Question 1

Which of the following is NOT one of the eight transactions mandated by HIPAA?

Accepted Answer

A)  Remittance and payment advice 
B)  Referral certification and authorization 
C)  Claim status inquiry and response 
D)  Health plan premium payments 
E)  Quality care response 
A)  Remittance and payment advice 
B)  Referral certification and authorization 
C)  Claim status inquiry and response 
D)  Health plan premium payments 
E)  Quality care response E

Question 2

A health insurance claim is an example of a(n):

Accepted Answer

A)  primary record. 
B)  secondary record. 
C)  hospital record. 
D)  electronic health record. 
E)  All of the above 
A)  primary record. 
B)  secondary record. 
C)  hospital record. 
D)  electronic health record. 
E)  All of the above B

Question 3

The acronym EMC stands for:

Accepted Answer

A)  electronic medical claims. 
B)  emergency medical claims. 
C)  electronic medical coordination. 
D)  electronic media claims. 
E)  employee media committee. 
A)  electronic medical claims. 
B)  emergency medical claims. 
C)  electronic medical coordination. 
D)  electronic media claims. 
E)  employee media committee. D

Question 4

Software used to analyze claims for errors before submission is called a(n):

Accepted Answer

A)  claim scrubber. 
B)  claim edits. 
C)  claim cleaner. 
D)  claim reviewer. 
E)  claim adjuster. 
A)  claim scrubber. 
B)  claim edits. 
C)  claim cleaner. 
D)  claim reviewer. 
E)  claim adjuster.

Question 5

The payment floor for paper claims is:

Accepted Answer

A)  24 hours. 
B)  48 hours. 
C)  10 days. 
D)  14 days. 
E)  29 days. 
A)  24 hours. 
B)  48 hours. 
C)  10 days. 
D)  14 days. 
E)  29 days.

Question 6

After all of the patient's insurance plans have responded with an EOB, any remaining amount owed is the responsibility of the:

Accepted Answer

A)  provider. 
B)  facility. 
C)  patient. 
D)  health care plan. 
E)  None of the above 
A)  provider. 
B)  facility. 
C)  patient. 
D)  health care plan. 
E)  None of the above

Question 7

The remittance information from the payers can be automatically posted by using a(n) electronic remittance advice system.

Accepted Answer

A) True 
 B)False

Question 8

A delay imposed by Medicare intermediaries and some other health plans in paying claims is called a payment floor.

Accepted Answer

A) True 
 B)False

Question 9

Institutional claims are submitted electronically using which of the following?

Accepted Answer

A)  ANSI 837-P 
B)  CMS-1500 
C)  UB-04 
D)  ANSI 837-I 
E)  CMS-1450 
A)  ANSI 837-P 
B)  CMS-1500 
C)  UB-04 
D)  ANSI 837-I 
E)  CMS-1450

Question 10

Claim scrubbers are used by payers to examine claims before adjudicating them.

Accepted Answer

A) True 
 B)False

Question 11

Which of the following is the FIRST step in the accounting workflow?

Accepted Answer

A)  A computer program generates a paper or electronic claim to be sent to the insurance plan. 
B)  The patient is treated and discharged. 
C)  A claim is sent to the secondary insurance plan. 
D)  The provider verifies patient insurance eligibility with the health plan. 
E)  A bill is sent to the patient for the amount that is the patient's responsibility. 
A)  A computer program generates a paper or electronic claim to be sent to the insurance plan. 
B)  The patient is treated and discharged. 
C)  A claim is sent to the secondary insurance plan. 
D)  The provider verifies patient insurance eligibility with the health plan. 
E)  A bill is sent to the patient for the amount that is the patient's responsibility.

Question 12

Standardized electronic data interchange formats were mandated by:

Accepted Answer

A)  ANSI. 
B)  HIPAA. 
C)  AHA. 
D)  AHIMA. 
E)  AMA. 
A)  ANSI. 
B)  HIPAA. 
C)  AHA. 
D)  AHIMA. 
E)  AMA.

Question 13

When using batch posting:

Accepted Answer

A)  superbills are posted in batches alphabetically. 
B)  superbills are gathered into a batch and posted later. 
C)  superbills are posted together on the same day as the patients were seen. 
D)  superbills are posted in diagnosis related batches. 
E)  All of the above 
A)  superbills are posted in batches alphabetically. 
B)  superbills are gathered into a batch and posted later. 
C)  superbills are posted together on the same day as the patients were seen. 
D)  superbills are posted in diagnosis related batches. 
E)  All of the above

Question 14

When a plan asks for further information, supporting documentation, or test results, the claim becomes a(n):

Accepted Answer

A)  claim attachment. 
B)  claim edit. 
C)  invalid claim. 
D)  suspended claim. 
E)  rejected claim. 
A)  claim attachment. 
B)  claim edit. 
C)  invalid claim. 
D)  suspended claim. 
E)  rejected claim.

