Exam (elaborations)
CBCS EXAM 2024 Questions with Correct Answers
- Course
- Nursing
- Institution
- Alexandria State University
CBCS EXAM 2024 Questions with Correct Answers
[Show more]
Content preview
CBCS EXAM WITH 100%ACCURATE SOLUTIONS
Medical Billing & Coding as a Career - Precise Answer ✔✔*Claims
assistant professional or claims manager, *Coding Specialist, *
Collection Manager, *Electronic Claims Processor, *Insurance Billing
Specialist, * Insurance Coordinator, *Insurance Counselor, *Medical
Biller, *Medical & Financial Records Manager, * Billing & Coding
Specialist
What are Medical Ethics? - Precise Answer ✔✔Standards of conduct
based on moral principle. They are generally accepted as a guide for
behavior towards pt's, dr's, co-workers, the gov, and ins co's.
What does acting within ethical behavior boundaries mean? - Precise
Answer ✔✔carrying out one's responsibilities w/ integrity, dignity,
respect, honesty, competence, fairness, & trust.
Legal Aspects of of Medical Billing & Coding: - Precise Answer ✔✔...
Compliance regulations: - Precise Answer ✔✔Most billing-related cases
are based on HIPPA and False Claims Act
Health Insurance Portability & Accountability Act (HIPPA) - Precise
Answer ✔✔Enacted in 1996, created by the Health Care Fraud & Abuse
,Control Program-enacted to check for fraud and abuse in the
Medicare/Medicaid Programs and private payers
What are the 2 provisions of HIPPA? - Precise Answer ✔✔Title I:
Insurance Reform
Title II: Administrative Simplification
What is Title I of HIPPA? - Precise Answer ✔✔Insurance Reform-
primary purpose is to provide continuous ins coverage for worker &
their dependents when they change or lose jobs. Also *Limits the use of
preexisting conditions exclusions *Prohibits discrimination from past or
present poor health *Guarantees certain employees/indv the right to
purchase new health ins coverage after losing job *Allows renewal of
health ins cov regardless of an indv's health cond. that is covered under
the particular policy.
What is Title II of HIPPA? - Precise Answer ✔✔Administrative
Simplification-goal is to focus on the health care practice setting to
reduce administrative cost & burdens. Has 2 parts- 1) development and
implementation of standardized health-related financial & administrative
activities electronically 2) Implementation of privacy & security
procedures to prevent the misuse of health info by ensuring
confidentiality
What is the False Claims Act (FCA)? - Precise Answer ✔✔Federal law
that prohibits submitting a fraudulent claim or making a false statement
or representation in connection w/ a claim. Also protects & rewards
whistle-blowers.
,What is the National Correct Coding Initiative (NCCI)? - Precise
Answer ✔✔Developed by CMS to promote the national correct coding
methodologies & to control improper coding that lead to inappropriate
payment of Part B health ins claims.
How many edits does NCCI include? - Precise Answer ✔✔2: 1)Column
1/Column 2 (prev called Comprehensive/Component) Edits
2) Mutually Exclusive Edits
Column 1/Column 2 edits (NCCI) - Precise Answer ✔✔Identifies code
pairs that should not be billed together b/c 1 code (Column 1) includes
all the services described by another code (Column 2)
Mutually Exclusive Edits (NCCI) - Precise Answer ✔✔ID's code pairs
that, for clinical reasons, are unlikely to be performed on the same pt on
the same day
What are the possible consequences of inaccurate coding and incorrect
billing? - Precise Answer ✔✔*delayed processing & payment of claims
*reduced payments, denied claims *fine and/or imprisonment
*exclusion from payer's programs, loss of dr's license to practice med
Who has the task of investigate and prosecuting health care fraud &
abuse? - Precise Answer ✔✔The Office of Inspector General (OIG)
, Fraud - Precise Answer ✔✔knowingly & intentionally deceiving or
misrepresenting info that may result in unauthorized benefits. It is a
felony and can result in fines and/or prison.
Who audits claims? - Precise Answer ✔✔State & federal agencies as
well as private ins co's
What are common forms of fraud? - Precise Answer ✔✔billing for
services not furnished, unbundling, & misrepresenting diagnosis to
justify payment
Abuse - Precise Answer ✔✔incidences or practices, not usually
considered fraudulent, that are inconsistent w/ the accepted medical
business or fiscal practices in the industry.
What are examples of Abuse? - Precise Answer ✔✔submitting a claim
for services/procedures performed that is not medically necessary, and
excessive charges for services, equipment or supplies.
What is a method use to minimize danger, hazards, & liabilities
associated w/ abuse? - Precise Answer ✔✔Risk Management
Patient Confidentiality - Precise Answer ✔✔All pt's have right to
privacy & all info should remain privileged. Only discuss pt info when
necessary to do job. Obtain a signed consent form to release medical
info to ins co or other individual.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller academicexpert. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
75759 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now