Health Insurance Portability and Accountability Act (HIPPA) Practice Exam

What is the primary function of a health care clearinghouse?

1. Direct patient care

2. Intermediary to submit claims on behalf of a provider

3. Process medical records

4. Provide legal advice

The correct answer is: Intermediary to submit claims on behalf of a provider

The primary function of a health care clearinghouse is to serve as an intermediary that submits claims on behalf of a health care provider to insurance payers. Clearinghouses facilitate the processing of claims by ensuring that the submitted information meets the necessary standards and formats required by payers. This includes checking for errors, ensuring proper coding, and converting data between various formats, enabling smoother and faster reimbursement for healthcare services. While direct patient care is vital in healthcare, it does not fall within the purview of clearinghouses. Their role is to handle the administrative aspects of claims processing rather than engage with patients directly. Similarly, the processing of medical records and providing legal advice are responsibilities that typically belong to other professionals or entities within the healthcare system, rather than the clearinghouses themselves. Thus, the intermediary role that a clearinghouse plays in the claims submission process is essential for the efficient functioning of the healthcare payment ecosystem.