Question 1

Notice of Proposed Rule Making defines all of the following types of electronic claims attachments EXCEPT:

Accepted Answer

A)  emergency department reports. 
B)  laboratory reports. 
C)  clinical reports. 
D)  eligibility reports. 
E)  ambulance services. 
A)  emergency department reports. 
B)  laboratory reports. 
C)  clinical reports. 
D)  eligibility reports. 
E)  ambulance services.

Question 2

The claim attachment standard became official in January of 2009.

Accepted Answer

A) True 
 B)False

Question 3

The referral certification and authorization process can be conducted electronically by using the:

Accepted Answer

A)  Health Care Services Request for Review and Response. 
B)  Health Care Claim Status Request. 
C)  Additional Patient Information in Support of a Health Claim or Encounter. 
D)  Eligibility Benefit Inquiry and Response. 
E)  Claim Status Inquiry and Response. 
A)  Health Care Services Request for Review and Response. 
B)  Health Care Claim Status Request. 
C)  Additional Patient Information in Support of a Health Claim or Encounter. 
D)  Eligibility Benefit Inquiry and Response. 
E)  Claim Status Inquiry and Response.

Question 4

Fees charged for using a clearinghouse are paid by the:

Accepted Answer

A)  health plan. 
B)  healthcare facility. 
C)  patient. 
D)  All of the above 
E)  None of the above 
A)  health plan. 
B)  healthcare facility. 
C)  patient. 
D)  All of the above 
E)  None of the above

Question 5

Which of the following refers to the time period after discharge that hospitals wait to ensure that all of the charges have been collected and coded?

Accepted Answer

A)  Payment floor 
B)  Billing floor 
C)  Bill hold period 
D)  Statement cycle 
E)  Bill cycle 
A)  Payment floor 
B)  Billing floor 
C)  Bill hold period 
D)  Statement cycle 
E)  Bill cycle

Question 6

Payment may be denied by the payer because:

Accepted Answer

A)  additional documentation may be needed. 
B)  the service was not covered by the plan. 
C)  a coding error was found. 
D)  All of the above 
E)  None of the above 
A)  additional documentation may be needed. 
B)  the service was not covered by the plan. 
C)  a coding error was found. 
D)  All of the above 
E)  None of the above

Question 7

All of the following are included on an encounter form EXCEPT:

Accepted Answer

A)  patient name. 
B)  provider name. 
C)  date of visit. 
D)  time of visit. 
E)  All of the above are found on an encounter form. 
A)  patient name. 
B)  provider name. 
C)  date of visit. 
D)  time of visit. 
E)  All of the above are found on an encounter form.

Question 8

The ________ is used to send the request for authorization and for the plan to return information about the authorization, certification, or referral to the provider.

Accepted Answer

A)  ANSI 270 
B)  ANSI 271 
C)  ANSI 278 
D)  ANSI 835 
E)  ANSI 837 
A)  ANSI 270 
B)  ANSI 271 
C)  ANSI 278 
D)  ANSI 835 
E)  ANSI 837

Question 9

The insurance bill is called a(n):

Accepted Answer

A)  statement. 
B)  claim. 
C)  billing record. 
D)  patient account. 
E)  patient bill. 
A)  statement. 
B)  claim. 
C)  billing record. 
D)  patient account. 
E)  patient bill.

Question 10

The payment floor for electronic 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 11

Which of the following is a document listing each charge, the amount paid by insurance, the amount written down by the provider, and the amount due from the patient?

Accepted Answer

A)  Open item statement 
B)  Balance forward patient statement 
C)  Reimbursement statement 
D)  Patient bill 
E)  Patient account 
A)  Open item statement 
B)  Balance forward patient statement 
C)  Reimbursement statement 
D)  Patient bill 
E)  Patient account

Question 12

To determine insurance eligibility or coverage, providers send an eligibility inquiry using the:

Accepted Answer

A)  ANSI 270. 
B)  ANSI 271. 
C)  ANSI 278. 
D)  ANSI 835. 
E)  ANSI 837. 
A)  ANSI 270. 
B)  ANSI 271. 
C)  ANSI 278. 
D)  ANSI 835. 
E)  ANSI 837.

Question 13

In situations that providers know will require an attachment, the ANSI ________ may be submitted along with the ANSI 837.

Accepted Answer

A)  270 
B)  271 
C)  275 
D)  276 
E)  835 
A)  270 
B)  271 
C)  275 
D)  276 
E)  835

Question 14

Which of the following is a payment sent to the provider after a claim has been adjudicated?

Accepted Answer

A)  Remittance 
B)  Remittance advice 
C)  Reimbursement 
D)  Disbursement 
E)  Contract allowance 
A)  Remittance 
B)  Remittance advice 
C)  Reimbursement 
D)  Disbursement 
E)  Contract allowance

Question 15

Which of the following is a paper or electronic document that explains the amounts that were paid to the provider?

