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CERTIFIED BILLING & CODING SPECIALIST EXAM REVIEW QUESTIONS WITH VERIFIED ANSWERS.
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CERTIFIED BILLING & CODING SPECIALIST EXAM REVIEW QUESTIONS WITH VERIFIED ANSWERS.
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CERTIFIED BILLING & CODINGSPECIALIST EXAM REVIEW QUESTIONS
WITH VERIFIED ANSWERS
What ppare ppMedical ppEthics? pp- ppAnswer ppStandards ppof ppconduct ppbased ppon
ppmoral ppprinciple. ppthey ppare ppgenerally ppaccepted ppas ppa ppguide ppfor ppbehavior
pptowards pppt's, ppdr's, ppcoworkers, ppthe ppgov, ppand ppins ppco's
What ppdoes ppacting ppwithin ppethical ppbehavior ppboundaries ppmean? pp- ppAnswer
ppCarrying ppout ppone's ppresponsibilities ppwith ppintegrity, ppdignity, pprespect, pphonesty,
ppcompetence, ppfairness, ppand pptrust
Compliance ppregulations pp- ppAnswer ppMost ppbilling-related ppcases ppare ppbased ppon
ppHIPAA ppand ppFalse ppClaims ppAct
Health ppInsurance ppPortability pp& ppAccountability ppAct pp(HIPAA) pp- ppAnswer
ppEnacted ppin pp1996, ppcreated ppby ppthe ppHealth ppCare ppFraud pp& ppAbuse ppControl
ppProgram- ppenacted ppto ppcheck ppfor ppfraud ppand ppabuse ppin ppthe ppMedicare/
ppMedicaid ppPrograms ppand ppprivate pppayers
What ppare pp2 ppprovisions ppof ppHIPAA? pp- ppAnswer ppTitle pp1: ppInsurance ppReform
Title pp2: ppAdministrative ppSimplification
What ppis ppTitle pp1 ppof ppHIPAA? pp- ppAnswer ppInsurance ppReform-primary pppurpose
ppis ppto ppprovide ppcontinuous ppcoverage ppfor ppworkers pp& pptheir ppdependents ppwhen
ppthey ppchange ppor pplose ppjobs. ppAlso ppLimits ppthe ppuse ppof pppre-existing
ppconditions ppexclusions pp
Prohibits ppdiscrimination ppfrom pppast ppor pppresent pppoor pphealth pp
Guarantees ppcertain ppemployees/ ppindividual ppthe ppright ppto pppurchase ppnew pphealth
ppinsurance ppcoverage ppafter pplosing ppjob
Allows pprenewal ppof pphealth ppinsurance ppcoverage ppregardless ppof ppan ppindividuals
pphealth ppcondition ppthat ppis ppcovered ppunder ppthe ppparticular pppolicy
What ppis ppTitle pp2 ppof ppHIPAA? pp- ppAnswer ppAdministrative ppSimplification- ppgoal ppis
ppto ppfocus ppon ppthe pphealth ppcare pppractice ppsetting ppto ppreduce ppadministrative
ppcost pp& ppburdens. pp
Has pp2 ppparts
,1) ppdevelopment ppand ppimplementation ppof ppstandardized pphealth pprelated ppfinancial
pp& ppadministrative ppactivities ppelectronically
2) ppimplementation ppof ppprivacy pp& ppsecurity ppprocedures ppto ppprevent ppthe ppmisuse
ppof pphealth ppinfo ppby ppensuring ppconfidentiality
What ppis ppthe ppFalse ppClaims ppAct pp(FCA)? pp- ppAnswer ppFederal pplaw ppthat
ppprohibits ppsubmitting ppa ppfraudulent ppclaim ppor ppmaking ppa ppfalse ppstatement ppor
pprepresentation ppin ppconnection ppwith ppa ppclaim. ppAlso ppprotects pp& pprewards
ppwhistle-blowers
What ppis ppthe ppNational ppCorrect ppCoding ppInitiative pp(NCCI)? pp- ppAnswer
ppDeveloped ppby ppCMS ppto pppromote ppthe ppnational ppcorrect ppcoding
ppmethodologies pp& ppto ppcontrol ppimproper ppcoding ppthat pplead ppto ppinappropriate
pppayment ppof ppPart ppB pphealth ppinsurance ppclaims
How ppmany ppedits ppdoes ppNCCI ppinclude? pp- ppAnswer pp2: pp
1.Column pp1/ ppColumn pp2 pp(previously ppcalled ppComprehensive/ ppComponent)
