Certified Medical Coding Specialist Technology & Digital Applications 5

Question 1

A practice receives an electronic remittance advice (ERA) via the X12 835 transaction. What information does this document contain?

Accepted Answer

Payment details, adjustments, and denial reasons for submitted claims

Answer

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?

Accepted Answer

Practices that unreasonably interfere with access, exchange, or use of electronic health information

Answer

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?

Accepted Answer

Encoder cross-referencing with LCD/NCD policies

Answer

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?

Accepted Answer

Individual Right of Access

Answer

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?

Accepted Answer

An intermediary that translates and routes claims between providers and payers

Answer

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.

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Technology & Digital Applications 5