Topics: Confidentiality, Computer, Insurance Pages: 3 (539 words) Published: August 4, 2013
Complete Reinforcement Exercises 10-1 through 10-3 from Chapter 10

Fill in the blank.

1. A(n) electronic claim is submitted to the insurance carrier via the Internet.

2. A(n) Clearinghouse distributes claims to the appropriate insurance carrier.
3. The Carrier-direct electronic claims submission method allows the provider to communicate directly with the insurance company.
4. Compliance monitoring is a process that checks the claim for accuracy and completeness.

5. The clearinghouse assigns a(n) unique identifier to each insurance company (carrier).

Provide a short answer for each item.

1. Briefly describe two components of an electronic claims processing agreement. (1) Must identify provider and insurance carrier responsibilities related to compliance monitoring. (2) Must describe how insurance information is submitted; who has access to the information.

2. List three components of an electronic claims processing agreement required by HIPAA. (1) security features or software that protect information when a wireless network is used. (2) non-redisclosure policies. (3) storage and retention policies.

3. Describe the differences between carrier-direct and clearinghouse electronic claims submission options. Carrier-direct; works directly with the insurance carrier. Clearinghouse electronic claims are compiled by one company and re-distributed to various carriers.

Provide a short answer for each item.

1. List three types of information required by nearly all insurance carriers. (1) Patient demographic information. (2) Insurance program information. (3) Treatment or clinical information.

2. Describe two edits often included in insurance billing software. (1) Edits evaluation and management (E/M) code that is not supported by the diagnosis and treatment codes. (2) Invalid diagnosis and treatment codes.

3. Identify sources and source...
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