CBCS BILLING AND CODING EXAM 400+QUESTIONS AND CORRECT DETAILED
ANSWERS|ALREADY GRADED A+
Medical Billing & Coding as a Career - CORRECT ANSWER✔✔*Claims assistant
professional or claims manager, *Coding Specialist, * Collection Manager, *Electronic
Claims Processor, *Insurance Billing Specialist, * Insurance Coordinator, *Insurance
Counselor, *Medical Biller, *Medical & Financial Records Manager, * Billing & Coding
Specialist
What are Medical Ethics? - CORRECT ANSWER✔✔Standards of conduct based on
moral principle. They are generally accepted as a guide for behavior towards pt's, dr's,
co-workers, the gov, and ins co's.
What does acting within ethical behavior boundaries mean? - CORRECT ANSWER✔✔
carrying out one's responsibilities w/ integrity, dignity, respect, honesty, competence,
fairness, & trust.
Legal Aspects of of Medical Billing & Coding: - CORRECT ANSWER✔✔...
Compliance regulations: - CORRECT ANSWER✔✔Most billing-related cases are
based on HIPPA and False Claims Act
Health Insurance Portability & Accountability Act (HIPPA) - CORRECT ANSWER✔✔
Enacted in 1996, created by the Health Care Fraud & Abuse Control Program-enacted
to check for fraud and abuse in the Medicare/Medicaid Programs and private payers
What are the 2 provisions of HIPPA? - CORRECT ANSWER✔✔Title I: Insurance
Reform
Title II: Administrative Simplification
What is Title I of HIPPA? - CORRECT ANSWER✔✔Insurance Reform-primary
purpose is to provide continuous ins coverage for worker & their dependents when they
change or lose jobs. Also *Limits the use of preexisting conditions exclusions *Prohibits
discrimination from past or present poor health *Guarantees certain employees/indv the
right to purchase new health ins coverage after losing job *Allows renewal of health ins
cov regardless of an indv's health cond. that is covered under the particular policy.
What is Title II of HIPPA? - CORRECT ANSWER✔✔Administrative Simplification-goal
is to focus on the health care practice setting to reduce administrative cost & burdens.
Has 2 parts- 1) development and implementation of standardized health-related
,financial & administrative activities electronically 2) Implementation of privacy & security
procedures to prevent the misuse of health info by ensuring confidentiality
What is the False Claims Act (FCA)? - CORRECT ANSWER✔✔Federal law that
prohibits submitting a fraudulent claim or making a false statement or representation in
connection w/ a claim. Also protects & rewards whistle-blowers.
What is the National Correct Coding Initiative (NCCI)? - CORRECT ANSWER✔✔
Developed by CMS to promote the national correct coding methodologies & to control
improper coding that lead to inappropriate payment of Part B health ins claims.
How many edits does NCCI include? - CORRECT ANSWER✔✔2: 1)Column 1/Column
2 (prev called Comprehensive/Component) Edits
2) Mutually Exclusive Edits
Column 1/Column 2 edits (NCCI) - CORRECT ANSWER✔✔Identifies code pairs that
should not be billed together b/c 1 code (Column 1) includes all the services described
by another code (Column 2)
Mutually Exclusive Edits (NCCI) - CORRECT ANSWER✔✔ID's code pairs that, for
clinical reasons, are unlikely to be performed on the same pt on the same day
What are the possible consequences of inaccurate coding and incorrect billing? -
CORRECT ANSWER✔✔*delayed processing & payment of claims *reduced
payments, denied claims *fine and/or imprisonment *exclusion from payer's programs,
loss of dr's license to practice med
Who has the task of investigate and prosecuting health care fraud & abuse? -
CORRECT ANSWER✔✔The Office of Inspector General (OIG)
Fraud - CORRECT ANSWER✔✔knowingly & intentionally deceiving or
misrepresenting info that may result in unauthorized benefits. It is a felony and can
result in fines and/or prison.
Who audits claims? - CORRECT ANSWER✔✔State & federal agencies as well as
private ins co's
What are common forms of fraud? - CORRECT ANSWER✔✔billing for services not
furnished, unbundling, & misrepresenting diagnosis to justify payment
Abuse - CORRECT ANSWER✔✔incidences or practices, not usually considered
fraudulent, that are inconsistent w/ the accepted medical business or fiscal practices in
the industry.
