Deck 7: Health Care Claim Preparation and Transmission

Question 1

What does the abbreviation RA stand for?

A) receiving action
B) rendering advisor
C) resource allocation
D) remittance advice

Answer 1

remittance advice

Question 2

What do primary payers issue to detail how a claim was processed, in order for a secondary claim to be submitted?

A) fee slip
B) Explanation of Benefits
C) Remittance Advice
D) walkout receipt

Answer 2

Remittance Advice

Question 3

When is it not necessary to submit a claim to a secondary payer?

A) when the patient has COBRA
B) when the patient has Medicare
C) when the payer handles EOB
D) when the payer handles COB

Answer 3

when the payer handles COB

Question 4

What does the abbreviation EMC stand for?

A) electronic miscellaneous claims
B) electronic Medicare claims
C) electronic media claims
D) electronic master codes

Question 5

If a paper RA is received, what should be sent to the secondary health plan?

A) CMS-1500
B) RA
C) medical records
D) both the CMS-1500 and the RA

Question 6

Which is not a major method of transmitting claims electronically?

A) clearinghouse
B) e-mail
C) direct transmission
D) direct data entry

Question 7

What is another name for the HIPAA claim?

A) HCFA form
B) e-claim
C) direct claim
D) 837P claim

Question 8

When in the billing process is an EOB sent to a patient?

A) after their visit at check out
B) after the claim gets paid or denied
C) before it is sent to the clearinghouse
D) it doesn't get sent to patient, it is sent to provider

Question 9

What is another name for the CMS-1500?

A) paper claim form
B) e-form
C) 837P claim
D) HIPAA claim

Question 10

A claim accepted by a health plan for adjudication is called _____.

A) clean claim
B) e-form
C) 837P claim
D) HIPAA claim

Question 11

Which association leads the National Uniform Claim Committee (NUCC)?

A) HIPAA Association
B) Central Medical Association
C) American Medical Association
D) American Association for Medical Assistants

Question 12

When are claims prepared for transmission?

A) after receiving COB
B) after receiving EOB
C) after the patient leaves the office
D) after data elements have been posted to the PMP

Question 13

What is the same as a COB transaction?

A) adjustment
B) EOB
C) HIPAA 837
D) RTCA

Question 14

What happens when a primary payer forwards the COB transaction?

A) a message appears on the primary payer's RA
B) there is no need for a RA
C) the secondary payer pays in full
D) it turns into a clean claim

Question 15

How many national crossover agreements do plans that are supplemental to Medicare sign?

A) none
B) one
C) up to four
D) as many as there are plans

Question 16

In the direct claims transmission approach, which formatting rules should the provider follow?

A) DDE
B) POS
C) PHI
D) EDI

Question 17

What is a responsibility of medical assistants before transmitting claims with Practice Management Programs?

A) extract and record data elements such as diagnoses, procedures, and charges
B) zip file the HIPAA claim
C) get all lab copies prior to the visit
D) transmit claims to payers

Question 18

What form should be used to bill a secondary health plan, when a paper RA is received?

A) HCPCS
B) HIPAA claim
C) CMS-1500
D) CMS-1600

Question 19

What replaced the HCFA-1500?

A) CMS-1500
B) HCFA-1600
C) CMS-1400
D) HCFA-1500 is still used

Question 20

What does HIT stand for?

A) healthy initiatives team
B) health integration technology
C) health interface technology
D) health information technology

Question 21

When does a primary payer not need to submit a claim to the secondary payer?

A) when the primary payer handles the COB
B) when the primary payer handles the EOB
C) when no RA is submitted
D) when it is done electronically

Question 22

When sending a claim to a tertiary payer, what needs to be attached?

A) nothing needs to be sent, it is electronic
B) HIPAA claim
C) secondary RA
D) CMS-1500

Question 23

What do the majority of providers use to send and receive data in correct EDI format?

A) IT personnel
B) clearinghouses
C) hub server
D) electronic claims

Question 24

Which types of claims are generally used for reporting physicians' services?

