Deck 3: Transactions and Code Sets

Question 1

The organization that designates the standard names or nomenclatures for national standards is called

A) Centers for Medicare and Medicaid Services.
B) Accredited Standards Committee.
C) American National Standards Institute.
D) Centers for Disease Control and Prevention.

Answer 1

American National Standards Institute.

Question 2

Physician services codes are five-place codes using all numbers or a combination of four numbers and one letter.

Answer 2

True

Question 3

The advantages of using electronic data interchange (EDI) are all of the following EXCEPT

A) to avoid all errors in submission of claims.
B) to receive response and reimbursement for claims in a short amount of time.
C) to submit clean claims and know they will all be accepted by the health plan.
D) to save time and energy since mailing paper claims costs money.

Answer 3

to avoid all errors in submission of claims.

Question 4

The World Health Organization has developed a tenth revision of the ICD codes.

Question 5

What is the name of the organization that developed the standard language that the DHHS adopted when they developed standard claims transactions?

A) Health Level 7
B) Accredited Standards Committee
C) EDI Forum
D) American Medical Association

Question 6

Biologics are considered

A) only prescription drugs created in a laboratory.
B) a product used in medicine.
C) not a medicinal product.
D) a product that is used to package a medication.

Question 7

If the Office of HIPAA Standards finds a covered entity not willing to comply with the regulations of the Transaction and Code Set Rule, the Department of Justice may investigate criminal charges.

Question 8

Trading Partner agreements are not required by HIPAA.

Question 9

Crossover claims encourage an automatic rejection from the secondary payer for any claim the primary payer has rejected.

Question 10

HIPAA has accepted the use of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR) as a standard for mental disorder diagnoses.

Question 11

Implementation Guides for the standard transactions may be obtained from the

A) Washington Publishing Company.
B) Department of Health and Human Services.
C) Designated Standard Maintenance Organization.
D) National Uniform Billing Committee.

Question 12

In order to send accurate standard transmissions, everyone in a covered entity must be trained to know the standard transmission (or EDI) format.

Question 13

One Trading Partner agreement is all that is necessary for the HIPAA Officer to write. It would be acceptable for any business partner that trades protected health information with them.

Question 14

Use of the ASC X12N standards for standard transactions makes the administration of claims submission a whole lot easier.

Question 15

Regulating standard ASC X12N transactions, the DHHS has eliminated all paper claims without exception.

Question 16

The Accredited Standards Committee sets up templates for the transaction files. The structure is referred to as the _____ of the file.

A) architecture
B) shape
C) database
D) source code

Question 17

The two major categories of code sets endorsed by HIPAA are

A) drug and diagnosis codes.
B) procedure and diagnosis codes.
C) medical and nonmedical codes.
D) none of the above.

Question 18

With electronic claims, a crossover claim is

A) a claim where benefits "cross-over" to another health plan.
B) sent electronically to more than one health plan before it is sent back to the provider.
C) not possible since it must be sent to more than one health plan.
D) returned to the provider after each health plan reviews the claim.

Question 19

Trading Partner agreements are only for electronic standard transactions.

Question 20

The data string for a standard transaction may be compared to

A) a collage of many parts of a claim placed in random order.
B) a line of various size train cars with an engine and caboose.
C) the rings of a tree with the most important part inside, surrounded by larger pieces of data.
D) complete gibberish nonsense that must be de-encrypted by a computer to be understood.

Question 21

Trading Partner agreements are important because they

A) allow the partners to set up their own arrangement for electronic claims.
B) restrict the partners from setting up their own arrangements for electronic claims.
C) permit each partner to change the manner in which their claim is submitted.
D) are regulated by the federal government to see that all partners agree.

Question 23

If the Office of HIPAA Standards finds noncompliance to the Transaction and Code Set Rule, they will expect to see a move toward compliance and improvement within

A) 20 days.
B) 30 days.
C) 60 days.
D) 90 days.

Question 24

Electronic systems use a standard set of conventions to format data in an electronic communications. These systems are said to use standard communication ____________________.

Question 25

For a health care provider to comply with the Transaction and Code Set Rule, they must

A) mail forms via Postal Service with return receipt requested.
B) receive permission first to send claims through fax machine.
C) send claims to insurance plans using ASC X12N format.
D) write insurance claims on special paper.

Question 26

If the HIPAA Office finds that a trading partner has changed the formatting of a standard transaction, the office may report the partner to

A) the Department of Justice.
B) the Office for Civil Rights.
C) the Department of Health and Human Services.
D) the Office of E-Health Standards and Services.

Question 27

Physician service codes are

A) five-place codes using all numbers or a combination of four numbers and one letter.
B) only number codes using 3, 4, or 5 spaces.
C) seven-space codes using both letters and numbers.
D) number codes using two digits, a decimal, and one or two more digits.

Question 28

A complaint relating to the Transaction and Code Set Rule might be about any of the following EXCEPT

A) code set received or sent and rejected.
B) noncompliant transaction received.
C) compliant transaction sent and rejected.
D) disclosure of protected health information to an outside entity.

Question 29

Being sure the covered entity is using the proper HIPAA mandated transactions is the responsibility of

A) the software vendor.
B) the head physician of the facility.
C) any member who works at the facility.
D) the HIPAA Officer.

Question 30

The phrase "adjudicate a claim" means to

A) decide if the claim has sufficient information to be paid.
B) use software to "scrub" the claim for errors.
C) review the claim for medical necessity.
D) process the claim for settlement.

Question 31

The Accredited Standards Committee architecture of ASC X12N is the basic standard for

A) the health care industry.
B) the insurance industry.
C) the information technology industry.
D) the medical doctor's profession.