Question 15

For every claim that is filed, a provider will receive a(n):

Accepted Answer

A)  EOB. 
B)  request for information. 
C)  payment. 
D)  All of the above 
E)  None of the above 
A)  EOB. 
B)  request for information. 
C)  payment. 
D)  All of the above 
E)  None of the above

Question 16

Which of the following is a supplemental document that provides additional medical information that cannot be sent within the claim format?

Accepted Answer

A)  Claim attachment 
B)  Claim edit 
C)  Claim scrubber 
D)  Claim documentation 
E)  Claim remittance 
A)  Claim attachment 
B)  Claim edit 
C)  Claim scrubber 
D)  Claim documentation 
E)  Claim remittance

Question 17

A claim is sent to the secondary insurance:

Accepted Answer

A)  at the same time it is sent to the primary. 
B)  before it is sent to the primary. 
C)  after the claim is paid by the primary. 
D)  All of the above 
E)  None of the above 
A)  at the same time it is sent to the primary. 
B)  before it is sent to the primary. 
C)  after the claim is paid by the primary. 
D)  All of the above 
E)  None of the above

Question 18

The electronic version of a professional claim form is the:

Accepted Answer

A)  ANSI 837-P. 
B)  CMS-1500. 
C)  UB-04. 
D)  ANSI 837-I. 
E)  None of the above 
A)  ANSI 837-P. 
B)  CMS-1500. 
C)  UB-04. 
D)  ANSI 837-I. 
E)  None of the above

Question 19

The specific function of converting data arriving in a noncompliant format into a HIPAA-compliant format is performed by a:

Accepted Answer

A)  third party payer. 
B)  clearinghouse. 
C)  hospital billing department. 
D)  billing clerk. 
E)  All of the above 
A)  third party payer. 
B)  clearinghouse. 
C)  hospital billing department. 
D)  billing clerk. 
E)  All of the above

Question 20

Claims must be submitted within a certain timeframe or they will not be paid.

Accepted Answer

A) True 
 B)False

Which of the following is NOT one of the eight transactions mandated by HIPAA?

A health insurance claim is an example of a(n):

The acronym EMC stands for:

Software used to analyze claims for errors before submission is called a(n):

The payment floor for paper claims is:

After all of the patient's insurance plans have responded with an EOB, any remaining amount owed is the responsibility of the:

The remittance information from the payers can be automatically posted by using a(n) electronic remittance advice system.

A delay imposed by Medicare intermediaries and some other health plans in paying claims is called a payment floor.

Institutional claims are submitted electronically using which of the following?

Claim scrubbers are used by payers to examine claims before adjudicating them.

Which of the following is the FIRST step in the accounting workflow?

Standardized electronic data interchange formats were mandated by:

When using batch posting:

When a plan asks for further information, supporting documentation, or test results, the claim becomes a(n):

For every claim that is filed, a provider will receive a(n):

Which of the following is a supplemental document that provides additional medical information that cannot be sent within the claim format?

A claim is sent to the secondary insurance:

The electronic version of a professional claim form is the:

The specific function of converting data arriving in a noncompliant format into a HIPAA-compliant format is performed by a:

Claims must be submitted within a certain timeframe or they will not be paid.

Healthcare Delivery Fundamentals

Health Information Professionals

Accreditation, Regulation, and Hipaa

Fundamentals of Information Systems

Healthcare Records

Organization, Storage, and Management of Health Records

Electronic Health Records

Additional Health Information Systems

Healthcare Coding and Reimbursement

Health Statistics, Research, and Quality Improvement

Management and Decision Support Systems

Filters

Exam 10: Healthcare Transactions and Billing

Which of the following is NOT one of the eight transactions mandated by HIPAA?

A health insurance claim is an example of a(n):

The acronym EMC stands for:

Software used to analyze claims for errors before submission is called a(n):

The payment floor for paper claims is:

After all of the patient's insurance plans have responded with an EOB, any remaining amount owed is the responsibility of the:

The remittance information from the payers can be automatically posted by using a(n) electronic remittance advice system.

A delay imposed by Medicare intermediaries and some other health plans in paying claims is called a payment floor.

Institutional claims are submitted electronically using which of the following?

Claim scrubbers are used by payers to examine claims before adjudicating them.

Which of the following is the FIRST step in the accounting workflow?

Standardized electronic data interchange formats were mandated by:

When using batch posting:

When a plan asks for further information, supporting documentation, or test results, the claim becomes a(n):

For every claim that is filed, a provider will receive a(n):

Which of the following is a supplemental document that provides additional medical information that cannot be sent within the claim format?

A claim is sent to the secondary insurance:

The electronic version of a professional claim form is the:

The specific function of converting data arriving in a noncompliant format into a HIPAA-compliant format is performed by a:

Claims must be submitted within a certain timeframe or they will not be paid.

Healthcare Delivery Fundamentals

Health Information Professionals

Accreditation, Regulation, and Hipaa

Fundamentals of Information Systems

Healthcare Records

Organization, Storage, and Management of Health Records

Electronic Health Records

Additional Health Information Systems

Healthcare Coding and Reimbursement

Health Statistics, Research, and Quality Improvement

Management and Decision Support Systems

Filters