A) paper claims
B) HIPAA claim
C) both paper claims and HIPAA claims
D) neither paper claims nor HIPAA claims

Question 25

What must a medical assistant do when preparing claims with PMPs?

A) extract the data elements
B) verify coverage
C) record diagnoses, procedures, and charges
D) transmit claims beneficiaries

Question 26

What type of information does the Provider section of practice management programs contain?

A) NPI
B) DEA
C) UPIN
D) license numbers

Question 27

What do some payers offer as an Internet-based service into which employees key the standard data elements?

A) EDI
B) EDE
C) DDE
D) clearinghouse

Question 28

What is not a major database in PMPs?

A) provider
B) guarantor
C) diagnosis codes
D) next of kin

Question 29

With a few exceptions, the electronic claim is the same as __________.

A) clearinghouse form
B) paper form
C) HCFA-1500
D) HCPCS form

Question 30

In the direct transmission approach, providers and payers exchange transactions directly without using what?

A) clearinghouse
B) paper form
C) HCFA-1500
D) HIPAA claim

Question 31

What is an RA (remittance advice)?

A) detailed account of why a claim was denied
B) paper form
C) detailed account of how the claim was processed
D) benefits explanation

Question 32

What is considered when the NUCC revises the paper claim?

A) CMS-1500
B) HCFA-1500
C) HIPAA claim
D) UB 04

Question 33

What organization provides updates the CMS-1500?

A) HIPAA
B) OIG
C) NUCC
D) CMS

Question 34

What is the first task a medical assistant must perform when preparing claims with PMPs?

A) extract the data elements
B) record patients' insurance and demographic information
C) record diagnoses, procedures, and charges
D) transmit claims to payers

Question 35

What does the administrative/billing medical assistant send in to the secondary payer with the claim form?

A) COB
B) file 837P
C) EOB
D) RA

Question 36

What is the most common method to handle health care claim transmission?

A) hire clearinghouses
B) file 837P
C) use a remittance advice
D) use bulk mail

Question 37

What are the financial aspects of an office visit, such as a copayment, called?

A) elements
B) exchanges
C) transactions
D) adjustments

Question 38

What are collections of related facts, such as diagnosis indices, patients of the practice?

A) elements
B) databases
C) line items
D) file folders

Question 39

Billing efficiency is increased by using what kind of software?

A) billing services
B) Project Management Programs
C) clearinghouses
D) Practice Management Programs

Question 40

A physician practice that uses a billing service to send its claims is the

A) destination payer
B) referring provider
C) billing provider
D) pay-to provider

Question 41

Which of these is associated with payers?

A) National Individual ID
B) National Payer ID
C) National Provider Identifier
D) National Uniform Claim Committee

Question 42

Patient information on a CMS-1500 information includes

A) type of insurance
B) ID number
C) address and phone
D) all of these

Question 43

A unit of information on a HIPAA claim is called a data

A) analysis
B) control number
C) report card
D) element

Question 44

The HIPAA-mandated electronic transaction for claims is often called the

A) HIPAA claim
B) 837P claim
C) CMS-1500 claim
D) both the HIPAA claim and the 837P claim

Question 45

The P in 837P stands for

A) physician
B) patient
C) provider
D) professional

Question 46

The carrier block on the CMS 1500 form is for

A) the payer ID
B) a section on the CMS-1500 for payer name and address
C) a section on the CMS-1500 for the payer's NPI
D) None of these

Question 47

On the CMS-1500, if patient and insured are the same person, where is the patient's name and address entered?

A) patient information INs
B) insured's information INs
C) carrier block
D) insurance plan INs

Question 48

What type of information might be found on a claim attachment?

A) additional form(s)
B) medical record item(s)
C) both additional form(s) and medical record item(s)
D) neither additional form(s) nor medical record item(s)

Question 49

The organization or person transmitting the claim to the payer is the

A) billing provider
B) pay-to provider
C) physician
D) patient

Question 50

The organization or person that should receive payment is the _____________.

