What government regulation is intended to promote the use of EHRs in physician's practices and hospitals through the use of financial incentives?
A.
HITECH Act
B.
Affordable Care Act (ACA)
C.
HIPAA Security Rule
D.
HIPAA Privacy Rule
2.
In order to be eligible for financial incentives through the HITECH Act, what are healthcare providers required to do?
demonstrate a need for financial assistance
implement the EHR
demonstrate meaningful use of electronic health records
complete the application process
3.
The utilization of certified EHR technology to improve quality, efficiency, and patient safety in the healthcare system is known as what?
medical security implementation
meaningful use
healthcare improvement
All of these are correct.
4.
A network of doctors and hospitals that shares responsibility for managing the quality and cost of care provided to a group of patients is known as a
healthcare association.
patient-centered medical home.
accountable care organization.
health information network.
5.
What term refers to the computer hardware, software, and networks that are used to record, store, and manage health information?
practice management program (PMP)
health information technology (HIT)
electronic data interchange (EDI)
electronic health record (EHR)
6.
A practice management program (PMP) is a software program that is used to
record patients' payments and generate receipts.
process the financial transactions.
calculate charges for office visits.
7.
Which task is not performed by a practice management program?
creating financial reports
billing patients
assigning diagnosis codes
receiving electronic payments
8.
What is the PMP used for after a claim file has been transmitted?
to follow up on the status of the claim
to send an electronic message to the health plan if there is a delay
to receive a document that lists the amount that has been paid on each claim
9.
Why is monitoring claim status necessary?
to reduce duplication of claims
to reduce claim processing cost
to ensure prompt payment of claims
10.
According to the Institute of Medicine, which of the following core functions should be included in an EHR?
decision support
order management
population reporting and management
11.
According to the Institute of Medicine, which of the following core functions should not necessarily be included in an EHR?
health information and data elements
procedure coding management
patient support
administrative support
12.
A major component of EHR order management is
electronic prescribing.
electronic transmission.
EHR results reporting.
EHR decision support.
13.
Which of the following is a method of patient support commonly offered by electronic health records (EHRs)?
access to appropriate educational materials on health topics
ability to report on home monitoring and testing to their physician
instructions for preparing for common medical tests
14.
A communication tool that provides the patient with relevant and actionable information and instructions is the
patient portal.
after-visit summary.
post-visit instructions.
electronic health records.
15.
What information cannot be included when electronic health records are used to advance medical knowledge through research?
disease registries
immunization status
patient's identity
patient progress and outcomes
16.
Every time a patient is treated by a healthcare provider, a record is made of the encounter. This record is known as
documentation.
patient encounter.
medical history.
diagnosis.
17.
The ten-step process that results in timely payment for medical services is known as the
reimbursement cycle.
medical documentation and billing cycle.
medical coding and billing cycle.
cash flow cycle.
18.
You are preregistering a new patient. Which of the following pieces of information should you collect?
the patient's name
the patient's contact information
the patient's reason for the visit
19.
When are copayments routinely collected?
at check-in
during patient chart review
at checkout
at either check-in or checkout
20.
What is the movement of monies into or out of a business?
reimbursement
cash flow
revenue
financial transactions
21.
Which of the following are recurring expenses for most medical practices?
salaries
utilities
insurance
22.
What does the signature on the patient information form indicate?
The patient authorizes the release of information required to process an insurance claim.
The patient authorizes the health plan to send payments directly to the provider.
The patient accepts responsibility for payment of charges not paid by the health plan.
23.
The process of translating a description of a diagnosis or procedure into a standardized code is known as
posting.
processing.
coding.
None of these are correct.
24.
The patient information form contains
personal information.
employment information.
insurance data for an insurance claim form.
25.
You are checking in an existing patient who hasn't been to the office for some time. Which documents should you photocopy and/or scan and add to the patient's chart?
insurance identification card
debit or credit card
birth certificate
social security card
26.
What must be carefully documented for each patient visit for the physician to receive payment?
diagnoses
procedures
encounter notes
both diagnoses and procedures
27.
Which of the following refers to diagnostic codes?
ICD
CPT
HCPCS
EOB
28.
