Workbook for Fordney's Medical Insurance - Assignments Chapter 15

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UEI College, Gardena *

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MEDICAL BI

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Computer Science

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Jan 9, 2024

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Key Abbreviations ANSI – American National Standards Institute ASC X12 – Accredited Standards Committee X12 ASET – Administrative Simplification Enforcement Tool ASP – Application Service Provider ATM – Automatic Teller Machine DDE – Direct Data Entry DHHS – Department of Health and Human Services DSL – Digital Subscriber Line EDI – Electronic Data Interchange EFT – Electronic Funds Transfer EHR – Electronic Health Record EMC – Electronic Medical Claim EOMB – Explanation of Medicare Benefits ERA – Electronic Remittance Advice HPID – Health Plan Identifier IRS – Internal Revenue Service MAC – Medicare Administrative Contractor NDC – National Drug Code NSF – Nonsufficient funds or not sufficient funds TCS rule – Transaction and Code Set (rule) 15.1 Review Questions 1. Electronic Data Interchange (EDI) 2. Encryption. 3. Application Service Provider 4. Clearinghouse 5. 2 weeks or less. 6. Audit trail 7. A. More reliable and timely processing – quicker reimbursement from payer B. Improved accuracy of data C. Easier and more efficient access to information D. Better tracking of transactions E. Reduction of data entry and manual labor F. Reduction in office expenses 8. A. Physician services: Current Procedural Terminology code set B. Diseases and Injuries: Classification of Diseases, 10 th Edition, Clinical Modification Volume 1 and 2 C. Pharmaceuticals and biologics: National Drug codes for Retail Pharmacy transactions 9. The family practice taxonomy code: 207Q00000X 10. Accredited Standards Committee X12 11. A. ASC X12N837P B. ASC X12N 837I C. ASC X12N 835 D. ASC X12N 276 E. ASC X12N 270 12. A. High-level information B. Claim-level information C. Specialty claim-level information

D. Service line-level information E. Specialty service line-level information F. Other information 13. 5010 14. January 1, 2016 15. NPI (National Provider Identifier) 16. Civil liberties 17. May print an insurance billing worksheet, or perform a front-end edit (online error checking) 18. Syntax errors, data content errors 19. Encoder. 20. Real time. 21. Recoup 22. Transaction Transmission Summary 23. Rejection Analysis Report 24. National Provider Identifier (NPI) 25. Nine 26. Administrative Simplification Enforcement tool 27. D 28. D 29. A 30. A 31. C 32. D 33. C 34. D 35. D 36. C 37. D 38. B 39. C 40. D 41. False 42. True 43. False 44. False 45. False 46. False 47. False 48. False 49. True 50. True 15.2 Critical Thinking a. Inpatient psychiatric facility: 51 b. Physician’s office: 11 c. Outpatient hospital: 22 d. Intermediate nursing facility: 33 e. Independent clinic: 49 f. Independent laboratory: 81

g. Birthing center: 25 h. End-stage renal disease treatment facility: 65 i. Inpatient hospital: 21 j. Hospice: 34

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