ppEdits
pp2.Mutually ppExclusive ppEdits
Column pp1/ ppColumn pp2 ppedits pp(NCCI) pp- ppAnswer ppIdentifies ppcode pppairs ppthat
ppshould ppnot ppbe ppbilled pptogether ppbecause pp1 ppcode pp(Column pp1) ppincludes ppall
ppthe ppservices ppdescribed ppby ppanother ppcode pp(Column pp2)
Mutually ppExclusive ppEdits pp(NCCI) pp- ppAnswer ppID's ppcode pppairs ppthat, ppfor
ppclinical ppreasons, ppare ppunlikely ppto ppbe pppreformed ppon ppthe ppsame pppatient ppon
ppthe ppsame ppday
What ppare ppthe pppossible ppconsequences ppof ppinaccurate ppcoding ppand ppincorrect
ppbilling? pp- ppAnswer ppdelayed ppprocessing pp& pppayment ppof ppclaims, ppreduced
pppayments, ppdenied ppclaims ppfine ppand ppor ppimprisonment, ppexclusion ppfrom
pppayer's ppprograms, pploss ppof ppDr.'s pplicense ppto pppractice ppmedicine
Who pphas ppthe pptask ppof ppinvestigate ppand ppprosecuting pphealth ppcare ppfraud pp&
ppabuse? pp- ppAnswer ppThe ppOffice ppof ppInspector ppGeneral pp(OIG)
Fraud pp- ppAnswer ppknowingly pp& ppintentionally ppdeceiving ppor ppmisrepresenting ppinfo
ppthat ppmay ppresult ppin ppunauthorized ppbenefits. ppit ppis ppa ppfelony ppand ppcan ppresult
ppin ppfines ppand ppor ppprison
Who ppaudits ppclaims? pp- ppAnswer ppState pp& ppFederal ppagencies ppas ppwell ppas
ppprivate ppinsurance ppcompanies
What ppare ppcommon ppforms ppof ppfraud? pp- ppAnswer ppbilling ppfor ppservices ppnot
ppfurnished, ppunbundling, ppand ppmisrepresenting ppdiagnosis ppto ppjustify pppayment
,Abuse pp- ppAnswer ppincidences ppor pppractices, ppnot ppusually ppconsidered ppfraudulent,
ppthat ppare ppinconsistent ppwith ppthe ppaccepted ppmedical ppbusiness ppor ppfiscal
pppractices ppin ppthe ppindustry
What ppare ppexamples ppof ppAbuse? pp- ppAnswer ppsubmitting ppa ppclaim ppfor ppservices/
ppprocedures ppperformed ppthat ppis ppnot ppmedically ppnecessary, ppand ppexcessive
ppcharges ppfor ppservices, ppequipment ppor ppsupplies
What ppis ppa ppmethod ppuse ppto ppminimize ppdanger, pphazards ppand ppliabilities
ppassociated ppwith ppabuse? pp- ppAnswer ppRisk ppManagement
Patient ppConfidentiality pp- ppAnswer ppAll pppatient's pphave ppright ppto ppprivacy ppand ppall
ppinfo ppshould ppremain ppprivileged. ppOnly ppdiscuss pppatient ppinfo ppwhen ppnecessary
ppto ppdo ppjob. ppObtain ppa ppsigned ppconsent ppform ppto pprelease ppmedical ppinfo ppto
ppinsurance ppcompany ppor ppother ppindividual
When ppmay ppa ppprovider ppuse ppPHI pp(Protected ppHealth ppInformation) ppwithout
ppspecific ppauthorization ppunder ppthe ppHIPAA ppPrivacy ppRule? pp- ppAnswer ppWhen
ppusing ppTPO, ppTreatment pp(primarily ppfor ppthe pppurpose ppof ppdiscussion ppof
pppatient's ppcase ppwith ppother ppDr's) pp
Payment pp(providers ppsubmit ppclaims ppon ppbehalf ppof pppatients)
Operations pp(for pppurposes ppsuch ppas pptraining ppstaff ppand ppquality ppimprovement)
What ppis ppEmployer ppLiability? pp- ppAnswer ppMeans ppphysicians ppare pplegally
ppresponsible ppfor pptheir ppown ppconduct ppand ppany ppactions ppof pptheir ppemployees
pp(designee) ppperformed ppwithin ppthe ppcontext ppof pptheir ppemployment. ppReferred ppto
ppas pp"vicarious ppliability" ppA.K.A pp" pprespondent ppsuperior"- pp"let ppthe ppmaster
ppanswer". ppMeans ppemployee ppcan ppbe ppsued pp& ppbrought ppto pptrial