,What are examples of Abuse? - CORRECT ANSWER✔✔submitting a claim for
services/procedures performed that is not medically necessary, and excessive charges
for services, equipment or supplies.
What is a method use to minimize danger, hazards, & liabilities associated w/ abuse? -
CORRECT ANSWER✔✔Risk Management
Patient Confidentiality - CORRECT ANSWER✔✔All pt's have right to privacy & all info
should remain privileged. Only discuss pt info when necessary to do job. Obtain a
signed consent form to release medical info to ins co or other individual.
When may providers use PHI (Protected Health Information) w/o specific authorization
under the HIPPA Privacy Rule? - CORRECT ANSWER✔✔When using for TPO,
Treatment (primarily for the purpose of discussion of pt's case w/ other dr's) Payment
(providers submit claims on behalf of pt's) & Operations (for purposes such as training
staff & quality improvement)
What is Employer Liability? - CORRECT ANSWER✔✔Means physicians are legally
responsible for their own conduct and any actions of their employees (designee)
performed w/in the context of their employment. Referred to as "vicarious liability. A.K.A
"respondent superior"-"let the master answer". Means employee can be sued & brought
to trial
What is Employee Liability? - CORRECT ANSWER✔✔"Errors & Omissions
Insurance"-protection against loss of monies caused by failure through error or
unintentional omission on the part of the indv or service submitting the claim. ****Some
dr's contract w/ a billing service (clearinghouse) to handle claims submission, & some
agreements contain a clause stating that the dr will hold the co harmless from "liability
resulting from claims submitted by the service for any account", means dr is responsible
for mistakes made by billing service, errors & omissions is not needed in the instance.
******However, if dr ever asks the ins biller to do the least bit questionable, such as write
of pt's balances for certain pt's automatically, make sure you have a legal document or
signed waiver of liability relieving you of responsibility for such actions.
What is a Medical Record & what is it comprised of? - CORRECT ANSWER✔✔
documentation of the pt's social & medical history, family history, physical exam
findings, progress notes, radiology & lab results, consultation reports and
correspondence to pt- Is the foremost tool of clinical care and communication.
What is a medical report? - CORRECT ANSWER✔✔part of the medical record & is a
permanent legal document that formally states the consequences of the pt's exam or
treatment in letter or report form. IT IS THIS RECORD THAT PROVIDES INFO
NEEDED TO COMPLETE THE INS CLAIM FORM.
, Reasons for Documentation - CORRECT ANSWER✔✔Important that every pt seen by
dr has comprehensive legible documentation about pt's illness, treatment, & plans for
following reasons:
*Avoidance of denied or delayed payment by ins co investigating the medical necessity
of services
*Enforcement of medical record-keeping rules by ins co requiring accurate
documentation that supports procedure & diagnosis codes.
*Subpoena of medical records by state investigators or the court for review
*Defense of professional liability claim
Retention Of Medical Records - CORRECT ANSWER✔✔Is governed by state & local
laws & may vary from state-to-state. Most dr are required to retain records indefinitely,
deceased pt records should be kept for @ least 5 years
Med Term - CORRECT ANSWER✔✔...
Diagnosis suffixes: - CORRECT ANSWER✔✔...
-algia - CORRECT ANSWER✔✔pain
-emia - CORRECT ANSWER✔✔blood condition
-itis - CORRECT ANSWER✔✔inflammation
-megaly - CORRECT ANSWER✔✔enlargement
-meter - CORRECT ANSWER✔✔measure
-oma - CORRECT ANSWER✔✔tumor, mass
-osis - CORRECT ANSWER✔✔abnormal condition
-pathy - CORRECT ANSWER✔✔disease condition
-rrhagia - CORRECT ANSWER✔✔bursting forth of blood
-rrhea - CORRECT ANSWER✔✔discharge, flow
-sclerosis - CORRECT ANSWER✔✔hardening
-scopy - CORRECT ANSWER✔✔to view
Procedural Suffixes: - CORRECT ANSWER✔✔...