Accepted Answer

A)  Remittance 
B)  Remittance advice 
C)  Reimbursement statement 
D)  Billing statement 
E)  Patient bill 
A)  Remittance 
B)  Remittance advice 
C)  Reimbursement statement 
D)  Billing statement 
E)  Patient bill

Question 16

Claims that have NOT been paid in a reasonable period of time must be investigated by:

Accepted Answer

A)  calling the plan help lines. 
B)  using the plan's automated voice response system. 
C)  sending a Health Care Claim Status Request. 
D)  entering data on a web page provided by the plan. 
E)  All of the above 
A)  calling the plan help lines. 
B)  using the plan's automated voice response system. 
C)  sending a Health Care Claim Status Request. 
D)  entering data on a web page provided by the plan. 
E)  All of the above

Question 17

Putting charges and payments into the patient accounting system is called charging.

Accepted Answer

A) True 
 B)False

Question 18

A(n) ________ claim occurs when the primary insurance plan automatically sends the claim on to the secondary insurance plan.

Accepted Answer

A)  secondary benefit 
B)  explanation of benefit 
C)  coordination of benefit 
D)  remittance benefit 
E)  billing benefit 
A)  secondary benefit 
B)  explanation of benefit 
C)  coordination of benefit 
D)  remittance benefit 
E)  billing benefit

Question 19

All eight of the electronic transactions mandated by HIPAA were developed by the American National Standards Institute (ANSI) Data Interchange Standards Association (DISA) Accredited Standards Committee (ASC) X12n.

Accepted Answer

A) True 
 B)False

Question 20

Charges and payments for one period are listed on a(n):

Accepted Answer

A)  open item statement. 
B)  balance forward statement. 
C)  remittance advice. 
D)  claim. 
E)  billing statement. 
A)  open item statement. 
B)  balance forward statement. 
C)  remittance advice. 
D)  claim. 
E)  billing statement.

Notice of Proposed Rule Making defines all of the following types of electronic claims attachments EXCEPT:

The claim attachment standard became official in January of 2009.

The referral certification and authorization process can be conducted electronically by using the:

Fees charged for using a clearinghouse are paid by the:

Which of the following refers to the time period after discharge that hospitals wait to ensure that all of the charges have been collected and coded?

Payment may be denied by the payer because:

All of the following are included on an encounter form EXCEPT:

The ________ is used to send the request for authorization and for the plan to return information about the authorization, certification, or referral to the provider.

The insurance bill is called a(n):

The payment floor for electronic claims is:

Which of the following is a document listing each charge, the amount paid by insurance, the amount written down by the provider, and the amount due from the patient?

To determine insurance eligibility or coverage, providers send an eligibility inquiry using the:

In situations that providers know will require an attachment, the ANSI ________ may be submitted along with the ANSI 837.

Which of the following is a payment sent to the provider after a claim has been adjudicated?

Which of the following is a paper or electronic document that explains the amounts that were paid to the provider?

Claims that have NOT been paid in a reasonable period of time must be investigated by:

Putting charges and payments into the patient accounting system is called charging.

A(n) ________ claim occurs when the primary insurance plan automatically sends the claim on to the secondary insurance plan.

All eight of the electronic transactions mandated by HIPAA were developed by the American National Standards Institute (ANSI) Data Interchange Standards Association (DISA) Accredited Standards Committee (ASC) X12n.

Charges and payments for one period are listed on a(n):

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

Notice of Proposed Rule Making defines all of the following types of electronic claims attachments EXCEPT:

The claim attachment standard became official in January of 2009.

The referral certification and authorization process can be conducted electronically by using the:

Fees charged for using a clearinghouse are paid by the:

Which of the following refers to the time period after discharge that hospitals wait to ensure that all of the charges have been collected and coded?

Payment may be denied by the payer because:

All of the following are included on an encounter form EXCEPT:

The ________ is used to send the request for authorization and for the plan to return information about the authorization, certification, or referral to the provider.

The insurance bill is called a(n):

The payment floor for electronic claims is:

Which of the following is a document listing each charge, the amount paid by insurance, the amount written down by the provider, and the amount due from the patient?

To determine insurance eligibility or coverage, providers send an eligibility inquiry using the:

In situations that providers know will require an attachment, the ANSI ________ may be submitted along with the ANSI 837.

Which of the following is a payment sent to the provider after a claim has been adjudicated?

Which of the following is a paper or electronic document that explains the amounts that were paid to the provider?

Claims that have NOT been paid in a reasonable period of time must be investigated by:

Putting charges and payments into the patient accounting system is called charging.

A(n) ________ claim occurs when the primary insurance plan automatically sends the claim on to the secondary insurance plan.

All eight of the electronic transactions mandated by HIPAA were developed by the American National Standards Institute (ANSI) Data Interchange Standards Association (DISA) Accredited Standards Committee (ASC) X12n.

Charges and payments for one period are listed on a(n):

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