Chapter 8 EDI Word Scramble

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Question	Answer
For large providers that submit paper claims to Medicare & have 10 or more employees the provider is required to do what?	To convert to electronic transactions
In regards to HIPAA, a provider who sends claims electronically is required to meet what?	HIPAA compliance
If a provider has less than 10 employees and submits claims to Medicare on paper can they continue to do so?	Yes if file a waiver
Is a provider with less than 10 employees who submits paper claims to Medicare required to be in compliance with HIPAA?	No
What are benefits of transaction code sets?	More reliable, timely processing Quicker reimbursement Improved accuracy of data Easier & more efficient access to information Better tracking of transactions Reduction of data entry and office expense
medical code sets are considered what?	data elements
Taxonomy codes	science of classification; numeric & alpha provider specialty codes
What is the most important function of a Practice Management System (PMS)?	Accounts Receivable
HIPAA standard apply only to what?	The format in which data is transmitted.
What should be done before submitting claims to look for and correct errors?	print an insurance billing worksheet or perform a front end edit
Encoder	add on software to PMS that can greatly reduce time it takes to build or review claims before batching
Grouper	software designed for use in a network that serves a group of users working on a related project that allows access to the same data
What are the 3 sections of the HIPAA security rule?	1. Administrative safeguards 2. Technical safeguards 3. Physical safeguards
Exchange of data in a standardized format through computer systems is technology known as what?	electronic data interchange (EDI)
The act of converting computerized data into a code so that unauthorized users are unable to read it is a security system know as what?	encryption
Payment to the provider of service of an electronically submitted insurance claim may be received in approximately what timeframe?	two weeks or less
Dr. Morgan has 10 or more full-time employees and submits insurance claims for his Medicare patients. Is his medical practice subject to the HIPAA transaction rules?	yes
Dr. Montez does not submit insurance claims electronically and has five full-time employees. Is she required to abide by HIPAA transaction rules?	no
What is the standard code set for physician services?	CPT
What is the standard code set for disease and injuries?	ICD-9-CM Vol 1 & 2
What is the standard code set for pharmaceuticals and biologics?	National drug codes for retail pharmacy transactions
the industry standard electronic format for a clinic to submit claims electronically is what?	837P
the industry standard electronic format for hospitals to transmit claims electronically is what?	837I
the industry standard electronic format for insurance carriers to transmit payment to clinics and hospitals is what?	ASC X12N 835
industry standard electronic format to transmit an inquiry is what?	ASC X12N 226
the industry standard electronic format to obtain health benefit and coverage information from an insurance carrier is what?	ASC 12N 270
The signature source code for data element #1351 indicating that there is a signature on file for a Medicare patient is what?	B
Name the levels for data collected to construct and submit an electronic claim	1. High-level information 2. Claim-level information 3. Specialty claim-level information 4. Service line-level information 5. Specialty service line-level information 6. Other information
The most important function fo a practice management system is what?	accounts receivable
an alert feature that may be incorporated into the software in a physician's office that finds errors so they may be corrected before transmitting a claim is called what?	online error-edit process
under HIPAA, data elements that are used uniformly to document why patients are seen (dx) and what is done to them during an encounter (procedure) are known as what?	medical code sets
The standard transaction that replaces the paper CMS-1500 claim form and more than 400 versions of the electronic National Standard Format (NSF) is called what?	837P
A paperless computerized system that enables payments automatically to be transferred to a physician's bank account by a 3rd party payer may be done via what?	electronic funds transfer (EFT)
an electronic Medicare remittance advice that takes the place of a paper EOB is referred to as what?	ANSI 835
true or false: when transmitting electronic claims, inaccuracies that violate the HIPAA standard transaction format are known as syntax errors.	true
true or false: 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 Administrative Simplification Enforcement Tool	true
true or false: incidental uses and disclosures of protected health information (PHI) are permissible under HIPAA when reasonable safeguards have been used to prevent inappropriate revelation of PHI	true
true or false: deleting files or formatting the hard drive is sufficient to keep electronic protected health information from being accessed.	false
true or false: employees who handle sensitive computer documents should sign an annual confidentiality statement.	true
true or false: when an insurance billing specialist e-mails a colleague to ask a coding question, it is permissible to refer to the case using the patient's name	false

Created by: mpeoples