Ch. 8 Insurance Bk.

26 terms by dororo4510

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Exchange of data in a standardized format through computer systems is a technology known as _________________

electronic data intechange (EDI)

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

Payment to the provider of service of an electronically submitted insurance claim may be received in approximately ______________________

2 weeks or less

List benefits of using HIPAA standard transactions and code sets

a.more reliable and timely processing--quicker reimbursement from payer
b.improved accuracy of data
c.easier and more efficient access to information
d.better tracking of transactions
e.reduction of data entry and manual labor
f.reduction in office expenses

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. Maria Montez does not submit insurance claims electronically and has five full-time employees. Is she required to abide by HIPAA transaction rules?

No

Name the standard code sets used for the following:
a. physician services
b. diseases and injuries International
c. pharmaceuticals and biologics

a. Current Procedural Terminology code set
b. Classification of Diseases, Ninth Edition, Clinical Modification, Volumes 1 and 2
c. National Drug Codes for Retail Pharmacy transactions

The family practice taxonomy code is ______________

207Q00000X

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

Name the levels for data collected to construct and submit an electronic claim.

a. High-level information
b. Claim-level information
c. Specialty claim-level information
d. Service line-level information
e. Specialty service line-level information
f. Other information

The most important function of a practice management system is _________________________

accounts receivable

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)

Add-on software to a practice management system that can reduce the time it takes to build or review a
claim before batching is known as a/an __________

encoder

Software that is used in a network that serves a group of users working on a related project allowing
access to the same data is called a/an ___________

grouper

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 an insurance claim is called a/an ___________________

a. online error-edit process.

Under HIPAA, 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 _____________________

a. 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 is called the __________

c. 837P

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 _________________________

c. electronic funds transfer (EFT)

An electronic Medicare remittance advice that takes the place of a paper Medicare explanation of benefits
(EOB) is referred to as __________________

d. 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 Administration Simplifiction Enforcement Tool (ASET)

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 that 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

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