ANSWERS|ALREADY GRADED A+
Medical Billing & Coding as a Career - CORRECT ANSWER✔✔*Claims assistant
professional or claims manager, *Coding Specialist, * Collection Manager, *Electronic
Claims Processor, *Insurance Billing Specialist, * Insurance Coordinator, *Insurance
Counselor, *Medical Biller, *Medical & Financial Records Manager, * Billing & Coding
Specialist
What are Medical Ethics? - CORRECT ANSWER✔✔Standards of conduct based on
moral principle. They are generally accepted as a guide for behavior towards pt's, dr's,
co-workers, the gov, and ins co's.
What does acting within ethical behavior boundaries mean? - CORRECT ANSWER✔✔
carrying out one's responsibilities w/ integrity, dignity, respect, honesty, competence,
fairness, & trust.
Legal Aspects of of Medical Billing & Coding: - CORRECT ANSWER✔✔...
Compliance regulations: - CORRECT ANSWER✔✔Most billing-related cases are
based on HIPPA and False Claims Act
Health Insurance Portability & Accountability Act (HIPPA) - CORRECT ANSWER✔✔
Enacted in 1996, created by the Health Care Fraud & Abuse Control Program-enacted
to check for fraud and abuse in the Medicare/Medicaid Programs and private payers
What are the 2 provisions of HIPPA? - CORRECT ANSWER✔✔Title I: Insurance
Reform
Title II: Administrative Simplification
What is Title I of HIPPA? - CORRECT ANSWER✔✔Insurance Reform-primary
purpose is to provide continuous ins coverage for worker & their dependents when they
change or lose jobs. Also *Limits the use of preexisting conditions exclusions *Prohibits
discrimination from past or present poor health *Guarantees certain employees/indv the
right to purchase new health ins coverage after losing job *Allows renewal of health ins
cov regardless of an indv's health cond. that is covered under the particular policy.
What is Title II of HIPPA? - CORRECT ANSWER✔✔Administrative Simplification-goal
is to focus on the health care practice setting to reduce administrative cost & burdens.
Has 2 parts- 1) development and implementation of standardized health-related
,financial & administrative activities electronically 2) Implementation of privacy & security
procedures to prevent the misuse of health info by ensuring confidentiality
What is the False Claims Act (FCA)? - CORRECT ANSWER✔✔Federal law that
prohibits submitting a fraudulent claim or making a false statement or representation in
connection w/ a claim. Also protects & rewards whistle-blowers.
What is the National Correct Coding Initiative (NCCI)? - CORRECT ANSWER✔✔
Developed by CMS to promote the national correct coding methodologies & to control
improper coding that lead to inappropriate payment of Part B health ins claims.
How many edits does NCCI include? - CORRECT ANSWER✔✔2: 1)Column 1/Column
2 (prev called Comprehensive/Component) Edits
2) Mutually Exclusive Edits
Column 1/Column 2 edits (NCCI) - CORRECT ANSWER✔✔Identifies code pairs that
should not be billed together b/c 1 code (Column 1) includes all the services described
by another code (Column 2)
Mutually Exclusive Edits (NCCI) - CORRECT ANSWER✔✔ID's code pairs that, for
clinical reasons, are unlikely to be performed on the same pt on the same day
What are the possible consequences of inaccurate coding and incorrect billing? -
CORRECT ANSWER✔✔*delayed processing & payment of claims *reduced
payments, denied claims *fine and/or imprisonment *exclusion from payer's programs,
loss of dr's license to practice med
Who has the task of investigate and prosecuting health care fraud & abuse? -
CORRECT ANSWER✔✔The Office of Inspector General (OIG)
Fraud - CORRECT ANSWER✔✔knowingly & intentionally deceiving or
misrepresenting info that may result in unauthorized benefits. It is a felony and can
result in fines and/or prison.
Who audits claims? - CORRECT ANSWER✔✔State & federal agencies as well as
private ins co's
What are common forms of fraud? - CORRECT ANSWER✔✔billing for services not
furnished, unbundling, & misrepresenting diagnosis to justify payment
Abuse - CORRECT ANSWER✔✔incidences or practices, not usually considered
fraudulent, that are inconsistent w/ the accepted medical business or fiscal practices in
the industry.
