Ch 16: Review Test Flashcards
The Role of Computers in Health Insurance
What are three specific areas of administrative simplification addressed by HIPAA?
- EDI
- Code sets
- Specific identifiers
What organization was created to reform health insurance and simplify the healthcare administration process?
HIPAA
The electronic transfer of information in a standard format between two entities is known as ____?
EDI
The numbers used in the administration of healthcare to distinguish individual providers, health plans, employers, and patients are called what?
Identifiers
To send claims electronically, the medical practice needs what?
- A computer
- A modem
- Code sets
If a medical practice chooses to submit claims electronically to an insurance carrier, it must go through a(n) ____?
Enrollment process
A business entity that receives claims from several medical facilities, consolidates these claims, and transmits them to various insurance carriers is called a ___?
Claims clearinghouse
The system wherein data representing money are moved electronically between accounts or organizations is called ____?
Electronic funds transfer (EFT)
An electronic file wherein patients’ health information is stored in a computer system is called ____?
Electronic medical record (EMR)
One of the most significant activities of the healthcare industry is ____?
Information management
One of the major disadvantages of EMRs is ____?
Cost
Submitting claims directly to an insurance carrier is referred to as ____?
Direct data entry (DDE)
If the practice submits claims primarily to one carrier, it may be advisable to use ____?
DDE (direct data entry)
The ultimate goal in healthcare is to establish an EMR system that is ____?
Intercommunicative
What is the acronym for the organization enacted by congress to improve the administration of Medicare by taking advantage of the efficiencies gained through electronic claim submission?
ASCA
