CBCS EXAM STUDY GUIDE QUESTIONS AND CORRECT VERIFIED ANSWERS

CBCS EXAM STUDY GUIDE QUESTIONS
AND CORRECT VERIFIED ANSWERS
MedicalA2BillingA2&A2CodingA2asA2aA2CareerA2-A2Ans--
*ClaimsA2assistantA2professionalA2orA2claimsA2manager,A2*CodingA2Specialist,A2*A2Collecti
onA2Manager,A2*ElectronicA2ClaimsA2Processor,A2*InsuranceA2BillingA2Specialist,A2*A2Insur
anceA2Coordinator,A2*InsuranceA2Counselor,A2*MedicalA2Biller,A2*MedicalA2&A2FinancialA2
RecordsA2Manager,A2*A2BillingA2&A2CodingA2Specialist

WhatA2areA2MedicalA2Ethics?A2-A2Ans--
StandardsA2ofA2conductA2basedA2onA2moralA2principle.A2TheyA2areA2generallyA2acceptedA2
asA2aA2guideA2forA2behaviorA2towardsA2pt's,A2dr's,A2co-workers,A2theA2gov,A2andA2insA2co's.

WhatA2doesA2actingA2withinA2ethicalA2behaviorA2boundariesA2mean?A2-A2Ans--
carryingA2outA2one'sA2responsibilitiesA2w/
A2integrity,A2dignity,A2respect,A2honesty,A2competence,A2fairness,A2&A2trust.


LegalA2AspectsA2ofA2ofA2MedicalA2BillingA2&A2Coding:A2-A2Ans--...

ComplianceA2regulations:A2-A2Ans--MostA2billing-
relatedA2casesA2areA2basedA2onA2HIPPAA2andA2FalseA2ClaimsA2Act

HealthA2InsuranceA2PortabilityA2&A2AccountabilityA2ActA2(HIPPA)A2-A2Ans--
EnactedA2inA21996,A2createdA2byA2theA2HealthA2CareA2FraudA2&A2AbuseA2ControlA2Progra
m-enactedA2toA2checkA2forA2fraudA2andA2abuseA2inA2theA2Medicare/
MedicaidA2ProgramsA2andA2privateA2payers

WhatA2areA2theA22A2provisionsA2ofA2HIPPA?A2-A2Ans--TitleA2I:A2InsuranceA2Reform
TitleA2II:A2AdministrativeA2Simplification

WhatA2isA2TitleA2IA2ofA2HIPPA?A2-A2Ans--InsuranceA2Reform-
primaryA2purposeA2isA2toA2provideA2continuousA2insA2coverageA2forA2workerA2&A2theirA2de
pendentsA2whenA2theyA2changeA2orA2loseA2jobs.A2AlsoA2*LimitsA2theA2useA2ofA2preexisting
A2conditionsA2exclusionsA2*ProhibitsA2discriminationA2fromA2pastA2orA2presentA2poorA2healt
hA2*GuaranteesA2certainA2employees/
indvA2theA2rightA2toA2purchaseA2newA2healthA2insA2coverageA2afterA2losingA2jobA2*AllowsA2r
enewalA2ofA2healthA2insA2covA2regardlessA2ofA2anA2indv'sA2healthA2cond.A2thatA2isA2covere
dA2underA2theA2particularA2policy.

WhatA2isA2TitleA2IIA2ofA2HIPPA?A2-A2Ans--AdministrativeA2Simplification-
goalA2isA2toA2focusA2onA2theA2healthA2careA2practiceA2settingA2toA2reduceA2administrativeA2
costA2&A2burdens.A2HasA22A2parts-
A21)A2developmentA2andA2implementationA2ofA2standardizedA2health-
relatedA2financialA2&A2administrativeA2activitiesA2electronicallyA22)A2ImplementationA2ofA2p

,rivacyA2&A2securityA2proceduresA2toA2preventA2theA2misuseA2ofA2healthA2infoA2byA2ensurin
gA2confidentiality

WhatA2isA2theA2FalseA2ClaimsA2ActA2(FCA)?A2-A2Ans--
FederalA2lawA2thatA2prohibitsA2submittingA2aA2fraudulentA2claimA2orA2makingA2aA2falseA2sta
tementA2orA2representationA2inA2connectionA2w/
A2aA2claim.A2AlsoA2protectsA2&A2rewardsA2whistle-blowers.


WhatA2isA2theA2NationalA2CorrectA2CodingA2InitiativeA2(NCCI)?A2-A2Ans--
DevelopedA2byA2CMSA2toA2promoteA2theA2nationalA2correctA2codingA2methodologiesA2&A2t
oA2controlA2improperA2codingA2thatA2leadA2toA2inappropriateA2paymentA2ofA2PartA2BA2healt
hA2insA2claims.

