EHR Revenue Cycle & Billing Integration 2

Question 1

Which code set is used to report diagnoses on inpatient hospital claims in the United States?

Accepted Answer

ICD-10-CM

Answer

ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) is the standard for diagnosis coding on all US claims.

Question 2

A claim is returned with a 'duplicate claim' denial. What is the most appropriate first step?

Accepted Answer

Verify whether the original claim was paid, pending, or denied before taking action

Answer

Before taking any action on a duplicate denial, staff must check the original claim's status to avoid creating additional duplicates or losing reimbursement.

Question 3

What does the term 'clean claim' mean in the revenue cycle context?

Accepted Answer

A claim that passes all edits and contains all required information for adjudication

Answer

A clean claim contains all required data elements and passes all edits, allowing the payer to process it without additional information.

Question 4

In EHR-integrated billing, what is the primary purpose of charge capture?

Accepted Answer

To record all billable services and supplies rendered so they can be translated into charges

Answer

Charge capture ensures every billable service, procedure, and supply is documented and converted into a charge that can be submitted for reimbursement.

Question 5

Which HIPAA transaction standard is used for submitting electronic health care claims to payers?

Accepted Answer

X12 837

Answer

The X12 837 transaction set is the HIPAA-mandated standard for electronic submission of professional (837P) and institutional (837I) claims.

(EHR) Electronic Health Records Program Certification Practice Test

(EHR) Electronic Health Records Program Certification Practice Test

EHR Revenue Cycle & Billing Integration 2