A) billing provider
B) pay-to provider
C) physician
D) patient

Question 51

Physician practices often hire other firms to send their claims, such as

A) billing services
B) clearinghouses
C) collection agencies
D) both billing services and clearinghouses

Question 52

If a practice sends claims directly to the payer, it is the

A) billing provider
B) pay-to provider
C) clearinghouse
D) both the billing provide and the pay-to provider

Question 53

The taxonomy codes are one of the nonmedical or nonclinical

A) administrative code sets
B) claim forms
C) fee schedules
D) none of these

Question 54

What can be used to track payments from a health plan?

A) claim control number
B) line control number
C) reference number
D) both the claim control number and the line control number

Question 55

What administrative code is used to identify the type of health plan?

A) claim frequency code
B) claim submission reason code
C) claim filing indictor code
D) both the claim frequency code and the claim submission reason code

Question 56

What code is used to indicate whether a claim is an original, replacement, or voided code?

A) claim frequency code
B) claim submission reason code
C) claim filing indictor code
D) both claim frequency code and claim submission reason code

Question 57

What are examples of data elements?

A) patient's first name
B) patient's last name
C) claim frequency code
D) both the patient's first name and the patient's last name

Question 58

Which of the following is not one of the five major sections, or levels, of data elements of a claim?

A) provider
B) relatives
C) services
D) subscriber

Question 59

The part of the HIPAA claim contains information about the payer to whom the claim is going to be sent, called the

A) destination payer
B) primary payer
C) secondary payer
D) guarantor

Question 60

A claim control number is assigned by

A) the medical office
B) Medicaid
C) health plan
D) subscriber

Question 61

The claim frequency code is sometimes known as the

A) claim adjudication number
B) claim submission reason code
C) provider number
D) None of these

Question 62

The claim frequency code for physician practice claims indicates all of the following except:

A) an original claim
B) a replacement of a prior claim
C) going to be rejected or not
D) a voided or canceled prior claim

Question 63

All of the financial aspects of office visits, such as charges and payments, are

A) transactions
B) claim forms
C) provider numbers
D) none of these

Question 64

The abbreviation NUCC stands for

A) National Uniform Coding Corporation
B) National Uniform Claim Committee
C) National Uniform Coding Company
D) National Uniform Collections Company

Question 65

The NUCC can be expected to continue to update what form?

A) CMS-75 form
B) Medicaid form
C) NUCC form
D) CMS-1500 form

Question 66

A code indicating what a number represents is a

A) qualifier
B) quantifier
C) transaction
D) none of these

Question 67

The term service line information describes section 24 of the CMS-1500 claim, which reports

A) the rendering provider
B) procedures performed for the patient
C) patient transactions
D) taxonomy codes

Question 68

Laboratory services rendered by an independent provider are performed by a(n)

A) subscriber
B) provider
C) outside laboratory
D) None of these

Question 69

What does a place of service (POS) code describe about a service provided?

A) office number
B) hospital room
C) location
D) none of these

Question 70

On the CMS-1500 claim, if the patient and the insured are not the same person, which of these is required?

A) insured's name
B) patient's relationship to the insured
C) insured's address
D) all of these

Question 71

The letters "SOF" on a claim mean

A) software used
B) signature on file
C) service on form
D) none of these

Question 72

How many digits are in a taxonomy code?

A) eight
B) ten
C) twelve
D) it varies by the situation

Question 73

If the claim indicates the patient's signature is on file, this requires

A) a current release if applicable
B) release covers the data on the claim
C) neither a current release if applicable nor release covers the data on the claim
D) both a current release if applicable and release covers the data on the claim

Question 74

What term does the HIPAA claim use for the insurance policyholder or guarantor?

A) provider
B) subscriber
C) patient
D) qualifier

Question 75

On the HIPAA claim, what code is required to specify the patient's relationship to the subscriber when the patient and the subscriber are not the same person?

A) individual relationship code
B) claim filing indictor code
C) claim submission reason code
D) patient code

Question 76

A unique number assigned by the sender to each service line is a

A) claim control number
B) patient number
C) line item control number
D) none of these