Deck 10: Healthcare Transactions and Billing

Question 1

Another name for an encounter form is a:

A) superbill.
B) charge ticket.
C) patient invoice.
D) Both A and B
E) Both A and C

Answer 1

Both A and B

Question 2

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

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

Answer 2

balance forward statement.

Question 3

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

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

Answer 3

coordination of benefit

Question 4

The insurance bill is called a(n):

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

Question 5

Two different types of claims are used by both Medicare and other insurance plans, one for professional billing and one for:

A) institutional billing.
B) service billing.
C) surgical billing.
D) outpatient billing.
E) rehabilitation billing.

Question 6

The first step in preparing a claim is to assign procedure and diagnosis codes.

Question 7

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?

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

Question 8

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

Question 9

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

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

Question 10

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

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

Question 11

Standardized electronic data interchange formats were mandated by:

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

Question 12

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

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 13

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.

Question 14

Which of the following medical professionals would bill for their services by using the professional claim ANSI837-P or CMS-1500?

A) Chiropractors
B) Therapists
C) Physicians
D) Osteopaths
E) All of the above

Question 15

The acronym EMC stands for:

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

Question 16

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

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

Question 17

All of the following transaction standards have been finalized EXCEPT:

A) health claims attachment.
B) enrollment and de-enrollment in a health plan.
C) first report of injury for reporting worker's compensation incidents.
D) Both A and B
E) Both A and C

Question 18

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

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

Question 19

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

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

Question 20

Which of the following refer to records created by abstracting relevant details from the primary records?

A) Data records
B) Electronic records
C) Billing records
D) Secondary records
E) None of the above

Question 21

The electronic version of a professional claim form is the:

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

Question 22

A claim is sent to the secondary insurance:

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 23

Institutional claims are submitted electronically using which of the following?

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

Question 24

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

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

Question 25

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

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 26

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

Question 27

Fees charged for using a clearinghouse are paid by the:

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

Question 28

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?

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

Question 29

When using batch posting:

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 30

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

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

Question 31

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

Question 32

Uncollected money owed during the billing process is called:

A) accounts receivable.
B) accounts payable.
C) unremitted accounts.
D) outstanding payments.
E) billed receivables.

Question 33

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

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

Question 34

Payment may be denied by the payer because:

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 35

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

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

Question 36

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

Question 37

The UB-04 is also known as the:

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

Question 38

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

Question 39

The payment floor for paper claims is:

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

Question 40

The payment floor for electronic claims is:

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

Question 41

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

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

Question 42

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

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

Question 43

A(n) ________ is an example of a common attachment to a claim.

A) operative report
B) discharge summary
C) certificate of medical necessity
D) laboratory report
E) All of the above

Question 44

The claim attachment standard became official in January of 2009.

Question 45

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

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 46

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

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

Question 47

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

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

Question 48

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

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 49

After a provider sends an eligibility request, a response is received from the payer using the:

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

Question 50

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.

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