Question

multiple select question

select all that apply

choose from the list all of the following that are true of preparing and transmitting claims.

most practices use the pmp to prepare claims.
a claim communicates information about the diagnoses, procedures, and charges to the payer.
claims communicate patients test results to the payers.
most practices send claims to the payer by mail.

Explanation:

Analyze the role of Practice Management Programs

Using the Practice Management Program knowledge point
Most medical practices utilize a Practice Management Program (PMP) to automate administrative tasks, including the preparation and generation of insurance claims.

Define the purpose of a healthcare claim

Using the Healthcare Claim knowledge point
A healthcare claim is a formal request sent to an insurance payer that communicates essential clinical and financial information, specifically the patient's diagnoses (represented by ICD codes), procedures performed (represented by CPT/HCPCS codes), and the associated charges.

Evaluate clinical data transmission

Claims do not communicate detailed clinical test results (such as lab values or imaging reports) to payers. Payers only require the diagnostic and procedural codes to determine medical necessity and payment.

Evaluate transmission methods

The vast majority of modern medical practices transmit claims electronically to payers or clearinghouses rather than sending them by physical mail, as electronic transmission is faster, more secure, and often mandated by regulations like HIPAA.

Answer:

• Most practices use the PMP to prepare claims. (Correct answer)
• A claim communicates information about the diagnoses, procedures, and charges to the payer. (Correct answer)
• Claims communicate patients' test results to the payers.
• Most practices send claims to the payer by mail.