Medical Billing and Coding Certificate exam With Complete Solution 2023

Medical Billing and Coding Certificate exam Chief Complaint (element 1 of history) - History of present illness, Review symptom, Past, Family, and Social history History Levels (Element 2 of history) and Examination Levels (Element 3 of History) - Problem focused, expanded problem focused, detailed, Comprehensive Medical Decision Making Complexity Levels (element 4 of history) - Straightforward, Low, Moderate, High straightforward - Minimal diagnosis Minimal risk Minimal complexity of data Low - Limited diagnosis Limited/low risk to patient Limited data Moderate - Multiple diagnosis Moderate risk to patient Moderate amount and complexity of data high - Extensive diagnosis high risk to patient extensive amount and complexity of data truncated coding (error in coding) - using diagnosis codes that are not as specific as possible assumption coding (fraudulent coding) - reporting items of services that are not actually documented errors of the coding process - -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 - when multiple codes are used to code a procedure when a single code should be used Upcoding - using a procedural code that provides a higher reimbursement rate than the correct code Downcoding - the document does not justify the level of service Most common billing errors - Billing non-covered services Billing over limit services Upcoding Downcoding Billing without signatures Using outdated codes External Audits Internal Audits Retrospective audits - Types of Audits done to avoid billing and coding errors External Audits - a private payer or government investigator's review of selected records of a practice for compliance Internal Audits - self-audit conducted by a staff member or consultant Retrospective Audits - conducted after the claim has been send the remittance advice has been received Adjustments - amounts added to or taken away from the balance of an account Two methods to determine rates to be paid to providers - Charge; Resource Charge - based fees are established using the fees of providers providing similar services resource - -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 - Edits and transmits batches of claims to insurance companies Fee schedule - Payment is predetermined according to a table of diagnoses and their eligible fees usual - fee normally charged for a given service Customary fee - fee in the range of usual fees charged by physicians of similar training experience for the same service within the same specific and limited socioeconomic are resonable fee - fee that meets both usual or customary fees or is considered justifiable by responsible medical opinion considering special circumstances of the particular case in question