What ppis ppEmployee ppLiability? pp- ppAnswer pp"Errors pp& ppOmissions ppInsurance"-
ppprotection ppagainst pploss ppof ppmonies ppcaused ppby ppfailure ppthrough pperror ppor
ppunintentional ppomission ppon ppthe pppart ppof ppthe ppindividual ppor ppservice ppsubmitting
ppthe ppclaim. pp***Some ppDr.'s ppcontract ppwith ppa ppbilling ppservice pp(clearinghouse)
ppto pphandle ppclaims ppsubmission ppand ppsome ppagreements ppcontain ppa ppclause
ppstating ppthat ppthe ppDr. ppwill pphold ppthe ppco ppharmless ppfrom pp"liability ppresulting
ppfrom ppclaims ppsubmitted ppby ppthe ppservice ppfor ppany ppaccount", ppmeans ppDr. ppis
ppresponsible ppfor ppmistakes ppmade ppby ppbilling ppservice, pperrors ppand ppomissions
ppis ppnot ppneeded ppin ppthe ppinstance.***
However, ppif ppthe ppDr. ppever ppasks ppthe ppinsurance ppbiller ppto ppdo ppthe ppleast ppbit
ppquestionable, ppsuch ppas ppwrite ppoff pppatients ppbalances ppfor ppcertain pppatients
ppautomatically, ppmake ppsure ppyou pphave ppa pplegal ppdocument ppor ppsigned ppwaiver
ppof ppliability pprelieving ppyou ppof ppresponsibility ppfor ppsuch ppactions.
What ppis ppa ppMedical ppRecord pp& ppwhat ppis ppit ppcomprised ppof? pp- ppAnswer
ppDocumentation ppof ppthe pppatients ppsocial ppand ppmedical pphistory, ppfamily pphistory,
, ppphysical ppexam ppfindings, ppprogress ppnotes, ppradiology ppand pplab ppresults,
ppconsultation ppreports ppand ppcorrespondence ppto pppatients
Is ppthe ppforemost pptool ppof ppclinical ppcare ppand ppcommunication
What ppis ppa ppmedical ppreport? pp- ppAnswer pppart ppof ppthe ppmedical pprecord pp& ppis
ppa pppermanent pplegal ppdocument ppthat ppformally ppstates ppthe ppconsequences ppof
ppthe pppatients ppexam ppor pptreatment ppin ppletter ppor ppreport ppform
IT ppIS ppTHIS ppRECORD ppTHAT ppPROVIDES ppINFO ppNEEDED ppTO ppCOMPLETE
ppTHE ppINSURANCE ppCLAIM ppFORM
Reasons ppfor ppDocumentation pp- ppAnswer ppImportant ppthat ppevery pppatient ppseen
ppby ppDr. pphas ppcomprehensive pplegible ppdocumentation ppabout pppatients ppillness,
pptreatment ppand ppplans ppfor ppfollowing ppreasons:
* ppAvoidance ppof ppdenied ppor ppdelayed pppayment ppby ppinsurance ppcompany
ppinvestigating ppthe ppmedical ppnecessity ppof ppservice
* ppEnforcement ppof ppmedical pprecord-keeping pprules ppby ppinsurance ppcompany's
pprequiring ppaccurate ppdocumentation ppthat ppsupports ppprocedure pp& ppdiagnosis
ppcodes
* ppSubpoena ppof ppmedical pprecords ppby ppstate ppinvestigators ppor ppthe ppcourt ppfor
ppreview
* ppDefense ppof ppprofessional ppliability ppclaim
Retention ppof ppMedical ppRecords pp- ppAnswer ppIs ppgoverned ppby ppstate pp& pplocal
pplaws pp& ppmay ppvary ppfrom ppstate-to-state. ppMost ppDr. ppare pprequired ppto ppretain
pprecords ppindefinitely, ppdeceased pppatient pprecords ppshould ppbe ppkept ppfor ppat
ppleast pp5 ppyears
-algia pp- ppAnswer pppain
-emia pp- ppAnswer ppblood ppcondition
-itis pp- ppAnswer ppinflammation
-megaly pp- ppAnswer ppenlargement
-meter pp- ppAnswer ppmeasure
-oma pp- ppAnswer pptumor, ppmass
-osis pp- ppAnswer ppabnormal ppcondition
-pathy pp- ppAnswer ppdisease ppcondition
-rrhagia pp- ppAnswer ppbursting ppforth ppof ppblood
-rrhea pp- ppAnswer ppdischarge, ppflow
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