Question 1

When the subscriber and the patient are the same person, what patient data is required on the HIPAA 837?

Accepted Answer

A)   the information must be duplicated in both sections
B)   the subscriber data is not required if the subscribed and the patient are the same
C)   the patient data is not required if the subscribed and the patient are the same
D)   none of these are correct; the subscriber and the patient cannot be the sameE) None of the above
F) All of the above

Question 2

Explain how a payer will respond to a claim that does not contain at least one diagnosis code.

Accepted Answer

A)   The payer will provide the code they deem most appropriate.
B)   The payer will deny the claim.
C)   None of these are correct.
D)   The payer will call the practice and ask for the code.E) C) and D)
F) B) and C)

Question 3

In what format can claim attachments be sent?

Accepted Answer

A)   claim attachments cannot be sent with the claim
B)   paper format only
C)   electronic or paper format
D)   electronic format onlyE) A) and B)
F) B) and C)

Question 4

How many characters can be entered into the Other ID# field in Line Number 17a?

Accepted Answer

A)   2
B)   4
C)   17
D)   10E) B) and C)
F) A) and B)

Question 5

Which of the following is a data element that is required on the HIPAA 837P claim?

Accepted Answer

A)   THE balance due
B)   THE billing provider name and telephone number
C)   THE physician's signature
D)   THE insured's marital status and genderE) A) and D)
F) A) and B)

Question 6

Identify the information included in blocks 1 through 13 of the CMS-1500.

Accepted Answer

A)   information about the provider
B)   information about the diagnoses, procedures, and charges
C)   information about the patient's condition
D)   information about the patient and the patient's insurance coverageE) None of the above
F) A) and B)

Question 7

Why has sending paper claims become less common?

Accepted Answer

A)   patients began requesting the use of less paper claims
B)   insurance companies do not require claims to be submitted
C)   the increased use of information technology as mandated by CMS and HIPAA
D)   increased costs of paper and mail deliveryE) A) and B)
F) None of the above

Question 8

Section 24 of the CMS-1500 records service line information, which contains the

Accepted Answer

A)   procedures performed for the patient.
B)   diagnoses made by the physician.
C)   patient's name and address.
D)   referring provider NPI number.E) C) and D)
F) None of the above

Question 9

What choice may be made in Item Number 6 to show that the insured is the patient?

Accepted Answer

A)   Spouse
B)   Other
C)   Child
D)   SelfE) A) and B)
F) A) and D)

Question 10

The provider who provides the procedure on a claim other than the pay-to provider is called the

Accepted Answer

A)   billing provider.
B)   primary provider.
C)   rendering provider.
D)   referring provider.E) A) and B)
F) A) and C)

Question 11

A HIPAA-mandated electronic transaction for claims may also be called

Accepted Answer

A)   HCFA1500.
B)   HIPAA X12 837 Health Care Claim.
C)   EDI.
D)   CMS1500.E) None of the above
F) A) and D)

Question 12

Which of the following is not considered to be a common error in generating claims?

Accepted Answer

A)   invalid procedure codes
B)   missing patient name
C)   incomplete other payer information
D)   missing patient date of birthE) A) and B)
F) C) and D)

Question 13

What does a claim filing indicator code identify?

Accepted Answer

A)   the physician's diagnosis
B)   the name of the health plan
C)   the type of health plan
D)   the procedures that were performedE) A) and B)
F) B) and D)

Question 14

Which of the following explains a reason that the five levels of the HIPAA 837 are set up as a hierarchy?

Accepted Answer

A)   None of these are correct.
B)   The most important information on the HIPAA 837 appears first.
C)   So that when the claim is sent electronically, the only data elements that have to be sent are those that do not repeat previous data.
D)   To conform with the order that payers demand the information to be transmitted.E) C) and D)
F) B) and C)

Question 15

What is the purpose of the shading in the top portions for the six service lines in Section 24 of the CMS-1500 claim form?

Accepted Answer

A)   to allow the payer to input notes
B)   to allow the provider to include a proprietary identifier in addition to the NPI and in some cases, other supplemental data
C)   there is no purpose for the shading in that section
D)   to allow the billing of twelve lines of serviceE) A) and B)
F) B) and D)

Question 16

Identify what is indicated by an individual relationship code.

Accepted Answer

A)   the subscriber's insurance plan
B)   the subscriber's relationship to the subscriber
C)   the patient's relationship to the subscriber
D)   the patient's relationship to the providerE) A) and C)
F) B) and D)

Question 17

What is the most common method of claim transmission?

Accepted Answer

A)   direct data entry
B)   direct transmission to the payer
C)   clearinghouse use
D)   the adjudication processE) C) and D)
F) A) and D)

Question 18

In which of these methods of transmitting claims do providers and payers exchange transactions directly without using a third party?

Accepted Answer

A)   clearinghouse use
B)   the adjudication process
C)   direct data entry
D)   direct transmission to the payerE) B) and D)
F) A) and B)

Question 19

Name the POS code used to indicate a procedure occurred in an on campus-outpatient hospital.

Accepted Answer

A)   24
B)   22
C)   21
D)   23E) None of the above
F) A) and C)

Question 20

You need to send a claim to a payer who does not accept electronic claims. Identify the claim form you would use to send a paper claim.

Accepted Answer

A)   CMS-1500 claim
B)   HIPAA claim
C)   EDI claim
D)   837 claimE) A) and B)
F) A) and C)

Exam 7: Health Care Claim Preparation and Transmission

Name the POS code used to indicate a procedure occurred in an on campus-outpatient hospital.

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Explain how a payer will respond to a claim that does not contain at least one diagnosis code.

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How many characters can be entered into the Other ID# field in Line Number 17a?

Correct AnswerverifiedShow Answer

Why has sending paper claims become less common?

Correct AnswerverifiedShow Answer

What does a claim filing indicator code identify?

Correct AnswerverifiedShow Answer

Identify the information included in blocks 1 through 13 of the CMS-1500.

Correct AnswerverifiedShow Answer

The provider who provides the procedure on a claim other than the pay-to provider is called the

Correct AnswerverifiedShow Answer

You need to send a claim to a payer who does not accept electronic claims. Identify the claim form you would use to send a paper claim.

Correct AnswerverifiedShow Answer

What choice may be made in Item Number 6 to show that the insured is the patient?

Correct AnswerverifiedShow Answer

In what format can claim attachments be sent?

Correct AnswerverifiedShow Answer

What is the purpose of the shading in the top portions for the six service lines in Section 24 of the CMS-1500 claim form?

Correct AnswerverifiedShow Answer

Which of the following is a data element that is required on the HIPAA 837P claim?

Correct AnswerverifiedShow Answer

When the subscriber and the patient are the same person, what patient data is required on the HIPAA 837?

Correct AnswerverifiedShow Answer

What is the most common method of claim transmission?

Correct AnswerverifiedShow Answer

Section 24 of the CMS-1500 records service line information, which contains the

Correct AnswerverifiedShow Answer

A HIPAA-mandated electronic transaction for claims may also be called

Correct AnswerverifiedShow Answer

Which of the following is not considered to be a common error in generating claims?

Correct AnswerverifiedShow Answer

Identify what is indicated by an individual relationship code.

Correct AnswerverifiedShow Answer

In which of these methods of transmitting claims do providers and payers exchange transactions directly without using a third party?

Correct AnswerverifiedShow Answer

Which of the following explains a reason that the five levels of the HIPAA 837 are set up as a hierarchy?

Correct AnswerverifiedShow Answer

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