This assessment measures your ability to explain the relationship between EHRs, reimbursement, HIPAA, and EDI transactions. Use your course materials and outside resources to determine your answers. You have 2 attempts to earn your best score.
1. Question 1
6.5/6.5
What is EDI?
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1.
Standardized electronic transmission of data
2.
Health care law enacted by Congress in 1996
3.
Electronic Data Investment
4.
A paper-based data and records system
2. Question 2
6.5/6.5
Select 3 of the following EDI transactions that are processed in the format established by the Health Insurance Portability and Accountability Act (HIPAA). (Select all that apply.)
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1.
Payment and remittance advice
2.
Claims status
3.
Release of Information
4.
Eligibility
5.
Consent forms
6.
Order management
3. Question 3
6.5/6.5
Provisions introduced in 2010 concerning the use of transactions were through:
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1.
Administrative Simplification standards
2.
The Mars Act
3.
HIPAA
4.
21st Century Cures Act
4. Question 4
6.5/6.5
The 270/271 transaction is:
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1.
An eligibility/benefit inquiry
2.
A request for payment
3.
A claims status inquiry
4.
An explanation of benefits
5. Question 5
6.5/6.5
What does EDI stand for?
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1.
Electronic data interchange
2.
Electronic data internet
3.
Eligibility data inquiry
4.
Eligibility discharge interest
6. Question 6
6.5/6.5
Which of the following are 3 benefits of electronic data interchange (EDI)? (Select all that apply.)
(A) Saves time in the revenue…, (B) Saves money by …, and (C) Reduces risk of errors … are correct
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1.
Saves time in the revenue cycle
2.
Saves money by eliminating the need for paper-based transactions
3.
Reduces risk of errors due to manual processes
4.
Creates a longer claims processing time frame
5.
Requires additional clerical staff to process claims
7. Question 7
6.5/6.5
Which billing tasks are completed before the patient visit?
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1.
Insurance information is confirmed.
2.
A clean claim is submitted.
3.
Appropriate codes are assigned.
4.
Referrals are generated.
8. Question 8
6.5/6.5
The out-of-pocket maximum (OOP) consists of which of the following?
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1.
The total amount the patient must pay per plan year
2.
A set amount that the patient must pay per plan year
3.
A percentage of charges
4.
A set amount per visit
9. Question 9
6.5/6.5
Which of the following tasks should be completed prior to claim submission?
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1.
Coding the visit
2.
Using the UB-20 form
3.
Provider signing the claim
4.
Manually sending the claim
10. Question 10
6.5/6.5
Coordination of benefits (COB) includes:
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1.
Reimbursement when a patient is covered by more than 1 health plan
2.
Reimbursement for non-covered services
3.
Reimbursement for not medically necessary services
4.
Reimbursement for diagnosis mismatch
11. Question 11
6.5/6.5
The difference between a remittance advice (RA) and an explanation of benefits (EOB) is:
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1.
The RA goes to the provider only and includes payment information.
2.
The EOB goes to the provider.
3.
The RA is sent to the patient and includes payment information.
4.
The EOB contains payment information.
12. Question 12
6.5/6.5
Which steps are part of the billing workflow process? (Select all that apply.)
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1.
Front desk calling to confirm patient appointment
2.
Billing third-party claims
3.
Coordination of benefits (COB)
4.
Verifying insurance eligibility
5.
Patient registers for portal
6.
Personnel enters diagnosis code into EHR
13. Question 13
6.5/6.5
Which of the following is a set amount that the patient must pay out of pocket per plan year prior to the insurance plan covering their portion of the bill?
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1.
Deductible
2.
Out-of-pocket maximum (OOP)
3.
Co-pay
4.
Coinsurance
14. Question 14
6.5/6.5
Which code set communicates the patient’s diagnosis?
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1.
ICD-10-CM
2.
ICD-10-PCS
3.
CPT
4.
HCPCS
15. Question 15
6.5/6.5
The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule:
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1.
Establishes standards for the use of protected health information (PHI)
2.
Specifies the safeguards for covered entities
3.
Tracks and handles security breaches
4.
Affects only providers and clinics
16. Question 16
6.5/6.5
Who must complete annual Health Insurance Portability and Accountability Act (HIPAA) training and education in a hospital or clinic setting?
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1.
