Ch 5: True and False

Question 1

T/F: The American Medical Association is responsible for creating the universal claim form known as the CMS-1500

Answer 1

False

The Health Care Financing Administration is responsible for creating the universal claim form known as the CMS-1500

Question 2

T/F: The CMS-1500 form (originally known as the HCFA-1500) was developed for the purpose of submitting Medicare claims

Answer 2

True

Question 3

T/F: Practice management software allows users to enter patient demographic information, schedule appointments, maintain lists of insurance payers, perform billing tasks, and generate reports

Answer 3

True

Question 4

T/F: The Centers for Medicare and Medicaid Services (CMS) initiated changes to promote uniformity in health care claim submission by adopting standards for electronic health information transactions

Answer 4

False

HIPAA initiated these changes

Question 5

T/F: Roster billing of Medicare-covered vaccinations for multiple beneficiaries must be submitted electronically

Answer 5

False

ASCA had identified limited exceptions

Question 6

T/F: Small entity providers are those with 25 or fewer full-time employees (FTEs) and physicians, practitioners, and suppliers with 10 or fewer FTEs

Answer 6

True

Question 7

T/F: The intent of HIPAA’s Administrative Simplification legislation was to provide consumers with lower healthcare costs

Answer 7

False

The intent of HIPAA’s Administrative Simplification legislation was to provide consumers with greater access to healthcare insurance, to protect the privacy of healthcare data, and to promote more standardization and efficiency in the healthcare industry

Question 8

T/F: HIPAA allows providers who conduct business electronically to use their own established healthcare transactions, code sets, and identifiers

Answer 8

False

Question 9

T/F: The health insurance professional’s most important responsibility is to obtain the maximum amount of reimbursement in the minimal amount of time that the patient’s health record will support

Answer 9

True

Question 10

T/F: The HIPAA Administrative Simplification Compliance Act (ASCA) prohibits the Department of Health ans Human Services (HHS) from paying all claims that are not submitted electronically, without exception

Answer 10

False

If the secretary grants a waiver, claims can be submitted by paper form

Question 11

T/F: The patient information form typically lists both demographic and insurance information

Answer 11

True

Question 12

T/F: The health insurance professional must obtain written permission from the patient to release healthcare information to any person or business entity except the patient’s insurance carrier

Answer 12

True

Question 13

T/F: If a claim requires an attachment to provide additional medical information to the claims processor, neither the claim nor the attachment can be submitted electronically; both must be mailed

Answer 13

False

Some patient accounting software and insurance carriers have methods for submitting claim attachments electronically

Question 14

T/F: The insurance claim process begins when the health insurance professional submits that claim to the insurance processor

Answer 14

False

The insurance claim process begins when the patient arrives at the medical facility for their appointment

Question 15

T/F: A clearinghouse is an independent, centralized service available to healthcare providers for the purpose of simplifying medical insurance claims submission for multiple carriers

Answer 15

True