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Advanced Coding and Reimbursement
Final Exam Questions and Correct
Answers/ Latest Update / Already Graded
The statement "Coding professionals should only assign and report
codes that are clearly and consistently supported by physician
documentation in the health record." is an example of ____ Standards
for Ethical Coding.
Ans: AHIMA's
Part of the ______ legislation includes provisions and funds for the
federal government to investigate fraud and abuse in the Medicare
system.
Ans: COBRA - Consolidated Omnibus Reconciliation Act
In the past hospitals used the UB-04 billing form and physician offices
and clinics used the CMS 1500 billing form. Today, most claims are
submitted electronically using the version ____ electronic transaction
set.
Ans: 5010
When an employee brings a suit against the employer for alleged
fraudulent activities, it is called ____.
All rights reserved © 2025/ 2026 |
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Ans: Qui tam action
The official publication for ICD-9-CM coding advice published by AHA
is called ________.
Ans: Coding Clinic
Which of the following cooperating organizations maintains a central
office to answer ICD-9-CM coding questions?
Ans: American Hospital Association
Which of the following organizations play which role in maintaining or
updating ICD-9-CM?
Ans: NCHS recommends changes for the diagnosis side and
CMS recommends changes for the procedure side.
In the United States, what is healthcare insurance?
Ans: Reduction of a person's or a group's exposure to risk for
unknown healthcare costs by the assumption of that risk by
another entity
All rights reserved © 2025/ 2026 |
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The financial manager of the physician group practice explained that
the healthcare insurance company would be reimbursing the practice
for its treatment of the exacerbation of congestive heart failure that
Mrs. Zale experienced. The exacerbation, treatment, and resolution
covered approximately five weeks. This ONE payment covered all the
services that Mrs. Zale incurred during the period. What method of
reimbursement was the physician group practice receiving?
Ans: Episode-of-care
In the type of reimbursement methodology does the health insurance
company have the greatest degree of risk because they have to pay for
all charges incurred?
Ans: Retrospective fee-for-service
Which of the following represent a core area of what should be covered
in a coding compliance plan?
Ans: Policies, procedures, education, training, auditing and
monitoring
In the payment notice (remittance advice) received from Blue
Cross/Blue Shield, the healthcare facility noted that the payment for
the individual x-ray test is $109.00. The bill that the radiology
department submitted for the test was $155.00. What does the
amount of $109.00 represent?
All rights reserved © 2025/ 2026 |
Advanced Coding and Reimbursement
Final Exam Questions and Correct
Answers/ Latest Update / Already Graded
The statement "Coding professionals should only assign and report
codes that are clearly and consistently supported by physician
documentation in the health record." is an example of ____ Standards
for Ethical Coding.
Ans: AHIMA's
Part of the ______ legislation includes provisions and funds for the
federal government to investigate fraud and abuse in the Medicare
system.
Ans: COBRA - Consolidated Omnibus Reconciliation Act
In the past hospitals used the UB-04 billing form and physician offices
and clinics used the CMS 1500 billing form. Today, most claims are
submitted electronically using the version ____ electronic transaction
set.
Ans: 5010
When an employee brings a suit against the employer for alleged
fraudulent activities, it is called ____.
All rights reserved © 2025/ 2026 |
, Page |2
Ans: Qui tam action
The official publication for ICD-9-CM coding advice published by AHA
is called ________.
Ans: Coding Clinic
Which of the following cooperating organizations maintains a central
office to answer ICD-9-CM coding questions?
Ans: American Hospital Association
Which of the following organizations play which role in maintaining or
updating ICD-9-CM?
Ans: NCHS recommends changes for the diagnosis side and
CMS recommends changes for the procedure side.
In the United States, what is healthcare insurance?
Ans: Reduction of a person's or a group's exposure to risk for
unknown healthcare costs by the assumption of that risk by
another entity
All rights reserved © 2025/ 2026 |
, Page |3
The financial manager of the physician group practice explained that
the healthcare insurance company would be reimbursing the practice
for its treatment of the exacerbation of congestive heart failure that
Mrs. Zale experienced. The exacerbation, treatment, and resolution
covered approximately five weeks. This ONE payment covered all the
services that Mrs. Zale incurred during the period. What method of
reimbursement was the physician group practice receiving?
Ans: Episode-of-care
In the type of reimbursement methodology does the health insurance
company have the greatest degree of risk because they have to pay for
all charges incurred?
Ans: Retrospective fee-for-service
Which of the following represent a core area of what should be covered
in a coding compliance plan?
Ans: Policies, procedures, education, training, auditing and
monitoring
In the payment notice (remittance advice) received from Blue
Cross/Blue Shield, the healthcare facility noted that the payment for
the individual x-ray test is $109.00. The bill that the radiology
department submitted for the test was $155.00. What does the
amount of $109.00 represent?
All rights reserved © 2025/ 2026 |
