Chapter 16 module 1

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Western Tech *

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1403

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Information Systems

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Apr 3, 2024

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Chapter 16 module 1 16-1 1. Specific areas of administrative simplification addressed by HIPPA include all of these except: EDI, Accreditation, Code sets, Specific identifiers. 2. The organization created to reform health insurance and simplify the healthcare administrative processes is known as: HIPPA 3. The electronic transfer of information in a standard format between two entities is known as: EDI (electronic data interchange) 4. The numbers used in the administration of healthcare to distinguish individual providers, health plans, employers, and patients are called: Identifiers 5. To send claims electronically, the medical practice needs : computer, modem, and HIPAA compliant software. 6. If a medical practice chooses to submit claims electronically to an insurance carrier, it must go through a(n): enrollment process 7. A business entity that receives claims from several medical facilities, consolidates these claims, and transmits them to various insurance carriers is called a(n): clearinghouse 8. The system wherein data representing money are moved electronically between accounts or organizations is called: Electronic funds transfer 9. An electronic file wherein patients’ health information is stored in a computer system is called: EMR 10. One of the most significant activities of the healthcare industry is: information management 11. One of the major disadvantages of EMRs is: cost, amount of time it takes to transfer records 12. Submitting claims directly to an insurance carrier is referred to as: (DDE) Direct data entry 13. If the practice submits claims primarily to one carrier, it may be advisable to use: DDE 14. The ultimate goal in healthcare is to establish an EMR system that is: intercommunicative EHR 15. The acronym for the organization enacted by congress to improve the administration of medicare by taking advantage of the efficiencies gained through electronic claim submission is: ASCA 16. The code set currently used for physician diagnoses is: ICD-10-CM 17. The record keeping method in which some documents are stored electronically and some are kept in paper form is referred to as: combination records 18. If the goal of a healthcare office is to change to a completely electronic medical record system, a ___ digital imaging hybrid____ may be a good choice. 19. Disadvantages to EMRs include all of these except: cost, security breaches, transfer time , lack of software available. 20. Medicare access and CHIP Reauthorization Act of 2015 (MACRA) replaced the meaningful use program with: Promoting Interoperability 16-2 1. Federal regulations now mandate that all healthcare information that is electronically transmitted follows specific rules and guidelines to provide security and protection for PHI. True
2. The administrative simplification and compliance act (ASCA) requires health plans and healthcare clearinghouses to use certain standard transaction formats and coded sets for the electronic transmission of health information. True 3. ASCA made it compulsory for all medicare claims to be submitted electronically effective October 16, 2003, without exception. True 4. ASCA’s “rule” does not require any other transactions (changes, adjustments, or appeals to the initial claim) to be submitted electronically. True 5. Claims submitted via DDE are considered to be electronic claims for purposes of the “rule”. True 6. The biggest obstacle to getting set up for electronic claims processing is the time it takes for approval from various federal and state agencies. True 7. The move from paper to electronic submissions will result in significant savings for all medical providers. True https://westerntech.instructure.com/calendar 8. ASCA’s “rule” is applicable only to providers, practitioners, and suppliers who submit claims under part A or part B medicare. True 9. ERA payments can be posted automatically to patient accounts. True 10. Experts predict that computerized medical records can improve the quality of patient care. True 11. Interoperability can help provide better public health date. True 12. A small provider of services is a medical facility ( hospital or skilled nursing facility) with fewer than 25 full time equivalent (FTE) employees. True 13. A small supplier is a physician, practitioner, facility, or supplier with fewer than 10 FTEs. True 14. Physicians who did not adopt an EMR by 2015 were penalized 10% of medicare payments, increasing incrementally to 25% by the end of the program. False 15. EMR is a system wherein data representing money are moved electronically between accounts or organizations. False 16-3 1. How many claims are on this RA? 2. What was the total amount billed to medicare? 3. Of the amount on Benny Fisher’s second claim, how much did medicare pay? 4. By what method were these claims paid? 5. What was the total amount of the payment? 6. Were there any crossover claims? 7. If so, which patients had their claim crossed over? 8. What was the total amount applied to patient’s deductible? 9. What does the code “PR” mean? 10. How much of I.M Hurt’s charge is he responsible for?
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