chapter 8 insurance
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| exchange of data in a standardized format throuhg computer systems is a technology known as | electronic data interchange (EDI)
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| the act of converting computerized data into a code so that unauthorized users are unable to read it is a security system known as | encryption
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| payment to the provider of service of an electronically submitted insurance claim may be recieved in approximately | 2 weeks or less
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| the benifits of using HIPPA standard transaction and code sets | more reliable and timely processing, improved accuracy of data, easier and more efficient access to information, better tracking of transactions, reduction of data entry and manual labor, reduction in office expenses
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| Dr. Morgan has 10 or more full-time employees and submits insurance claims for his Medicare patients. Is his medical practice subject to the HIPPA transaction rules | yes
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| Dr. Maria Montez does not submit insurance claims electronically and has five full- time emploees. Is she required to abide by HIPPA transaction rules | no
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| standard code sets for physician services | current procedural terminology
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| standards code sets for diseases and injuries | International classification of diseases, ninth edition, clinical modification
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| standards code sets for pharmaceuticals and biologics | national drug codes for retail pharmacy transactions
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| the staff at college clinic submits professional health care claims for each other of their providers and must use the industry standard electronic format called __________________ to transmit them electronically | ASC X12N 837P
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| the billing department at college hospital must use the industry standard electronic format called ________________ to transmit health care claims electronically | ASC X12N 8371
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| the medicare fiscal intermediary (insurance carrier) uses the industry standard electronic format called _______________ to transmit payment information to the college clinic and college hospital | ASC X12N 835
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| it has been 3 weeks since Gordon Marshall's health care claim was transmitted to the XYZ insurance company and you wish to inquire about the status of the claim. The industry standard electronic format that must be used to transmit this inquiry is called | ASC X12N 276
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| Dr. Practon's insurance billing specialist must use the industry standard electronic format called _____________ to obtain information about Beatrice Garcia's health policy benifits and coverage from the insurance plan | ASC X12N 270
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| the family practice taxonomy code is | 207Q00000X
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| a medicare patient, Charles Gorman, signed a signature authorization form, which is on file. The patient's signature source code for data element #1351 is | B
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| the levels for data collected to construct and submit an electronic claim | high level information, claim level information, specialty claim level information, service line level information, specialty service line level information, other information
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| the most important function of a practice managment system is | accounts recivable
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| to look for and correct all errors before the health claim is transmitted to the insurance carrier, you may | print an insurance billing worksheet or perform a front end edit (online error checking)
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| add on software to a practice managment system that can reduce the time it takes to build or review a claim before batching is known as a | encoder
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| software that is used in a network that serces a group of users workingon a related project allowing to the same data is called a | grouper
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| an alert feature that may be incorporated into hte software in a physicians office that finds errors so they may be corrected before transmitting an insurance claim is called | online error edit process
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| under HIPPA, data elements that are used uniformly to document why patients are seen (diagnosis) and what is done to them during their encounter (procedure) are known as | medical code sets
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| the standard transaction that replaces the paper CMS-1500 (08-05) claim form and more than 400 versions of the electronic National Standard Format is called the | 837P
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| a paperless computerized system that enables payments automatically to be transferred to a physician's bank account by a third party payer may be done via | electronic funds transfer (EFT)
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| an electronic Medicare remittance advice that takes the place of a paper Medicare explanation of benifits (EOB) is referred to as | ANSI 835
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| when transmitting electronic claims, inaccuracies that violate the HIPPA standard transaction format are known as syntax errors | True
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| an organization may file a complaint online against someone whose actions impact the ability of a transaction to be accepted or efficiently processed by using the Administration Simplification Enforcment Tool (ASET) | True
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| incidental uses and disclosures of protected health information (PHI) are permissible under HIPPA when reasonable safeguards have been used to prevent inappropriate revalation of PHI | True
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| deleting files or formatting the hard drive is sufficient to keep electronic protected health information from being accessed | False
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| Employees who handle senstive computer documents should sign an annual confidentiality statement | True
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| when an insurance billing specialist e-mails a colleague to ask a coding question, it is permissible to refer to the case using the patients name | False
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