IHMO Chapter test 8
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| The exchange of data in a standardized format through computer systems is known as electronic data interchange | True
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| A disadvantage of electronic claims submission is more time spent processing claims, which requires additional staffing. | False
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| 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
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| Any provider who submits claims to Medicare is considered a covered entity. | False
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| The American Medical Association (AMA) developed the standards for electronic data exchange. | False
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| The National Provider Identifier identifies each individual health plan and is required on all claims as of May 23, 2007 | False
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| 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
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| Health care providers must comply with electronic fund transfer rules by January 1, 2014 | True
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| Clearinghouses always charge a flat fee for claim processing. | False
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| Confidential data should be stored only in the computer's hard drive. | False
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| Insurance claims transmitted electronically are usually paid in? | 2 weeks or less
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| 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
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| 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.
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| Supplemental documents that provide additional medical information to a claim are referred to as | claim attachments
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| The most important function of a practice management system is | accounts receivable
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| Back-and-forth communication between user and computer that occurs during online real time is called | interactive transaction
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| When a medical practice has its own computer and transmits claims electronically directly to the insurance carrier, this system is known as | carrier-direct
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| The HIPAA security rule addresses security of electronic PHI in which of the following areas? | All of the above
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| The most common type of physical access control to limit access to areas where medical charts are kept is | locks on doors
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| 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
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| Batch, scrub, edit, and transmit claims | daily or weekly
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| make follow up calls to resolve reasons for rejections | weekly
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| correct rejections and resubmit claims | daily
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| research unpaid claims | weekly
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| The implementation of standard formats, procedures and data content into the electronic data interchange process is the result of __________ regulations. | HIPAA
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| 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
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| 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
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| HIPAA requires employers to obtain ______ Numbers to identify themselves during the enrollment process for employees into a health plan. | EIN
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| 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
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| For assignment of benefits, each patient's ________ must be obtained. | Signature
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