MODULE 11: DIPLOMA IN MEDICAL
CODING AND BILLING - ASSESSMENT 2
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
When a medical claim is denied, the medical biller will receive a code giving an explanation for the
denial. What is that code? - ANSWER CARC - claim adjustment reason code
Match the phrases to complete these statements about coding audits. - ANSWER Retrospective audits
occur after claim submission and reimbursement
Audits can identify payer reimbursement issues, software
Prospective audits identify errors before claims are
Abiding by a Code of Ethics requires medical coders and billers to use technology, data, and information
resources in the way they are intended. - ANSWER True
Accurate and detailed ___ is crucial for coding in ICD-10. - ANSWER documentation
Coding audits may include validation of present-on-admission assignment, reason for visit and HCPCS
use and modifiers. - ANSWER True
The Code of Ethics for coders and billers includes the intention to "Advocate, uphold, and defend the
consumer's right to __ and the doctrine of confidentiality in the use and disclosure of information. -
ANSWER privacy
Private health insurance plans often include a "deductible" which is the amount the patient must pay
before the policy is activated. - ANSWER True
Which of the following are commonly used reimbursement methodologies in healthcare? Select four
correct answers. - ANSWER Payment for Performance
Diagnosis Related Groups
Capitation
, Fee for Service
In filling out medical billing claims, a common error is failing to write a particular digit clearly. Which
number is it? - ANSWER 0
__ is run by individual states and provides healthcare for those on low incomes, and long-term
residential care - ANSWER Medicaid
How many years is the maximum prison sentence under the Health Care Fraud Statute? - ANSWER 10
The Hospital __ Reduction Program (HRRP) imposes a 3 percent reduction in payments from Medicare
for readmissions of patients following treatment for certain conditions. - ANSWER Readmissions
ICD has been translated into __ different languages. - ANSWER 43
Billing staff should familiarise themselves with __ based payments (VBP) for health care providers other
than hospitals. - ANSWER value
The International Classification of Diseases is used to track and report health data from around the
world. - ANSWER True
__ is recommended when filling out a claim form. - ANSWER Writing in capital letters
__ is defined as "making false statements or representations of material facts to get some help or
payment for which no entitlement would otherwise exist". - ANSWER Fraud
Sort these steps in the medical billing process into the order they should be performed. - ANSWER
Register the patient's information and health plan
Notify the patient whether their policy covers treatment
Record each diagnosis and procedure, together with its code
Submit a claim to the insurance company
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 Performance. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $12.99. You're not tied to anything after your purchase.
