Exam 5: Claim Submission Methods

Which of the following is a function included in most practice management software that allows reports to be generated showing outstanding claims by date,by carrier,or by some other sorting function?

Roster billing of Medicare-covered vaccinations for multiple beneficiaries must be submitted electronically.

Name the two entities that have the responsibility of updating and revising the CMS-1500 universal form?

HIPAA allows providers who conduct business electronically to use their own established healthcare transactions,code sets,and identifiers.

The standard unique identifier that was adopted to identify all healthcare providers and health plans is the:

For entities that choose to transmit claims electronically,__________________ or a clearinghouse is necessary to handle the conversion of data to meet HIPAA requirements.

The multipurpose billing document used by many providers is called a/an:

If a claim is computer generated,there is no need for proofreading.

HIPAA includes administrative simplification provisions that contain standards for electronic claims submission.

All electronic claims must be routed through a claims clearinghouse.

Define a "small provider."

The health insurance claims process is typically an interaction between the healthcare provider and:

The insurance claim process begins when the health insurance professional submits the claim to the insurance processor.

ASCA has identified that providers with 25 or fewer full-time employees (FTEs)and physicians,practitioners,and suppliers with 10 or fewer FTEs should be referred to as:

The nine-digit federal tax identification number is commonly referred to as the:

Name two advantages of filing claims electronically.

The format required for completing paper claims so that it can be "scanned" is __________.

The most common format used for computer text files and on the Internet is:

Medicare claims must be submitted electronically,unless the HHS Secretary grants a/an:

Services or supplies that are appropriate and necessary for the symptoms,diagnosis,and treatment of the medical condition and meet the standards of good medical practice is the definition for: