Question 1

Name the electronic format that practices use to ask payers about claims.

Accepted Answer

A)   HIPAA claim
B)   HIPAA X12 837
C)   CMS-1500
D)   HIPAA X12 276/277

Question 2

The person or company that provides or supervised the care is known as the __________.

Accepted Answer

A)   Main Provider
B)   Rendering Provider
C)   Consulting Provider
D)   Ordering Provider

Question 3

Correct medical code sets are those that are

Accepted Answer

A)   valid at the time the service was performed.
B)   valid when the claim is paid.
C)   valid when the claim is processed.
D)   valid based on payers guidelines.

Question 4

Identify the claim filing indicator code that is used to indicate that the health plan is Medicaid.

Accepted Answer

A)   MC
B)   OF
C)   AM
D)   MB

Question 5

Choose the editing software programs used to check claims for error correction.

Accepted Answer

A)   claim scrubbers
B)   clearinghouses
C)   claim checkers
D)   claim transmitters

Question 6

Which of the following must be supplied by the provider on every claim?

Accepted Answer

A)   not required unless specified under contract data element
B)   required if applicable data element
C)   not required data element
D)   required data element

Question 7

Name the condition code you would apply to an abortion performed due to social or economic reasons.

Accepted Answer

A)   AF
B)   AH
C)   AG
D)   AE

Question 8

Name the POS code used to indicate a procedure occurred in a skilled nursing facility.

Accepted Answer

A)   11
B)   31
C)   12
D)   81

Question 9

On a HIPAA claim, determine which of the following is assigned to a claim by the sender.

Accepted Answer

A)   claim control number only
B)   claim control number and claim submission reason code
C)   line item control number only
D)   claim control number and line item control number

Question 10

What indicates the role of the provider being reported in Item Number 17?

Accepted Answer

A)   modifier
B)   signature
C)   attachment
D)   qualifier

Question 11

You are working at a practice and need to submit a claim, but cannot reach a patient to obtain his or her address, which is not on file. What should you do?

Accepted Answer

A)   Do not submit the claim until you are able to retrieve the patient's address
B)   Submit the claim using the practice's address in place of the patient's address'
C)   Submit the claim with "Unknown" entered for the patient's address.
D)   Submit the claim with the patient's address left blank.

Question 12

Which of the following is a valid tip for entering data?

Accepted Answer

A)   Use only valid data in all fields.
B)   Use prefixes for people's names.
C)   Use hyphens, dashes, spaces, special characters, or parentheses in telephone numbers.
D)   Use a dash, space, or special character in a Zip code field.

Question 13

Which qualifier would be reported in Item Number 15 to indicate the date being reported is last x-ray?

Accepted Answer

A)   439
B)   454
C)   444
D)   455

Question 14

How many diagnosis codes may be reported on the HIPAA 837?

Accepted Answer

A)   eight
B)   four
C)   six
D)   twelve

Question 15

A data element that HIPAA always mandates reporting is called a(n)

Accepted Answer

A)   required data element.
B)   situational data element.
C)   not required data element.
D)   NRUC data element.

Question 16

On a HIPAA claim, which of the following is assigned to a particular service being reported?

Accepted Answer

A)   a line item control number
B)   a claim control number
C)   either claim control number or line item control number
D)   neither claim control number nor line item control number

Question 17

Name the function of the carrier block.

Accepted Answer

A)   It allows for a four-line address for the payer.
B)   It allows the payer to make notes.
C)   It allows for a four-line address for the patient.
D)   It allows the payer to input their own codes.

Question 18

Which of the following describes the reason for and the process of "dropping to paper"?

Accepted Answer

A)   The practice prints and sends the CMS-1500 paper claim because the payer has not acknowledged receipt of it via electronic transmission.
B)   The practice sends the payer a CMS-1500 paper claim in addition to an electronic claim to make the process easier for the payer.
C)   All of these are correct.
D)   The practice can no longer afford to submit claims electronically and reverts to sending the CMS-1500 paper claim.

Question 19

What type of code may not be required by HIPAA, but if used, must be chosen from the NUCC list?

Accepted Answer

A)   administrative codes
B)   place of service codes
C)   diagnosis codes
D)   taxonomy codes

Question 20

Which of the following is the HIPAA-mandated electronic transaction for claims from physicians and other medical professionals?

Accepted Answer

A)   847P
B)   837I
C)   847I
D)   837P

Exam 7: Health Care Claim Preparation and Transmission

Choose the editing software programs used to check claims for error correction.

Correct AnswerverifiedShow Answer

Which of the following is the HIPAA-mandated electronic transaction for claims from physicians and other medical professionals?

Correct AnswerverifiedShow Answer

Name the function of the carrier block.

Correct AnswerverifiedShow Answer

Name the electronic format that practices use to ask payers about claims.

Correct AnswerverifiedShow Answer

The person or company that provides or supervised the care is known as the __________.

Correct AnswerverifiedShow Answer

Correct medical code sets are those that are

Correct AnswerverifiedShow Answer

On a HIPAA claim, which of the following is assigned to a particular service being reported?

Correct AnswerverifiedShow Answer

You are working at a practice and need to submit a claim, but cannot reach a patient to obtain his or her address, which is not on file. What should you do?

Correct AnswerverifiedShow Answer

Name the POS code used to indicate a procedure occurred in a skilled nursing facility.

Correct AnswerverifiedShow Answer

Which of the following describes the reason for and the process of "dropping to paper"?

Correct AnswerverifiedShow Answer

Which qualifier would be reported in Item Number 15 to indicate the date being reported is last x-ray?

Correct AnswerverifiedShow Answer

On a HIPAA claim, determine which of the following is assigned to a claim by the sender.

Correct AnswerverifiedShow Answer

What indicates the role of the provider being reported in Item Number 17?

Correct AnswerverifiedShow Answer

Name the condition code you would apply to an abortion performed due to social or economic reasons.

Correct AnswerverifiedShow Answer

Which of the following is a valid tip for entering data?

Correct AnswerverifiedShow Answer

What type of code may not be required by HIPAA, but if used, must be chosen from the NUCC list?

Correct AnswerverifiedShow Answer

How many diagnosis codes may be reported on the HIPAA 837?

Correct AnswerverifiedShow Answer

Identify the claim filing indicator code that is used to indicate that the health plan is Medicaid.

Correct AnswerverifiedShow Answer

A data element that HIPAA always mandates reporting is called a(n)

Correct AnswerverifiedShow Answer

Which of the following must be supplied by the provider on every claim?

Correct AnswerverifiedShow Answer

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