in the upper right portion of the form. C. in the center of the form. D. on the back of the form.	B. in the upper right portion of the form.
Which item on the CMS-1500 contains the patient’s name? A. Item 1 B. Item 2 C. Item 7 D. Item 12	B. Item 2
What information is reported in Item 6 of the CMS-1500? A. Insurance plan name B. Referring provider C. Patient relationship to insured D. Patient diagnosis	C. Patient relationship to insured
Which provider is the healthcare professional who actually treated the patient? A. Billing provider B. Pay-to provider C. Referring provider D. Rendering provider	D. Rendering provider
Which provider receives payment for services on a claim? A. Rendering provider B. Pay-to provider C. Referring provider D. Ordering provider	B. Pay-to provider
Which section of the CMS-1500 reports procedures performed for the patient? A. Section 12 B. Section 18 C. Section 24 D. Section 33	C. Section 24
A Healthcare Provider Taxonomy Code represents the provider’s A. insurance group number. B. payer identification. C. medical specialty. D. claim control number.	C. medical specialty.
A data element is defined as A. a denied claim. B. the smallest unit of information in a HIPAA transaction. C. a paper attachment. D. a type of insurance plan.	B. the smallest unit of information in a HIPAA transaction.
Which type of data element must always be supplied on an electronic claim? A. Optional B. Situational C. Required D. Conditional	C. Required
Which of the following is NOT one of the five major sections of the HIPAA 837P claim? A. Provider information B. Claim information C. Pharmacy information D. Subscriber information	C. Pharmacy information
In the HIPAA 837P claim, the term “subscriber” refers to the A. physician. B. insurance policyholder. C. claims processor. D. clearinghouse employee.	B. insurance policyholder.
What is a clean claim? A. A handwritten claim B. A claim with no diagnosis codes C. A claim accepted by a health plan for adjudication D. A claim paid in cash	C. A claim accepted by a health plan for adjudication
Which of the following is a common claim error? A. Complete payer information B. Valid procedure codes C. Missing patient date of birth D. Correct service facility information	C. Missing patient date of birth
Which method of claim transmission is used by most providers? A. Direct data entry only B. Paper mailing C. Clearinghouses D. Fax transmission	C. Clearinghouses
Online direct data entry into a payer’s system is called A. EFT B. DDE C. NPI D. EOB	B. DDE
Which of the following may be sent as a claim attachment? A. Grocery receipts B. Driver’s license C. Lab results D. Utility bills	C. Lab results
HIPAA requires most healthcare claims to be transmitted A. by fax only. B. electronically. C. through handwritten forms. D. through certified mail.	B. electronically.
Which practices are generally exempt from HIPAA’s electronic claim transmission requirement? A. Practices with fewer than 10 full-time equivalent employees that do not send electronic transactions B. Hospital systems C. Insurance companies D. Pharmacies only	A. Practices with fewer than 10 full-time equivalent employees that do not send electronic
Which item on the CMS-1500 indicates whether another health benefit plan exists? A. Item 10d B. Item 11d C. Item 21 D. Item 27	B. Item 11d
Which item on the CMS-1500 contains diagnosis codes? A. Item 17 B. Item 20 C. Item 21 D. Item 33	C. Item 21
The payer to whom a claim is sent is called the A. rendering provider. B. destination payer. C. clearinghouse. D. subscriber.	B. destination payer.
A unique number assigned by the sender to each claim is called the A. taxonomy code. B. diagnosis pointer. C. claim control number. D. NPI number.	C. claim control number.
Which of the following is an example of a situational data element? A. Data that is never required B. Information required only in certain situations C. A handwritten signature D. A denied claim code	B. Information required only in certain situations
Which section of the HIPAA 837P claim contains information related to accidents and diagnoses? A. Claim information B. Provider information C. Subscriber information D. Payer information	A. Claim information
Electronic funds transfer (EFT) is associated with A. paper claim mailing. B. claim denial only. C. electronic payment processing. D. handwritten claims.	C. electronic payment processing
Which of the following is one advantage of using clearinghouses? A. They eliminate all coding requirements. B. They help transmit claims in the correct EDI format. C. They replace health insurance plans. D. They remove the need for NPIs.	B. They help transmit claims in the correct EDI format.

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