Which of the following refers to procedure codes?
HCFA
29.
A(n) ______ is a list of procedures and diagnoses for a patient's visit.
encounter form
remittance advice
patient information form
schedule of benefits
30.
The patient's primary complaint (the illness or condition that is the reason for the visit) is assigned a
procedure code.
complaint code.
diagnosis code.
medical code.
31.
Each procedure (service, treatment, or test) the physician performs is assigned a
32.
A(n) ______ is a listing of standard charges for procedures.
list of benefits
fee schedule
procedure list
33.
What information does a health plan need to pay a claim?
procedures the provider performed while the patient was in the office
the date of the office visit
the patient's diagnosis
34.
A company that receives electronic claims and forwards the claim to the payer is known as
a clearinghouse.
a superbill.
a processor.
a coding agency.
35.
What is a series of steps designed to determine whether a claim should be paid?
adjudication
claim processing
claim transmittal
compliance
36.
The remittance advice provides details about each patient transaction, including
the transactions included on the claim.
the amount paid.
explanation of why certain charges weren't paid.
37.
Each remittance advice is compared against the claim to check that
the codes on the payment transactions match those on the claim.
the payment listed for each procedure is as expected.
any unpaid charges are explained.
38.
When a medical practice receives an overpayment from a health plan, it
keeps the funds.
notifies the patient.
issues a refund.
files the payment in the PMP.
39.
What information is listed on a statement?
the amount paid by the health plan
the remaining balance owed by the patient
the diagnosis and procedure codes
the amount paid by the health plan and the remaining balance owed the by the patient
40.
Most medical practices
do not have a regular schedule for sending statements to patients.
have a regular schedule for sending statements to patients.
send statements to patients on the fifteenth of the month.
send statements to patients on the thirtieth of the month.
41.
Revenue cycle management refers to
documenting medical practice revenue.
managing the activities associated with a patient encounter to ensure the provider is paid.
filing collection notices.
filing insurance claims in a timely fashion.
42.
HIPAA was designed to
ensure the security and privacy of health information.
provide insurance coverage for providers.
increase hospital testing ability.
expand government programs.
43.
What is an electronic format that providers and health plans must use to send and receive healthcare transactions?
HIPAA Electronic Transaction and Code Sets
EDI
44.
Electronic data interchange involves sending information from
paper chart to computer.
fax machine to computer.
computer to computer.
recorder to computer.
45.
Most physician practices are required to use the HIPAA-standard electronic claim format called
X12-835 Claims Payment and Remittance Advice.
X12.278 Health Care Services Review.
X12-837 Health Care Claim.
X12.270/271 Health Care Eligibility Benefit Inquiry and Response.
46.
Finalized in 2013, this legislation made significant changes to the privacy, security, and enforcement provisions of the original HIPAA legislation.
HIPAA Omnibus Rule
Electronic data exchange (EDI)
Protected health information (PHI)
47.
Under the HIPAA Administrative Simplification legislation, each healthcare provider was assigned a unique identification number known as
NPI.
EDI.
NDC.
PHI.
48.
Information about a patient's health or payment for healthcare that can be used to identify the person is known as
patient health information.
professional health information.
personal health information.
protected health information.
49.
The HIPAA security standards comprise
physical safeguards.
administrative safeguards.
technical safeguards.
50.
The automated processes used to protect data and control access to data are
functional safeguards.
51.
Which term refers to the acquisition, access, use, or disclosure of unsecured PHI in a manner not permitted under the HIPAA Privacy Rule, thus compromising the security or privacy of the PHI?
break
crack
breach
leak
52.
Laura works at a large clinic where her duties mainly consist of scheduling appointments. Because she does not deal with any financial tasks, Laura does not have access to the billing data. This is an example of what type of security safeguard?
administrative
physical
technical
functional
53.
If a breach of unsecured health information affects more than 500 individuals, the HIPAA Breach Notification Rule requires covered entities and their business associates to notify
individuals.
the Secretary of Health and Human Services.
the media.
54.
This legislation is part of the American Recovery and Reinvestment Act of 2009 that provides financial incentives to physicians and hospitals to adopt EHRs and strengthens HIPAA privacy and security regulations.
