Medical Billing Software Technology & Digital Applications 2 — Questions and Answers
Question 1: Which integration standard allows medical billing software to exchange clinical data with EHR systems?
- HL7 FHIR (Correct answer)
- SMTP
- FTP
- OAuth 2.0
Correct answer: HL7 FHIR
HL7 FHIR (Fast Healthcare Interoperability Resources) is the modern standard enabling seamless data exchange between billing software and EHR systems.
Question 2: What does the term 'clearinghouse' refer to in medical billing software workflows?
- A bank that processes payments
- An intermediary that translates and routes claims between providers and payers (Correct answer)
- A cloud storage service for patient records
- A software module for generating superbills
Correct answer: An intermediary that translates and routes claims between providers and payers
A clearinghouse acts as an intermediary that scrubs, translates, and routes electronic claims from providers to the appropriate insurance payers.
Question 3: Which file format is most commonly used to transmit electronic remittance advice (ERA) from payers to billing software?
- CSV
- 835 EDI transaction (Correct answer)
- XML
Correct answer: 835 EDI transaction
The ANSI X12 835 EDI transaction set is the standard format payers use to send electronic remittance advice detailing payment explanations.
Question 4: In medical billing software, what is the primary function of an Explanation of Benefits (EOB) parser?
- Generate patient statements
- Automatically post insurance payments and adjustments to patient accounts (Correct answer)
- Submit prior authorization requests
- Export billing data to accounting software
Correct answer: Automatically post insurance payments and adjustments to patient accounts
An EOB parser reads remittance data and automatically posts payments, contractual adjustments, and denials to the correct patient accounts.
Question 5: What technology allows medical billing software to automatically verify patient insurance eligibility in real time before an appointment?
- Batch processing overnight scripts
- 270/271 EDI transactions via clearinghouse API (Correct answer)
- Manual phone verification workflows
- PDF scraping tools
Correct answer: 270/271 EDI transactions via clearinghouse API
The 270 (eligibility inquiry) and 271 (eligibility response) EDI transactions are used to query payers in real time through a clearinghouse API.
Question 6: A medical billing platform uses a REST API to connect with a patient payment portal. Which authentication method is the industry best practice for securing these API calls?
- Basic HTTP authentication with username/password
- API keys transmitted in URL query strings
- OAuth 2.0 with short-lived bearer tokens (Correct answer)
- IP whitelisting only
Correct answer: OAuth 2.0 with short-lived bearer tokens
OAuth 2.0 with short-lived bearer tokens provides secure, auditable, and revocable access for API integrations handling sensitive patient payment data.
Question 7: Which HIPAA technical safeguard requires medical billing software to record who accessed, modified, or transmitted PHI and when?
- Encryption at rest
- Audit controls (Correct answer)
- Automatic logoff
- Data backup
Correct answer: Audit controls
HIPAA's audit controls requirement mandates that covered entities implement hardware, software, or procedural mechanisms to record and examine PHI access activity.
Medical Billing Software Technology & Digital Applications 2
Which integration standard allows medical billing software to exchange clinical data with EHR systems?