Question

True/False Directions: Read the following sentences. If the statement is true, place a “T” in the blank preceding the number. If it is false, place an “F” in the blank and then rewrite the sentence in the space provided beneath so that it is true. The first one is done for you as an example.

1. Roster billing of Medicare-covered vaccinations for multiple beneficiaries must be submitted electronically.

2. If a claim requires an attachment to provide additional medical information to the claims processor, neither the claim nor the attachment can be submitted electronically; both must be mailed.

3. The insurance claim process begins when the health insurance professional submits the claim to the insurance processor.

4.The Centers for Medicare and Medicaid Services (CMS) initiated changes to promote uniformity in health care claim submission by adopting standards for electronic health information transactions.

Answer 1

1. False

Medicare-covered vaccines are exempt from the HIPAA electronic billing requirement. This exemption applies to providers without a MAC agreement to submit electronic mass immunization claims. When you submit roster bills, don’t list other covered services with the flu or pneumococcal shot and administration. If you have other services to bill, use normal claims filing procedures and forms.

2. True

3. False

Claims processing begins when a healthcare provider has submitted a claim request to the insurance company. Sometimes, claim requests are directly submitted by medical billers in the healthcare facility and sometimes, it is done through a clearing house.

4. False

Under HIPAA, HHS adopted certain standard transactions for the electronic exchange of health care data