Question 1

The phrase "adjudicate a claim" means to

Accepted Answer

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 2

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.

Accepted Answer

A) True 
 B)False

Question 3

Physician service codes are

Accepted Answer

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 4

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

Accepted Answer

A) True 
 B)False

Question 5

Trading Partner agreements are important because they

Accepted Answer

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. B

Question 6

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

Accepted Answer

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

Question 7

With electronic claims, a crossover claim is

Accepted Answer

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. B

Question 8

Trading Partner agreements are only for electronic standard transactions.

Accepted Answer

A) True 
 B)False

Question 9

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

Accepted Answer

The answer of Electronic systems use a standard set of...

Question 10

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

Accepted Answer

A) True 
 B)False

Question 11

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

Accepted Answer

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

Question 12

The two major categories of code sets endorsed by HIPAA are

Accepted Answer

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

Question 13

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.

Accepted Answer

A) True 
 B)False

Question 14

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

Accepted Answer

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 15

Biologics are considered

Accepted Answer

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 16

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

Accepted Answer

A) True 
 B)False

Question 17

Match between columns
                        Premises: Health Care Claim Payment/Advice
Health Care Services Review
Health Care Claim, Professional
Benefit Enrollment and Maintenance
Health Care Claim Status Request
Health Care Eligibility Benefit Inquiry
Health Care Claim Status Response

Accepted Answer

The Answer of ASC X12N 277 and ASC X12N 837 is...

Question 18

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

Accepted Answer

A) True 
 B)False  True

Question 19

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

Accepted Answer

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

Question 20

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

Accepted Answer

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.

Exam 3: Transactions and Code Sets

The phrase "adjudicate a claim" means to

Correct Answer
verified

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.

Correct Answer
verified

Physician service codes are

Correct Answer
verified

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

Correct Answer
verified

Trading Partner agreements are important because they

Correct Answer
verified
B

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

Correct Answer
verified

With electronic claims, a crossover claim is

Correct Answer
verified
B

Trading Partner agreements are only for electronic standard transactions.

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

The two major categories of code sets endorsed by HIPAA are

Correct Answer
verified

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.

Correct Answer
verified

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

Correct Answer
verified

Biologics are considered

Correct Answer
verified

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

Correct Answer
verified

Match the name of the transaction standard with the ID number assigned.

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

Correct Answer
verified
True

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

Correct Answer
verified

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

Correct Answer
verified

Exam 3: Transactions and Code Sets

The phrase "adjudicate a claim" means to

Correct AnswerverifiedShow Answer

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.

Correct AnswerverifiedShow Answer

Physician service codes are

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Trading Partner agreements are important because they

Correct AnswerverifiedB

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

Correct AnswerverifiedShow Answer

With electronic claims, a crossover claim is

Correct AnswerverifiedB

Trading Partner agreements are only for electronic standard transactions.

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

The two major categories of code sets endorsed by HIPAA are

Correct AnswerverifiedShow Answer

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.

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Biologics are considered

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Match the name of the transaction standard with the ID number assigned.

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

Correct AnswerverifiedTrue

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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B

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B

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True

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