Medical Billing and Coding Certificate exam EXAM
2024 ACTUAL EXAM COMPLETE 200 QUESTIONS
WITH ANSWERS
Chief Complaint (element 1 of history) - ANSWER History of present illness,
Review symptom,
Past, Family, and Social history
History Levels (Element 2 of history) and Examination Levels (Element 3 of History) -
ANSWER Problem focused,
expanded problem focused,
detailed,
Comprehensive
Medical Decision Making Complexity Levels (element 4 of history) - ANSWER
Straightforward,
Low,
Moderate,
High
straightforward - ANSWER Minimal diagnosis
Minimal risk
Minimal complexity of data
Low - ANSWER Limited diagnosis
Limited/low risk to patient
Limited data
Moderate - ANSWER Multiple diagnosis
Moderate risk to patient
Moderate amount and complexity of data
high - ANSWER Extensive diagnosis
high risk to patient
extensive amount and complexity of data
truncated coding (error in coding) - ANSWER using diagnosis codes that are not
as specific as possible
assumption coding (fraudulent coding) - ANSWER reporting items of services that
are not actually documented
, errors of the coding process - 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 - ANSWER when multiple codes are used to code a procedure
when a single code should be used
Upcoding - ANSWER using a procedural code that provides a higher
reimbursement rate than the correct code
Downcoding - ANSWER the document does not justify the level of service
Most common billing errors - ANSWER Billing non-covered services
Billing over limit services
Upcoding
Downcoding
Billing without signatures
Using outdated codes
External Audits
Internal Audits
Retrospective audits - ANSWER Types of Audits done to avoid billing and coding
errors
External Audits - ANSWER a private payer or government investigator's review of
selected records of a practice for compliance
Internal Audits - ANSWER self-audit conducted by a staff member or consultant
Retrospective Audits - ANSWER conducted after the claim has been send the
remittance advice has been received
Adjustments - ANSWER amounts added to or taken away from the balance of an
account
Two methods to determine rates to be paid to providers - ANSWER Charge;
Resource
Charge - ANSWER based fees are established using the fees of providers
providing similar services
resource - ANSWER -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
2024 ACTUAL EXAM COMPLETE 200 QUESTIONS
WITH ANSWERS
Chief Complaint (element 1 of history) - ANSWER History of present illness,
Review symptom,
Past, Family, and Social history
History Levels (Element 2 of history) and Examination Levels (Element 3 of History) -
ANSWER Problem focused,
expanded problem focused,
detailed,
Comprehensive
Medical Decision Making Complexity Levels (element 4 of history) - ANSWER
Straightforward,
Low,
Moderate,
High
straightforward - ANSWER Minimal diagnosis
Minimal risk
Minimal complexity of data
Low - ANSWER Limited diagnosis
Limited/low risk to patient
Limited data
Moderate - ANSWER Multiple diagnosis
Moderate risk to patient
Moderate amount and complexity of data
high - ANSWER Extensive diagnosis
high risk to patient
extensive amount and complexity of data
truncated coding (error in coding) - ANSWER using diagnosis codes that are not
as specific as possible
assumption coding (fraudulent coding) - ANSWER reporting items of services that
are not actually documented
, errors of the coding process - 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 - ANSWER when multiple codes are used to code a procedure
when a single code should be used
Upcoding - ANSWER using a procedural code that provides a higher
reimbursement rate than the correct code
Downcoding - ANSWER the document does not justify the level of service
Most common billing errors - ANSWER Billing non-covered services
Billing over limit services
Upcoding
Downcoding
Billing without signatures
Using outdated codes
External Audits
Internal Audits
Retrospective audits - ANSWER Types of Audits done to avoid billing and coding
errors
External Audits - ANSWER a private payer or government investigator's review of
selected records of a practice for compliance
Internal Audits - ANSWER self-audit conducted by a staff member or consultant
Retrospective Audits - ANSWER conducted after the claim has been send the
remittance advice has been received
Adjustments - ANSWER amounts added to or taken away from the balance of an
account
Two methods to determine rates to be paid to providers - ANSWER Charge;
Resource
Charge - ANSWER based fees are established using the fees of providers
providing similar services
resource - ANSWER -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
