Question 1

Identify the choice that best completes the statement or answers the question.
-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 2

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

-Health Care Claim Payment/Advice

Accepted Answer

A)  ASC X12N 270
B)  ASC X12N 275
C)  ASC X12N 276
D)  ASC X12N 277
E)  ASC X12N 278F) ASC X12N 834G) ASC X12N 835H) ASC X12N 837

Question 3

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

Accepted Answer

A) True 
 B)False

Question 4

Identify the code with the name of the source document.

-S52.501A

Accepted Answer

A)  ICD-10-CM, Diagnosis
B)  ICD-10-PCS, Hospital Procedures
C)  CPT-4, Physician Procedures
D)  CDT-4, Dental Procedures
E)  HCPCS, Non-physician Procedures

Question 5

Identify the choice that best completes the statement or answers the question.
-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 6

Identify the choice that best completes the statement or answers the question.
-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.

Question 7

Identify the choice that best completes the statement or answers the question.
-What is the name of the organization that developed the standard language that the DHHS adopted when they developed standard claims transactions?

Accepted Answer

A)  Health Level 7
B)  Accredited Standards Committee
C)  EDI Forum
D)  American Medical Association

Question 8

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

Accepted Answer

A) True 
 B)False

Question 9

Match the correct reference book to the appropriate types of codes.

-Hospital procedures

Accepted Answer

A)  Medicare Level II codes - HCPCS
B)  ICD-10-CM
C)  ICD-10-PCS
D)  CPT-4
E)  CDT-4F) NDC codes

Question 10

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 11

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

-Health Care Claim, Professional

Accepted Answer

A)  ASC X12N 270
B)  ASC X12N 275
C)  ASC X12N 276
D)  ASC X12N 277
E)  ASC X12N 278F) ASC X12N 834G) ASC X12N 835H) ASC X12N 837

Question 12

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

-Health Care Services Review

Accepted Answer

A)  ASC X12N 270
B)  ASC X12N 275
C)  ASC X12N 276
D)  ASC X12N 277
E)  ASC X12N 278F) ASC X12N 834G) ASC X12N 835H) ASC X12N 837

Question 13

Trading Partner agreements are only for electronic standard transactions.

Accepted Answer

A) True 
 B)False

Question 14

Crossover claims encourage an automatic rejection from the secondary payer for any claim the primary payer has rejected.

Accepted Answer

A) True 
 B)False

Question 15

Identify the code with the name of the source document.

-E78.5

Accepted Answer

A)  ICD-10-CM, Diagnosis
B)  ICD-10-PCS, Hospital Procedures
C)  CPT-4, Physician Procedures
D)  CDT-4, Dental Procedures
E)  HCPCS, Non-physician Procedures

Question 16

Identify the code with the name of the source document.

-29125

Accepted Answer

A)  ICD-10-CM, Diagnosis
B)  ICD-10-PCS, Hospital Procedures
C)  CPT-4, Physician Procedures
D)  CDT-4, Dental Procedures
E)  HCPCS, Non-physician Procedures

Question 17

Identify the choice that best completes the statement or answers the question.
-The data string for a standard transaction may be compared to

Accepted Answer

A)  a collage of many parts of a claim placed in random order.
B)  a line of various size train cars with a header and trailer.
C)  the rings of a tree with the most important part inside, surrounded by larger pieces of data.
D)  complete gibberish nonsense that must be de-encrypted by a computer to be understood.

Question 18

Match the correct reference book to the appropriate types of codes.

-Non-physician procedures

Accepted Answer

A)  Medicare Level II codes - HCPCS
B)  ICD-10-CM
C)  ICD-10-PCS
D)  CPT-4
E)  CDT-4F) NDC codes

Question 19

The World Health Organization developed a tenth revision of the ICD codes.

Accepted Answer

A) True 
 B)False

Question 20

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

Exam 3: Transactions and Code Sets

Identify the choice that best completes the statement or answers the question. -The phrase "adjudicate a claim" means to

Correct AnswerverifiedShow Answer

Identify the choice that best completes the statement or answers the question. -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

Match the correct reference book to the appropriate types of codes. -Hospital procedures

Correct AnswerverifiedShow Answer

Identify the code with the name of the source document. -E78.5

Correct AnswerverifiedShow Answer

The World Health Organization developed a tenth revision of the ICD codes.

Correct AnswerverifiedShow Answer

Identify the code with the name of the source document. -29125

Correct AnswerverifiedShow Answer

Identify the code with the name of the source document. -S52.501A

Correct AnswerverifiedShow Answer

Match the name of the transaction standard with the ID number assigned. -Health Care Services Review

Correct AnswerverifiedShow Answer

Identify the choice that best completes the statement or answers the question. -What is the name of the organization that developed the standard language that the DHHS adopted when they developed standard claims transactions?

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

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. -Health Care Claim, Professional

Correct AnswerverifiedShow Answer

Match the correct reference book to the appropriate types of codes. -Non-physician procedures

Correct AnswerverifiedShow Answer

Identify the choice that best completes the statement or answers the question. -For a health care provider to comply with the Transaction and Code Set Rule, they must

Correct AnswerverifiedShow Answer

Match the name of the transaction standard with the ID number assigned. -Health Care Claim Payment/Advice

Correct AnswerverifiedShow Answer

Crossover claims encourage an automatic rejection from the secondary payer for any claim the primary payer has rejected.

Correct AnswerverifiedShow Answer

Trading Partner agreements are only for electronic standard transactions.

Correct AnswerverifiedShow Answer

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

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

Identify the choice that best completes the statement or answers the question. -The data string for a standard transaction may be compared to

Correct AnswerverifiedShow Answer

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