Exam (elaborations)
MEDICAL BILLING AND CODING CERTIFICATE EXAM QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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MEDICAL BILLING AND CODING CERTIFICATE EXAM QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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MEDICAL BILLING AND CODINGCERTIFICATE EXAM QUESTIONS AND
ANSWERS WITH SOLUTIONS 2024
Chief Complaint (element 1 of history) - ANSWER History of present illness,
Review symptom,
Past, Family, and Social history
History Levels (Element 2 of history) and Examination Levels (Element 3 of History) - ANSWER Problem
focused,
expanded problem focused,
detailed,
Comprehensive
Medical Decision Making Complexity Levels (element 4 of history) - ANSWER Straightforward,
Low,
Moderate,
High
straightforward - ANSWER Minimal diagnosis
Minimal risk
Minimal complexity of data
Low - ANSWER Limited diagnosis
Limited/low risk to patient
Limited data
Moderate - ANSWER Multiple diagnosis
Moderate risk to patient
Moderate amount and complexity of data
,high - ANSWER Extensive diagnosis
high risk to patient
extensive amount and complexity of data
truncated coding (error in coding) - ANSWER using diagnosis codes that are not as specific as possible
assumption coding (fraudulent coding) - ANSWER reporting items of services that are not actually
documented
errors of the coding process - ANSWER -altering documentation after services are reported
-coding without documentation
-reporting services provided by unlicensed or unqualified clinical personnel
-coding a unilateral service twice instead of choosing the bilateral
-not satisfying the condition of coverage for a particular service
-codes that report more than one diagnosis with one code is a combination code
Unbundling codes - ANSWER when multiple codes are used to code a procedure when a single code
should be used
Upcoding - ANSWER using a procedural code that provides a higher reimbursement rate than the correct
code
Downcoding - ANSWER the document does not justify the level of service
Most common billing errors - ANSWER Billing non-covered services
Billing over limit services
Upcoding
Downcoding
Billing without signatures
, Using outdated codes
External Audits
Internal Audits
Retrospective audits - ANSWER Types of Audits done to avoid billing and coding errors
External Audits - ANSWER a private payer or government investigator's review of selected records of a
practice for compliance
Internal Audits - ANSWER self-audit conducted by a staff member or consultant
Retrospective Audits - ANSWER conducted after the claim has been send the remittance advice has been
received
Adjustments - ANSWER amounts added to or taken away from the balance of an account
Two methods to determine rates to be paid to providers - ANSWER Charge; Resource
Charge - ANSWER based fees are established using the fees of providers providing similar services
resource - ANSWER -how difficult is it for the provider to do the procedure
-how much office overhead is involved
-the relative risk the procedure presents to the patient and the provider
Clearing Houses - ANSWER Edits and transmits batches of claims to insurance companies
Fee schedule - ANSWER Payment is predetermined according to a table of diagnoses and their eligible
fees
usual - ANSWER fee normally charged for a given service
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