1|Page
MEDICAL CODING AND BILLING CERTIFICATION EXAM STUDYGUIDE 2024
ACTUAL EXAM COMPLETE 200 QUESTIONS WITH DETAILED VERIFIED
ANSWERS (100% CORRECT ANSWERS) ALREADY GRADED A
truncated coding (error in coding) - CORRECT ANSWER
>>>>using diagnosis codes that are not as specific as
possible
assumption coding (fraudulent coding) - CORRECT
ANSWER >>>>reporting items of services that are not
actually documented
errors of the coding process - CORRECT ANSWER >>>>-
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
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-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 - CORRECT ANSWER >>>>when
multiple codes are used to code a procedure when a
single code should be used
Upcoding - CORRECT ANSWER >>>>using a procedural
code that provides a higher reimbursement rate than the
correct code
Downcoding - CORRECT ANSWER >>>>the document
does not justify the level of service
Most common billing errors - CORRECT ANSWER
>>>>Billing non-covered services
Billing over limit services
Upcoding
Downcoding
Billing without signatures
Using outdated codes
External Audits
Internal Audits
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Retrospective audits - CORRECT ANSWER >>>>Types of
Audits done to avoid billing and coding errors
External Audits - CORRECT ANSWER >>>>a private payer
or government investigator's review of selected records
of a practice for compliance
Internal Audits - CORRECT ANSWER >>>>self-audit
conducted by a staff member or consultant
Retrospective Audits - CORRECT ANSWER >>>>conducted
after the claim has been send the remittance advice has
been received
Adjustments - CORRECT ANSWER >>>>amounts added to
or taken away from the balance of an account
Two methods to determine rates to be paid to providers
- CORRECT ANSWER >>>>Charge; Resource
Charge - CORRECT ANSWER >>>>based fees are
established using the fees of providers providing similar
services
resource - CORRECT ANSWER >>>>-how difficult is it for
the provider to do the procedure
MEDICAL CODING AND BILLING CERTIFICATION EXAM STUDYGUIDE 2024
ACTUAL EXAM COMPLETE 200 QUESTIONS WITH DETAILED VERIFIED
ANSWERS (100% CORRECT ANSWERS) ALREADY GRADED A
truncated coding (error in coding) - CORRECT ANSWER
>>>>using diagnosis codes that are not as specific as
possible
assumption coding (fraudulent coding) - CORRECT
ANSWER >>>>reporting items of services that are not
actually documented
errors of the coding process - CORRECT ANSWER >>>>-
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
,2|Page
-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 - CORRECT ANSWER >>>>when
multiple codes are used to code a procedure when a
single code should be used
Upcoding - CORRECT ANSWER >>>>using a procedural
code that provides a higher reimbursement rate than the
correct code
Downcoding - CORRECT ANSWER >>>>the document
does not justify the level of service
Most common billing errors - CORRECT ANSWER
>>>>Billing non-covered services
Billing over limit services
Upcoding
Downcoding
Billing without signatures
Using outdated codes
External Audits
Internal Audits
, 3|Page
Retrospective audits - CORRECT ANSWER >>>>Types of
Audits done to avoid billing and coding errors
External Audits - CORRECT ANSWER >>>>a private payer
or government investigator's review of selected records
of a practice for compliance
Internal Audits - CORRECT ANSWER >>>>self-audit
conducted by a staff member or consultant
Retrospective Audits - CORRECT ANSWER >>>>conducted
after the claim has been send the remittance advice has
been received
Adjustments - CORRECT ANSWER >>>>amounts added to
or taken away from the balance of an account
Two methods to determine rates to be paid to providers
- CORRECT ANSWER >>>>Charge; Resource
Charge - CORRECT ANSWER >>>>based fees are
established using the fees of providers providing similar
services
resource - CORRECT ANSWER >>>>-how difficult is it for
the provider to do the procedure