All staff, including volunteers
2.
Patients
3.
Community members
4.
Clinicians, providers, and police
17. Question 17
6.5/6.5
What are common devices used in health care that put patient information at risk?
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1.
Tablets, phones, and thumb drives
2.
Televisions, phones, and tasers
3.
Thumb drives, technology, and patient discussions
4.
Tablets and providers
18. Question 18
6.5/6.5
PHI stands for which of the following?
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1.
Protected health information
2.
Public health information
3.
Private hospital insurance
4.
Private health incident
19. Question 19
6.5/6.5
Which of the following are possible Health Insurance Portability and Accountability Act (HIPAA) violations? (Select all that apply.)
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1.
Denying a patient access to their chart
2.
Confirming to a local newspaper that a well-known politician is a patient
3.
Requiring patients to indicate their primary complaint using a sign-in sheet on the reception desk
4.
Sharing medical records with the referring physician on file
5.
Releasing a partial medical record to a judge after a subpoena is issued
6.
Sending lab results to a patient’s spouse listed on the HIPAA release form
20. Question 20
6.5/6.5
Which of the following is considered a covered entity under the Health Insurance Portability and Accountability Act (HIPAA)?
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1.
Hospital
2.
School
3.
Patient
4.
Parent or pediatric patient
21. Question 21
6.5/6.5
The Health Insurance Portability and Accountability Act (HIPAA) Security Rule addresses which of the following? (Select all that apply.)
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1.
Privacy of PHI
2.
Technical safeguards
3.
Administrative safeguards
4.
Physical safeguards
5.
Authorization release forms
22. Question 22
6.5/6.5
What does TPO stand for?
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1.
Treatment, payment, and health care operations
2.
Technical provision operations
3.
Transmission, payment, and operations
4.
Treatment provisions and operations
23. Question 23
6.5/6.5
How has the Health Insurance Portability and Accountability Act (HIPAA) changed how information is transmitted through electronic data interchange (EDI)?
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1.
Established standardization of format
2.
Required patient consent
3.
Established privacy provisions
4.
Established insurance portability
24. Question 24
6.5/6.5
How does the Health Insurance Portability and Accountability Act (HIPAA) facilitate electronic transactions?
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1.
Gives providers access to a centralized patient database
2.
Generates paper reports as a back-up system
3.
Gives covered providers unique identifiers to use with coding system
4.
Allows anyone with computer access to file claims
25. Question 25
6.5/6.5
How has the Health Insurance Portability and Accountability Act (HIPAA) changed how health care information is stored and accessed within an electronic health record (EHR)?
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1.
Implements security requirements
2.
Limits patient access
3.
Requires thumbprint access protection
4.
Requires paper backup
26. Question 26
6.5/6.5
What are the effects of the Health Insurance Portability and Accountability Act (HIPAA) on electronic data interchange (EDI)? (Select all that apply.)
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1.
Privacy requirements
2.
Security requirements
3.
Standardized code sets
4.
Generation of paper trails
5.
ANSI requirements
6.
Increased cost of transactions
27. Question 27
6.5/6.5
Roshelle, the billing specialist for a doctor’s office, needs to verify the codes sent to the insurance company using electronic data interchange (EDI) corresponding to the patient’s visit. Which system will she use to find this information?
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1.
Radiology information system
2.
Telehealth system
3.
Electronic health record (EHR)
4.
Paper chart
28. Question 28
6.5/6.5
What aspect of the Health Insurance Portability and Accountability Act (HIPAA) gives patients the right to access the information found in their health record?
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1.
Privacy Rule
2.
Security Rule
3.
Standardization code set
4.
Hospital quality initiative
29. Question 29
6.5/6.5
What aspect of the Health Insurance Portability and Accountability Act (HIPAA) addresses protection of protected health information (PHI) in electronic form (ePHI)?
Hide answer choices
1.
Privacy Rule
2.
Security Rule
3.
Standardization code set
4.
Hospital quality initiative
30. Question 30
6.5/6.5
Which Health Insurance Portability and Accountability Act (HIPAA) requirements specify how health care information is stored and accessed in the electronic health record (EHR)? (Select all that apply.)
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1.
Paper back-up of all EHR information as safeguards
2.
Administrative safeguards
3.
Technical safeguards
4.
Designates a set number of employees with access to EHR