,What are examples of Abuse? - CORRECT ANSWER✔✔submitting a claim for
services/procedures performed that is not medically necessary, and excessive charges
for services, equipment or supplies.
What is a method use to minimize danger, hazards, & liabilities associated w/ abuse? -
CORRECT ANSWER✔✔Risk Management
Patient Confidentiality - CORRECT ANSWER✔✔All pt's have right to privacy & all info
should remain privileged. Only discuss pt info when necessary to do job. Obtain a
signed consent form to release medical info to ins co or other individual.
When may providers use PHI (Protected Health Information) w/o specific authorization
under the HIPPA Privacy Rule? - CORRECT ANSWER✔✔When using for TPO,
Treatment (primarily for the purpose of discussion of pt's case w/ other dr's) Payment
(providers submit claims on behalf of pt's) & Operations (for purposes such as training
staff & quality improvement)
What is Employer Liability? - CORRECT ANSWER✔✔Means physicians are legally
responsible for their own conduct and any actions of their employees (designee)
performed w/in the context of their employment. Referred to as "vicarious liability. A.K.A
"respondent superior"-"let the master answer". Means employee can be sued & brought
to trial
What is Employee Liability? - CORRECT ANSWER✔✔"Errors & Omissions
Insurance"-protection against loss of monies caused by failure through error or
unintentional omission on the part of the indv or service submitting the claim. ****Some
dr's contract w/ a billing service (clearinghouse) to handle claims submission, & some
agreements contain a clause stating that the dr will hold the co harmless from "liability
resulting from claims submitted by the service for any account", means dr is responsible
for mistakes made by billing service, errors & omissions is not needed in the instance.
******However, if dr ever asks the ins biller to do the least bit questionable, such as write
of pt's balances for certain pt's automatically, make sure you have a legal document or
signed waiver of liability relieving you of responsibility for such actions.
What is a Medical Record & what is it comprised of? - CORRECT ANSWER✔✔
documentation of the pt's social & medical history, family history, physical exam
findings, progress notes, radiology & lab results, consultation reports and
correspondence to pt- Is the foremost tool of clinical care and communication.
What is a medical report? - CORRECT ANSWER✔✔part of the medical record & is a
permanent legal document that formally states the consequences of the pt's exam or
treatment in letter or report form. IT IS THIS RECORD THAT PROVIDES INFO
NEEDED TO COMPLETE THE INS CLAIM FORM.
, Reasons for Documentation - CORRECT ANSWER✔✔Important that every pt seen by
dr has comprehensive legible documentation about pt's illness, treatment, & plans for
following reasons:
*Avoidance of denied or delayed payment by ins co investigating the medical necessity
of services
*Enforcement of medical record-keeping rules by ins co requiring accurate
documentation that supports procedure & diagnosis codes.
*Subpoena of medical records by state investigators or the court for review
*Defense of professional liability claim
Retention Of Medical Records - CORRECT ANSWER✔✔Is governed by state & local
laws & may vary from state-to-state. Most dr are required to retain records indefinitely,
deceased pt records should be kept for @ least 5 years
Med Term - CORRECT ANSWER✔✔...
Diagnosis suffixes: - CORRECT ANSWER✔✔...
-algia - CORRECT ANSWER✔✔pain
-emia - CORRECT ANSWER✔✔blood condition
-itis - CORRECT ANSWER✔✔inflammation
-megaly - CORRECT ANSWER✔✔enlargement
-meter - CORRECT ANSWER✔✔measure
-oma - CORRECT ANSWER✔✔tumor, mass
-osis - CORRECT ANSWER✔✔abnormal condition
-pathy - CORRECT ANSWER✔✔disease condition
-rrhagia - CORRECT ANSWER✔✔bursting forth of blood
-rrhea - CORRECT ANSWER✔✔discharge, flow
-sclerosis - CORRECT ANSWER✔✔hardening
-scopy - CORRECT ANSWER✔✔to view
Procedural Suffixes: - CORRECT ANSWER✔✔...
