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Exam 5: Claim Submission Methods

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Question 21

True/False

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Small providers that are not computerized can use the paper version of the CMS-1500.

A) True
B) False

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Question 22

Multiple Choice

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A business entity that specializes in consolidating claims received from providers and transmitting them in batches to each respective third-party payer.

A) Clearinghouse
B) Third-party administrator
C) Small provider
D) Fiscal intermediary

E) All of the above
F) B) and C)

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Question 23

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According to HIPAA,which of the following code sets is acceptable for the electronic transmission of healthcare data?

List the five documents needed for filing an insurance claim.

What is meant by "assigning benefits"?

Complete this statement: "A complete medical record should _______."

The _________ may grant a waiver from the mandatory electronic claims submission rule.

HIPAA's new 5010 transaction standards only impact __________ claim submissions.

The paper claim form approved by the AMA Council on Medical Services,which was subsequently adopted by all government healthcare programs.

The two main sections of the CMS-1500 are ____________ and ____________.

HIPAA Standards Version ____ addresses many of the limitations in the former version and supports the reporting of national provider identifiers (NPIs) and the new ICD-10 codes.

The intent of HIPAA's Administrative Simplification legislation was to provide consumers with lower healthcare costs.

Documents needed to generate an insurance claim include all of the following,except a:

Additional software may be required to send claims directly to a third-party payer.

The HIPAA Administrative Simplification Compliance Act (ASCA)prohibits Medicare from paying claims that are not submitted electronically,with certain exceptions.

One of the recent technological advances that makes verification of patient insurance eligibility easier and faster is the:

If the decision is made to go direct to the carrier,there will be multiple _______ that occur when a computer is programmed to automatically connect to another computer.

If a medical facility has only one employee but is utilizing some type of electronic software,the office must be in compliance with HIPAA's privacy rules and regulations.This is referred to as the ___________ rule.

After the paper form has been completed according to the applicable payer guidelines,it should be ____________ to check for errors.

Direct claim submission is considered the best method if most claims are being sent to a single carrier.