Chief Complaint (element 1 of history) -correct answerHistory of present illness,
Review symptom,
Past, Family, and Social history
History Levels (Element 2 of history) and Examination Levels (Element 3 of History) -correct
answerProblem focused,
expanded problem focused,
detailed,
Comprehensive
Medical Decision Making Complexity Levels (element 4 of history) -correct
answerStraightforward,
Low,
Moderate,
High
straightforward -correct answerMinimal diagnosis
Minimal risk
Minimal complexity of data
Low -correct answerLimited diagnosis
Limited/low risk to patient
Limited data
Moderate -correct answerMultiple diagnosis
Moderate risk to patient
Moderate amount and complexity of data
high -correct answerExtensive diagnosis
high risk to patient
extensive amount and complexity of data
truncated coding (error in coding) -correct answerusing diagnosis codes that are not as
specific as possible
assumption coding (fraudulent coding) -correct answerreporting 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
-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 answerwhen multiple codes are used to code a procedure when
a single code should be used
Upcoding -correct answerusing a procedural code that provides a higher reimbursement rate
than the correct code
Downcoding -correct answerthe document does not justify the level of service
Most common billing errors -correct answerBilling non-covered services
Billing over limit services
Upcoding
Downcoding
Billing without signatures
Using outdated codes
External Audits
Internal Audits
Retrospective audits -correct answerTypes of Audits done to avoid billing and coding errors
External Audits -correct answera private payer or government investigator's review of
selected records of a practice for compliance
Internal Audits -correct answerself-audit conducted by a staff member or consultant
Retrospective Audits -correct answerconducted after the claim has been send the
remittance advice has been received
Adjustments -correct answeramounts added to or taken away from the balance of an
account
Two methods to determine rates to be paid to providers -correct answerCharge; Resource
Review symptom,
Past, Family, and Social history
History Levels (Element 2 of history) and Examination Levels (Element 3 of History) -correct
answerProblem focused,
expanded problem focused,
detailed,
Comprehensive
Medical Decision Making Complexity Levels (element 4 of history) -correct
answerStraightforward,
Low,
Moderate,
High
straightforward -correct answerMinimal diagnosis
Minimal risk
Minimal complexity of data
Low -correct answerLimited diagnosis
Limited/low risk to patient
Limited data
Moderate -correct answerMultiple diagnosis
Moderate risk to patient
Moderate amount and complexity of data
high -correct answerExtensive diagnosis
high risk to patient
extensive amount and complexity of data
truncated coding (error in coding) -correct answerusing diagnosis codes that are not as
specific as possible
assumption coding (fraudulent coding) -correct answerreporting 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
-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 answerwhen multiple codes are used to code a procedure when
a single code should be used
Upcoding -correct answerusing a procedural code that provides a higher reimbursement rate
than the correct code
Downcoding -correct answerthe document does not justify the level of service
Most common billing errors -correct answerBilling non-covered services
Billing over limit services
Upcoding
Downcoding
Billing without signatures
Using outdated codes
External Audits
Internal Audits
Retrospective audits -correct answerTypes of Audits done to avoid billing and coding errors
External Audits -correct answera private payer or government investigator's review of
selected records of a practice for compliance
Internal Audits -correct answerself-audit conducted by a staff member or consultant
Retrospective Audits -correct answerconducted after the claim has been send the
remittance advice has been received
Adjustments -correct answeramounts added to or taken away from the balance of an
account
Two methods to determine rates to be paid to providers -correct answerCharge; Resource