HowA2manyA2editsA2doesA2NCCIA2include?A2-A2Ans--2:A21)ColumnA21/
ColumnA22A2(prevA2calledA2Comprehensive/Component)A2Edits
2)A2MutuallyA2ExclusiveA2Edits

ColumnA21/ColumnA22A2editsA2(NCCI)A2-A2Ans--
IdentifiesA2codeA2pairsA2thatA2shouldA2notA2beA2billedA2togetherA2b/
cA21A2codeA2(ColumnA21)A2includesA2allA2theA2servicesA2describedA2byA2anotherA2codeA2(C
olumnA22)

MutuallyA2ExclusiveA2EditsA2(NCCI)A2-A2Ans--
ID'sA2codeA2pairsA2that,A2forA2clinicalA2reasons,A2areA2unlikelyA2toA2beA2performedA2onA2th
eA2sameA2ptA2onA2theA2sameA2day

WhatA2areA2theA2possibleA2consequencesA2ofA2inaccurateA2codingA2andA2incorrectA2billing
?A2-A2Ans--
*delayedA2processingA2&A2paymentA2ofA2claimsA2*reducedA2payments,A2deniedA2claimsA2*
fineA2and/
orA2imprisonmentA2*exclusionA2fromA2payer'sA2programs,A2lossA2ofA2dr'sA2licenseA2toA2pra
cticeA2med

WhoA2hasA2theA2taskA2ofA2investigateA2andA2prosecutingA2healthA2careA2fraudA2&A2abuse?
A2-A2Ans--TheA2OfficeA2ofA2InspectorA2GeneralA2(OIG)


FraudA2-A2Ans--
knowinglyA2&A2intentionallyA2deceivingA2orA2misrepresentingA2infoA2thatA2mayA2resultA2inA2
unauthorizedA2benefits.A2ItA2isA2aA2felonyA2andA2canA2resultA2inA2finesA2and/orA2prison.

WhoA2auditsA2claims?A2-A2Ans--
StateA2&A2federalA2agenciesA2asA2wellA2asA2privateA2insA2co's

WhatA2areA2commonA2formsA2ofA2fraud?A2-A2Ans--
billingA2forA2servicesA2notA2furnished,A2unbundling,A2&A2misrepresentingA2diagnosisA2toA2j
ustifyA2payment

,AbuseA2-A2Ans--
incidencesA2orA2practices,A2notA2usuallyA2consideredA2fraudulent,A2thatA2areA2inconsistent
A2w/A2theA2acceptedA2medicalA2businessA2orA2fiscalA2practicesA2inA2theA2industry.


WhatA2areA2examplesA2ofA2Abuse?A2-A2Ans--submittingA2aA2claimA2forA2services/
proceduresA2performedA2thatA2isA2notA2medicallyA2necessary,A2andA2excessiveA2chargesA
2forA2services,A2equipmentA2orA2supplies.


WhatA2isA2aA2methodA2useA2toA2minimizeA2danger,A2hazards,A2&A2liabilitiesA2associatedA2
w/A2abuse?A2-A2Ans--RiskA2Management

PatientA2ConfidentialityA2-A2Ans--
AllA2pt'sA2haveA2rightA2toA2privacyA2&A2allA2infoA2shouldA2remainA2privileged.A2OnlyA2discus
sA2ptA2infoA2whenA2necessaryA2toA2doA2job.A2ObtainA2aA2signedA2consentA2formA2toA2releas
eA2medicalA2infoA2toA2insA2coA2orA2otherA2individual.

WhenA2mayA2providersA2useA2PHIA2(ProtectedA2HealthA2Information)A2w/
oA2specificA2authorizationA2underA2theA2HIPPAA2PrivacyA2Rule?A2-A2Ans--
WhenA2usingA2forA2TPO,A2TreatmentA2(primarilyA2forA2theA2purposeA2ofA2discussionA2ofA2p
t'sA2caseA2w/
A2otherA2dr's)A2PaymentA2(providersA2submitA2claimsA2onA2behalfA2ofA2pt's)A2&A2Operation
sA2(forA2purposesA2suchA2asA2trainingA2staffA2&A2qualityA2improvement)

