Chapter 27 — Quiz
26 questions. Answers and explanations are in the instructor guide.
1. HIPAA's Administrative Simplification provisions standardized:
- A. What each payer requires in every field
- B. The format of defined electronic health care transactions
- C. Payer reimbursement rates
- D. Clearinghouse edits
2. An implementation guide classifies a data element as required, not used, or:
- A. Optional
- B. Situational
- C. Conditional
- D. Reserved
3. The document stating how a specific payer requires the standard transaction populated is the:
- A. Implementation guide
- B. Companion guide
- C. Provider manual
- D. Edit list
4. Besides transactions, Administrative Simplification also standardized:
- A. Fee schedules and contracts
- B. Code sets and identifiers
- C. Medical records formats
- D. Appeal procedures
5. The 270 and 271 transactions are:
- A. Claim and remittance
- B. Eligibility inquiry and response
- C. Status inquiry and response
- D. Authorization request and response
6. Prior authorization is requested with the:
- A. 276
- B. 277
- C. 278
- D. 834
7. The remittance advice transaction is the:
- A. 835
- B. 837
- C. 277
- D. 999
8. The 999 reports whether:
- A. The payer accepted the claim into adjudication
- B. The file was syntactically valid
- C. The claim will be paid
- D. The envelope was readable
9. The 277CA reports whether:
- A. The file was syntactically valid
- B. The payer accepted the claim into adjudication
- C. The claim was paid
- D. The interchange envelope was readable
10. A 999 acceptance proves:
- A. The claim is in the payer's system
- B. The file followed the rules of the format, and nothing about content
- C. The claim will be paid
- D. Timely filing was met
11. An 837 is best described as:
- A. An image of the claim form
- B. The form's data with the boxes removed
- C. A summary of the claim
- D. A payer-specific file
12. Which appears in the 837I and not the 837P?
- A. Diagnosis pointers
- B. Revenue codes
- C. Place of service
- D. Modifiers
13. The six-service-line limit is a property of:
- A. The 837P
- B. The paper CMS-1500
- C. HIPAA
- D. The clearinghouse
14. In the 837, a "loop" is:
- A. A repeating error
- B. A level in the hierarchy of information
- C. A batch of claims
- D. A payer's edit cycle
15. Loop 2400 refers to information at the:
- A. Claim level
- B. Service-line level
- C. Subscriber level
- D. Billing-provider level
16. SV107 carries:
- A. The charge
- B. The units
- C. The diagnosis pointers
- D. The modifiers
17. A rejection reading "Loop 2310A, NM109 is invalid" concerns the:
- A. Billing provider's NPI
- B. Rendering provider's NPI
- C. Referring provider's NPI
- D. Subscriber's member number
18. A clearinghouse that silently repairs a defect your system generates means that:
- A. The problem is solved
- B. You have a defect you will never find until something changes
- C. The claim is invalid
- D. The payer will reject it
19. Passing a clearinghouse's edits proves the claim is:
- A. Going to be paid
- B. Well-formed and plausible, and nothing about adjudication
- C. Medically necessary
- D. Correctly coded
20. To receive the 835 electronically, a practice must complete:
- A. EDI enrollment only
- B. ERA enrollment, which is separate
- C. EFT enrollment only
- D. No enrollment; it is automatic
21. A rejected claim:
- A. Has appeal rights
- B. Was never adjudicated and is not in the payer's system
- C. Has a CARC and a RARC
- D. Appears in the denial rate
22. Regarding timely filing, a rejection:
- A. Stops the clock
- B. Extends the deadline
- C. Does not stop the clock, because from the payer's view nothing was submitted
- D. Resets the clock to zero
23. The strongest proof of timely filing is:
- A. The practice management system's claim history
- B. A payer acknowledgment naming the claim
- C. A clearinghouse transmission report
- D. A note documenting a phone call
24. Regarding attachments, the current situation is:
- A. Fully standardized through the 275
- B. No universal mechanism; partial solutions and persistent fax
- C. Prohibited on electronic claims
- D. Handled entirely by clearinghouses
25. Eligibility runs in real time and claims run in batch because:
- A. HIPAA requires it
- B. An eligibility answer is a lookup; a claim requires adjudication
- C. Claims are larger files
- D. Clearinghouses cannot process claims in real time
26. Account 10-4471's claim was acknowledged on day 3 and line 1 was denied on day 17. This shows that:
- A. The acknowledgment was wrong
- B. Acceptance is not adjudication
- C. The clearinghouse failed
- D. The claim was rejected