Medicare Blog

"any provider who submits claims to medicare is considered a covered entity"

by Macy Stroman Published 3 years ago Updated 1 year ago

Any provider who submits claims to Medicare is considered a covered entity. The American Medical Association (AMA) developed the standards for electronic data exchange. Encounter form's procedure and diagnostic codes should be audited annually to determine if code changes have been made and if the form needs to updated accordingly.

Any provider who submits claims to Medicare is considered a covered entity. CPT, ICD-10, and HCPCS codes are referred to as medical code sets and are standardized under HIPAA. Certain data elements are required when submitting a HIPAA standard transaction, whereas others are only necessary in specific situations.

Full Answer

Question

The exchange of data in a standardized format through computer systems is known as electronic data interchange

Question

A disadvantage of electronic claims submission is more time spent processing claims, which requires additional staffing.

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