Certified Medical Coding Specialist Technology & Digital Applications 5 — Questions and Answers
Question 1: A practice receives an electronic remittance advice (ERA) via the X12 835 transaction. What information does this document contain?
- Patient demographic and insurance eligibility data
- Payment details, adjustments, and denial reasons for submitted claims (Correct answer)
- Provider credentialing and enrollment information
- Prior authorization approvals and reference numbers
Correct answer: Payment details, adjustments, and denial reasons for submitted claims
The X12 835 ERA contains payment amounts, contractual adjustments, patient responsibility amounts, and claim adjustment reason codes explaining any denials or reductions.
Question 2: What is 'information blocking' as defined by the 21st Century Cures Act?
- Encrypting PHI to prevent unauthorized access
- Practices that unreasonably interfere with access, exchange, or use of electronic health information (Correct answer)
- Blocking spam emails containing patient data
- Restricting EHR access to credentialed users only
Correct answer: Practices that unreasonably interfere with access, exchange, or use of electronic health information
Information blocking refers to practices by providers, health IT developers, or HIEs that interfere with the lawful access, exchange, or use of EHI, which is prohibited by the 21st Century Cures Act.
Question 3: Which coding tool feature helps coders ensure that diagnosis codes support the medical necessity of a billed procedure?
- Encoder cross-referencing with LCD/NCD policies (Correct answer)
- Automated appointment scheduling integration
- Patient portal messaging module
- Revenue code master file
Correct answer: Encoder cross-referencing with LCD/NCD policies
Encoder software that cross-references Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) helps verify that diagnosis codes establish medical necessity for procedures.
Question 4: A practice implements a patient portal. Which HIPAA provision is MOST directly supported by allowing patients to view and download their records online?
- Minimum Necessary Standard
- Individual Right of Access (Correct answer)
- Business Associate Agreement requirement
- Notice of Privacy Practices
Correct answer: Individual Right of Access
HIPAA's individual right of access allows patients to inspect, obtain copies of, and transmit their PHI, which patient portals facilitate electronically.
Question 5: What is the role of a 'clearinghouse' in the electronic claims submission process?
- A government agency that approves all electronic transactions
- An intermediary that translates and routes claims between providers and payers (Correct answer)
- A software tool that assigns CPT codes from clinical documentation
- A database storing all payer fee schedules
Correct answer: An intermediary that translates and routes claims between providers and payers
A clearinghouse acts as a middleman that receives claims from providers, checks them for errors, translates them into payer-specific formats, and routes them to the appropriate insurance companies.
Question 6: Which security measure requires users to verify their identity using two separate authentication factors when logging into an EHR?
- Role-based access control (RBAC)
- Multi-factor authentication (MFA) (Correct answer)
- Single sign-on (SSO)
- Data masking
Correct answer: Multi-factor authentication (MFA)
MFA requires users to present two or more verification factors (e.g., password plus a phone-generated code) to access systems, significantly reducing unauthorized access risk.
Question 7: A hospital coding department adopts a clinical documentation improvement (CDI) software tool. What is the PRIMARY goal of this technology?
- Automating claim submission to reduce staff workload
- Identifying documentation gaps to improve specificity and accuracy before coding (Correct answer)
- Generating patient satisfaction surveys after discharge
- Managing provider scheduling and availability
Correct answer: Identifying documentation gaps to improve specificity and accuracy before coding
CDI software analyzes clinical documentation in real-time to identify opportunities for clarification, helping ensure the record supports accurate, complete code assignment and appropriate reimbursement.
Certified Medical Coding Specialist Technology & Digital Applications 5
A practice receives an electronic remittance advice (ERA) via the X12 835 transaction.
What information does this document contain?