Exam 8: The Electronic Claim

Third-party payer claims examiners are forbidden from __ CPT and/or ICD-9 data that has been entered on a claim by the insurance billing specialist as health care providers are responsible for submitting an accurate bill.

The implementation of standard formats, procedures, and data content into the electronic data interchange process is the result of ______ regulations.

The National Provider Identifier identifies each individual health plan and is required on all claims as of May 23, 2007.

Match the frequency with which each of the procedures described below should be done with the word correctly describing that frequency. -Correct rejections and resubmit claims.

Practice management systems can be "rented" over the Internet.

What are medical code sets?

A screen prompt is a __.

Match the frequency with which each of the procedures described below should be done with the word correctly describing that frequency. -Make follow-up calls to resolve reasons for rejections.

Which of the following is the best way to protect computers and prevent data file damage during power outages?

Match the frequency with which each of the procedures described below should be done with the word correctly describing that frequency. -Review clearinghouse/payer transmission reports.

Under HIPAA, if a provider submits claims to Medicare and has 10 or more employees, the provider is considered a ___ and must comply with electronic transmission requirements to Medicare.

Name the organization that is responsible for issuance and maintenance of National Provider Identifiers.

The employer's identification number is assigned by

A disadvantage of electronic claim submission is more time spent processing claims, which requires additional staffing.

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.

___ allows third-party payers to deposit funds into the physician's bank account automatically and eliminates the need for personal handling of checks.

Incorrect sequencing of patient information on an electronic claim results in inaccuracies that violate the HIPAA standard transaction format and are known as

Identify common claim attachments that provide additional medical information to a claims processor.

Match the frequency with which each of the procedures described below should be done with the word correctly describing that frequency. -Update practice management system with payer information.

Medical data which are compiled and produced in the specific format used throughout the health care industry and sent in electronic files are HIPAA ___ transactions.