Ch. 8; Electronic Data Interchange: Transactions and Security

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Multiple Choice

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

Electronic data into a code interchange (EDI)

The act of converting computerized data into a code so that unauthorized users are unable to read it is a security system known

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 standards transactions and code sets.

a. More reliable and timely processing - quicker reimbursement from player
b. improved accuracy of data
c.easier and more efficient access to information
c. better tracking of transactions
d. 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 aid by HIPPA transaction rule?

NO

Name the standard code sets used for the following :

a.physician service: CPT-4
b. disease and injuries : ICD-9-CM
c. pharmaceuticals and biologics : NDC national Drug Codes

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 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 reduced 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 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

Online error-edit process

Under HIPAA, data element 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

The standard transaction that replaces the paper CMS-1500 ()*-05) claim form and more than 400 versions of the electronic National Standards Format is called the

837P

A paperless computerized system that enables payments automatically to be transferred to a physician's bank account by third -party may be done via

electronic funds transfer (EFT)

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

ANSI 820

When transmitting electronic claims, inaccuracies that violate the HIPAA standard transaction format are known as syntax errors

sd

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