WhatA2isA2EmployerA2Liability?A2-A2Ans--
MeansA2physiciansA2areA2legallyA2responsibleA2forA2theirA2ownA2conductA2andA2anyA2actio
nsA2ofA2theirA2employeesA2(designee)A2performedA2w/
inA2theA2contextA2ofA2theirA2employment.A2ReferredA2toA2asA2"vicariousA2liability.A2A.K.AA2"
respondentA2superior"-"letA2theA2masterA2answer".A2MeansA2employeeA2canA2beA2suedA2
&A2broughtA2toA2trial

WhatA2isA2EmployeeA2Liability?A2-A2Ans--"ErrorsA2&A2OmissionsA2Insurance"-
protectionA2againstA2lossA2ofA2moniesA2causedA2byA2failureA2throughA2errorA2orA2unintenti
onalA2omissionA2onA2theA2partA2ofA2theA2indvA2orA2serviceA2submittingA2theA2claim.A2****So
meA2dr'sA2contractA2w/
A2aA2billingA2serviceA2(clearinghouse)A2toA2handleA2claimsA2submission,A2&A2someA2agree
mentsA2containA2aA2clauseA2statingA2thatA2theA2drA2willA2holdA2theA2coA2harmlessA2fromA2"li
abilityA2resultingA2fromA2claimsA2submittedA2byA2theA2serviceA2forA2anyA2account",A2means
A2drA2isA2responsibleA2forA2mistakesA2madeA2byA2billingA2service,A2errorsA2&A2omissionsA2i
sA2notA2neededA2inA2theA2instance.A2******However,A2ifA2drA2everA2asksA2theA2insA2billerA2to
A2doA2theA2leastA2bitA2questionable,A2suchA2asA2writeA2ofA2pt'sA2balancesA2forA2certainA2pt's
A2automatically,A2makeA2sureA2youA2haveA2aA2legalA2documentA2orA2signedA2waiverA2ofA2li
abilityA2relievingA2youA2ofA2responsibilityA2forA2suchA2actions.

WhatA2isA2aA2MedicalA2RecordA2&A2whatA2isA2itA2comprisedA2of?A2-A2Ans--
documentationA2ofA2theA2pt'sA2socialA2&A2medicalA2history,A2familyA2history,A2physicalA2ex

, amA2findings,A2progressA2notes,A2radiologyA2&A2labA2results,A2consultationA2reportsA2andA2
correspondenceA2toA2pt-
A2IsA2theA2foremostA2toolA2ofA2clinicalA2careA2andA2communication.


WhatA2isA2aA2medicalA2report?A2-A2Ans--
partA2ofA2theA2medicalA2recordA2&A2isA2aA2permanentA2legalA2documentA2thatA2formallyA2st
atesA2theA2consequencesA2ofA2theA2pt'sA2examA2orA2treatmentA2inA2letterA2orA2reportA2form
.A2ITA2ISA2THISA2RECORDA2THATA2PROVIDESA2INFOA2NEEDEDA2TOA2COMPLETEA2T
HEA2INSA2CLAIMA2FORM.

ReasonsA2forA2DocumentationA2-A2Ans--
ImportantA2thatA2everyA2ptA2seenA2byA2drA2hasA2comprehensiveA2legibleA2documentationA2
aboutA2pt'sA2illness,A2treatment,A2&A2plansA2forA2followingA2reasons:
*AvoidanceA2ofA2deniedA2orA2delayedA2paymentA2byA2insA2coA2investigatingA2theA2medical
A2necessityA2ofA2services
*EnforcementA2ofA2medicalA2record-
keepingA2rulesA2byA2insA2coA2requiringA2accurateA2documentationA2thatA2supportsA2proce
dureA2&A2diagnosisA2codes.
*SubpoenaA2ofA2medicalA2recordsA2byA2stateA2investigatorsA2orA2theA2courtA2forA2review
*DefenseA2ofA2professionalA2liabilityA2claim

RetentionA2OfA2MedicalA2RecordsA2-A2Ans--
IsA2governedA2byA2stateA2&A2localA2lawsA2&A2mayA2varyA2fromA2state-to-
state.A2MostA2drA2areA2requiredA2toA2retainA2recordsA2indefinitely,A2deceasedA2ptA2records
A2shouldA2beA2keptA2forA2@A2leastA25A2years


MedA2TermA2-A2Ans--...

DiagnosisA2suffixes:A2-A2Ans--...

-algiaA2-A2Ans--pain

-emiaA2-A2Ans--bloodA2condition

-itisA2-A2Ans--inflammation

-megalyA2-A2Ans--enlargement

-meterA2-A2Ans--measure

-omaA2-A2Ans--tumor,A2mass

-osisA2-A2Ans--abnormalA2condition

-pathyA2-A2Ans--diseaseA2condition