MEDICAL CODING AND BILLING CERTIFICATION EXAM 2024/2025
Medical Billing and Coding Certificate exam
ACTUAL EXAM COMPLETE QUESTIONS WITH DETAILED VERIFIED
Study online at https://quizlet.com/_fl11v3
ANSWERS / ALREADY GRADED A+
1. Chief Complaint History of present illness,
(element 1 of his- Review symptom,
tory) Past, Family, and Social history
2. History Levels (El- Problem focused,
ement 2 of his- expanded problem focused,
tory) and Exami- detailed,
nation Levels (El- Comprehensive
ement 3 of Histo-
ry)
3. Medical Decision Straightforward,
Making Complex- Low,
ity Levels (ele- Moderate,
ment 4 of history) High
4. straightforward Minimal diagnosis
Minimal risk
Minimal complexity of data
5. Low Limited diagnosis
Limited/low risk to patient
Limited data
6. Moderate Multiple diagnosis
Moderate risk to patient
Moderate amount and complexity of data
7. high Extensive diagnosis
high risk to patient
extensive amount and complexity of data
8. using diagnosis codes that are not as specific as possible
, Medical Billing and Coding Certificate exam
Study online at https://quizlet.com/_fl11v3
truncated coding
(error in coding)
9. assumption cod- reporting items of services that are not actually documented
ing (fraudulent
coding)
10. errors of the cod- -altering documentation after services are reported
ing process -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
11. Unbundling when multiple codes are used to code a procedure when a single code should be
codes used
12. Upcoding using a procedural code that provides a higher reimbursement rate than the
correct code
13. Downcoding the document does not justify the level of service
14. Most common Billing non-covered services
billing errors Billing over limit services
Upcoding
Downcoding
Billing without signatures
Using outdated codes
15. External Audits Types of Audits done to avoid billing and coding errors
Internal Audits
Retrospective au-
dits
, Medical Billing and Coding Certificate exam
Study online at https://quizlet.com/_fl11v3
16. External Audits a private payer or government investigator's review of selected records of a
practice for compliance
17. Internal Audits self-audit conducted by a staff member or consultant
18. Retrospective conducted after the claim has been send the remittance advice has been received
Audits
19. Adjustments amounts added to or taken away from the balance of an account
20. Two methods to Charge; Resource
determine rates
to be paid to
providers
21. Charge based fees are established using the fees of providers providing similar services
22. 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
23. Clearing Houses Edits and transmits batches of claims to insurance companies
24. Fee schedule Payment is predetermined according to a table of diagnoses and their eligible
fees
25. usual fee normally charged for a given service
26. 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
27. 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
Medical Billing and Coding Certificate exam
ACTUAL EXAM COMPLETE QUESTIONS WITH DETAILED VERIFIED
Study online at https://quizlet.com/_fl11v3
ANSWERS / ALREADY GRADED A+
1. Chief Complaint History of present illness,
(element 1 of his- Review symptom,
tory) Past, Family, and Social history
2. History Levels (El- Problem focused,
ement 2 of his- expanded problem focused,
tory) and Exami- detailed,
nation Levels (El- Comprehensive
ement 3 of Histo-
ry)
3. Medical Decision Straightforward,
Making Complex- Low,
ity Levels (ele- Moderate,
ment 4 of history) High
4. straightforward Minimal diagnosis
Minimal risk
Minimal complexity of data
5. Low Limited diagnosis
Limited/low risk to patient
Limited data
6. Moderate Multiple diagnosis
Moderate risk to patient
Moderate amount and complexity of data
7. high Extensive diagnosis
high risk to patient
extensive amount and complexity of data
8. using diagnosis codes that are not as specific as possible
, Medical Billing and Coding Certificate exam
Study online at https://quizlet.com/_fl11v3
truncated coding
(error in coding)
9. assumption cod- reporting items of services that are not actually documented
ing (fraudulent
coding)
10. errors of the cod- -altering documentation after services are reported
ing process -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
11. Unbundling when multiple codes are used to code a procedure when a single code should be
codes used
12. Upcoding using a procedural code that provides a higher reimbursement rate than the
correct code
13. Downcoding the document does not justify the level of service
14. Most common Billing non-covered services
billing errors Billing over limit services
Upcoding
Downcoding
Billing without signatures
Using outdated codes
15. External Audits Types of Audits done to avoid billing and coding errors
Internal Audits
Retrospective au-
dits
, Medical Billing and Coding Certificate exam
Study online at https://quizlet.com/_fl11v3
16. External Audits a private payer or government investigator's review of selected records of a
practice for compliance
17. Internal Audits self-audit conducted by a staff member or consultant
18. Retrospective conducted after the claim has been send the remittance advice has been received
Audits
19. Adjustments amounts added to or taken away from the balance of an account
20. Two methods to Charge; Resource
determine rates
to be paid to
providers
21. Charge based fees are established using the fees of providers providing similar services
22. 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
23. Clearing Houses Edits and transmits batches of claims to insurance companies
24. Fee schedule Payment is predetermined according to a table of diagnoses and their eligible
fees
25. usual fee normally charged for a given service
26. 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
27. 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