ACA
HITECH
HIT
HIPAA
55.
The HIPAA Security Rule and the HIPAA Privacy Rule are enforced by the
Office of Civil Rights (OCR).
Federal Bureau of Investigation (FBI).
Centers for Medicare & Medicaid Services (CMS).
Occupational Safety and Health Administration (OSHA).
56.
An individual or entity that creates, receives, maintains, or transmits PHI on behalf of a covered entity and may also include subcontractors of an entity is known as a
clearinghouse.
patient.
provider.
business associate.
57.
A report that traces who has accessed electronic information, when information was accessed, and whether any information was changed is a(n)
clearinghouse summary.
business associate trace.
breech report.
audit trail.
58.
Laura, a new medical office receptionist, accidentally sent the patient's PHI to the wrong provider. Under HIPAA Privacy Rule, this is known as a(n)
incident.
audit.
breach.
negligence.
59.
An automated process used to protect data and control access to data is known as a(n)
technical safeguard.
administrative safeguard.
physical safeguard.
60.
Mechanisms that are required to protect electronic systems, equipment, and data from threats, environmental hazards, and unauthorized intrusion are known as
the audit trail.
61.
Administrative policies and procedures designed to protect electronic health information are known as
62.
A formal examination or review undertaken to determine whether a healthcare organization's staff members comply with regulations is known as a(n)
regulation review.
enforcement.
63.
Single payments to multiple providers involved in an episode of care, creating a sense of shared accountability among providers, are known as
shared payments.
one-time payments.
bundled payments.
network payments.
64.
______ is protected health information that is created, stored, transmitted, or received electronically.
PHI
EHR
PHR
ePHI
65.
An electronic document that lists patients, dates of service, charges, and the amount paid or denied by the insurance carrier is the
ERA.
EHR.
EOB.
EFT.
66.
A model of physician reimbursement in which payment is provided for specific, individual services provided to a patient is known as
pay-for-performance.
fee-for-service.
67.
Linda, a new patient, received a printed document that explains the medical office's use and disclosure of PHI. What is the name of this document?
HIPAA Privacy Rule Statement
Notice of Privacy Practices
Notice of Office Use and Disclosure
HIPAA Notice
68.
Dr. Klager encourages his patients to use a secure online website that allows them to communicate with their provider and access their health information at any time. This tool is known as
a patient portal.
personal health records.
Chapter 01 Introduction to Health Information Technology and Medical Billing Answer Key
Multiple Choice Questions
1.
The Health Information Technology for Economic and Clinical Health (HITECH) Act is intended to promote the use of EHRs in physician's practices and hospitals through the use of financial incentives.
ABHES: 7.c. Comply with federal, state, and local laws relating to exchange of information and describe elements of meaningful use and reports generatedAccessibility: Keyboard NavigationBloom's: RememberCAAHEP: X.C.1. Differentiate between scope of practice and standards of care for medical assistantsCAAHEP: X.C.4. Describe components of the Health Information Portability and Accountability Act (HIPAA)CAHIIM: I.C.1. Apply policies and procedures to ensure the accuracy and integrity of health dataCAHIIM: V.A.3. Adhere to the legal and regulatory requirements related to the health information managementDifficulty: 1 EasyEst Time: 0-1 minuteLearning Outcome: 01.01Topic: The Changing Healthcare Landscape
To be eligible for financial incentives, providers must do more than simply purchase EHRs; they must demonstrate meaningful use of electronic health records.
ABHES: 7.c. Comply with federal, state, and local laws relating to exchange of information and describe elements of meaningful use and reports generatedAccessibility: Keyboard NavigationBloom's: UnderstandCAAHEP: X.C.1. Differentiate between scope of practice and standards of care for medical assistantsCAAHEP: X.C.4. Describe components of the Health Information Portability and Accountability Act (HIPAA)CAHIIM: I.C.1. Apply policies and procedures to ensure the accuracy and integrity of health dataCAHIIM: V.A.3. Adhere to the legal and regulatory requirements related to the health information managementDifficulty: 2 MediumEst Time: 0-1 minuteLearning Outcome: 01.01Topic: The Changing Healthcare Landscape
Meaningful use is the utilization of certified EHR technology to improve quality, efficiency, and patient safety in the healthcare system.
