Medical Billing Software Technology & Digital Applications 2

Question 1

Which integration standard allows medical billing software to exchange clinical data with EHR systems?

Accepted Answer

HL7 FHIR

Answer

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?

Accepted Answer

An intermediary that translates and routes claims between providers and payers

Answer

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?

Accepted Answer

835 EDI transaction

Answer

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?

Accepted Answer

Automatically post insurance payments and adjustments to patient accounts

Answer

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?

Accepted Answer

270/271 EDI transactions via clearinghouse API

Answer

The 270 (eligibility inquiry) and 271 (eligibility response) EDI transactions are used to query payers in real time through a clearinghouse API.

Medical Billing Software Practice Test

Medical Billing Software Practice Test

Medical Billing Software Technology & Digital Applications 2