ABHES: 7.b. Utilize Electronic Medical Records (EMR) and Practice Management SystemsAccessibility: Keyboard NavigationBloom's: UnderstandCAAHEP: X.C.1. Differentiate between scope of practice and standards of care for medical assistantsCAAHEP: X.C.4. Describe components of the Health Information Portability and Accountability Act (HIPAA)CAHIIM: I.C.1. Apply policies and procedures to ensure the accuracy and integrity of health dataCAHIIM: III.A.1. Utilize software in the completion of HIM processesCAHIIM: III.A.2. Explain policies and procedures of networks, including intranet and Internet to facilitate clinical and administrative applicationsCAHIIM: V.A.3. Adhere to the legal and regulatory requirements related to the health information managementDifficulty: 2 MediumEst Time: 0-1 minuteLearning Outcome: 01.01Topic: The Changing Healthcare Landscape
An accountable care organization is a network of doctors and hospitals that share responsibility for managing the quality and cost of care provided to a group of patients.
Health information technology (HIT) refers to the computer hardware, software, and networks that are used to record, store, and manage patient healthcare information.
ABHES: 7.b. Utilize Electronic Medical Records (EMR) and Practice Management SystemsAccessibility: Keyboard NavigationBloom's: RememberCAAHEP: X.C.4. Describe components of the Health Information Portability and Accountability Act (HIPAA)CAAHEP: X.P.2. Apply HIPAA rules in regard toCAHIIM: I.B.3. Identify a complete health record according to, organizational policies, external regulations, and standardsCAHIIM: III.A.1. Utilize software in the completion of HIM processesCAHIIM: III.A.2. Explain policies and procedures of networks, including intranet and Internet to facilitate clinical and administrative applicationsDifficulty: 1 EasyEst Time: 0-1 minuteLearning Outcome: 01.01Topic: The Changing Healthcare Landscape
A PMP is a software program that automates the administrative and financial tasks required to run a medical practice.
ABHES: 7.b. Utilize Electronic Medical Records (EMR) and Practice Management SystemsAccessibility: Keyboard NavigationBloom's: UnderstandCAAHEP: VI.C.6. Identify equipment and supplies needed for medical records in order toCAHIIM: III.A.1. Utilize software in the completion of HIM processesCAHIIM: III.B.1. Explain the process used in the selection and implementation of health information management systemsDifficulty: 2 MediumEst Time: 0-1 minuteLearning Outcome: 01.02Topic: Functions of Practice Management Programs
Most offices use a practice management program (PMP) to complete routine office tasks including verifying insurance eligibility and benefits, organizing patients and payer information, monitoring the status of claims, and recording payment from payers.
After a claim file has been transmitted to the health plan, the PMP is used to follow up on the claim and can send an electronic message if the claim has not been processed within the expected time frame. When the health plan has processed the claim, the PMP receives a document that lists the amount that has been paid on each claim as well as the reasons for nonpayment or partial payment.
ABHES: 7.b. Utilize Electronic Medical Records (EMR) and Practice Management SystemsABHES: 8.c.1. Differentiate between procedures of private, federal, and state payersAccessibility: Keyboard NavigationBloom's: ApplyCAAHEP: VIII.C.1. IdentifyCAHIIM: III.A.1. Utilize software in the completion of HIM processesCAHIIM: III.B.2. Utilize health information to support enterprise wide decision support for strategic planningDifficulty: 2 MediumEst Time: 0-1 minuteLearning Outcome: 01.02Topic: Functions of Practice Management Programs
Monitoring claims is necessary to ensure prompt payment of claims.
ABHES: 7.b. Utilize Electronic Medical Records (EMR) and Practice Management SystemsABHES: 8.c.1. Differentiate between procedures of private, federal, and state payersAccessibility: Keyboard NavigationBloom's: RememberCAAHEP: VIII.C.1. IdentifyCAHIIM: III.A.1. Utilize software in the completion of HIM processesCAHIIM: III.B.2. Utilize health information to support enterprise wide decision support for strategic planningDifficulty: 1 EasyEst Time: 0-1 minuteLearning Outcome: 01.02Topic: Functions of Practice Management Programs
The Institute of Medicine suggested that an EHR should include eight core functions: health information and data elements, results management, order management, decision support, patient support, electronic communication and connectivity, administrative support, and population reporting and management.
ABHES: 7.b. Utilize Electronic Medical Records (EMR) and Practice Management SystemsABHES: 7.c. Comply with federal, state, and local laws relating to exchange of information and describe elements of meaningful use and reports generatedAccessibility: Keyboard NavigationBloom's: RememberCAAHEP: VI.P.6. Utilize an EMRCAHIIM: II.B.1. Apply confidentiality, privacy and security measures and policies and procedures for internal and external use and exchange to protect electronic health informationCAHIIM: II.C.1. Apply policies and procedures surrounding issues of access and disclosure of protected health informationCAHIIM: III.A.1. Utilize software in the completion of HIM processesDifficulty: 1 EasyEst Time: 0-1 minuteLearning Outcome: 01.03Topic: Functions of Electronic Health Record Programs
A major component of order management is electronic prescribing—the use of computers and handheld devices to transmit prescriptions to pharmacies in digital format.
Electronic health records offer patients access to appropriate educational materials on health topics, instructions for preparing for common medical tests, and the ability to report to their physician on home monitoring and testing.
ABHES: 7.b. Utilize Electronic Medical Records (EMR) and Practice Management SystemsABHES: 7.c. Comply with federal, state, and local laws relating to exchange of information and describe elements of meaningful use and reports generatedAccessibility: Keyboard NavigationBloom's: UnderstandCAAHEP: VI.P.6. Utilize an EMRCAHIIM: II.B.1. Apply confidentiality, privacy and security measures and policies and procedures for internal and external use and exchange to protect electronic health informationCAHIIM: II.C.1. Apply policies and procedures surrounding issues of access and disclosure of protected health informationCAHIIM: III.A.1. Utilize software in the completion of HIM processesDifficulty: 2 MediumEst Time: 0-1 minuteLearning Outcome: 01.03Topic: Functions of Electronic Health Record Programs
Patients are given a printed after-visit summary before they leave the office. An after-visit summary (AVS) is a communication tool that provides the patient with relevant and actionable information and instructions.
Electronic health records also contain a wealth of information related to particular diseases and treatments. This information, as long as it does not include any patient's identity, can be used to advance medical knowledge through research.
ABHES: 7.b. Utilize Electronic Medical Records (EMR) and Practice Management SystemsAccessibility: Keyboard NavigationBloom's: UnderstandCAAHEP: VI.P.6. Utilize an EMRCAHIIM: II.B.1. Apply confidentiality, privacy and security measures and policies and procedures for internal and external use and exchange to protect electronic health informationCAHIIM: II.C.1. Apply policies and procedures surrounding issues of access and disclosure of protected health informationCAHIIM: III.A.1. Utilize software in the completion of HIM processesDifficulty: 2 MediumEst Time: 0-1 minuteLearning Outcome: 01.03Topic: Functions of Electronic Health Record Programs
Every time a patient is treated by a healthcare provider, a record, known as documentation, is made of the encounter.
ABHES: 7.b. Utilize Electronic Medical Records (EMR) and Practice Management SystemsABHES: 7.c. Comply with federal, state, and local laws relating to exchange of information and describe elements of meaningful use and reports generatedAccessibility: Keyboard NavigationBloom's: RememberCAAHEP: VI.C.4. Define types of information contained in the patient's medical recordCAAHEP: VI.C.5. Identify methods of organizing the patient's medical record based onCAHIIM: I.B.1. Analyze the documentation in the health record to ensure it supports the diagnosis and reflects the patient's progress, clinical findings, and discharge statusCAHIIM: I.B.2. Verify the documentation in the health record is timely, complete, and accurateCAHIIM: I.C.1. Apply policies and procedures to ensure the accuracy and integrity of health dataDifficulty: 1 EasyEst Time: 0-1 minuteLearning Outcome: 01.03Topic: Functions of Electronic Health Record Programs
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