Medical Billing and Coding Certificate exam with Verified
Answers Graded A+
1. Chief Complaint History of present illness,
(element 1 of his- Review symptom,
tory) Past, Family, and Social history
2. History Levels Problem focused,
(Element 2 of his- expanded problem focused,
tory) and Exami- detailed,
nation Levels (El- Comprehensive
ement 3 of Histo-
ry)
3. Medical Decision Straightforward,
Making Com- Low,
plexity Levels (el- Moderate,
ement 4 of histo- High
ry)
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. truncated coding using diagnosis codes that are not as specific as possible
(error in coding)
9. assumption cod- reporting items of services that are not actually docu-
ing (fraudulent mented
coding)
, Medical Billing and Coding Certificate exam with Verified
Answers Graded A+
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
codes a single code should be used
12. Upcoding using a procedural code that provides a higher reimburse-
ment 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Using outdated codes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
audits
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
Audits advice has been received
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 com-
panies
24. Fee schedule Payment is predetermined according to a table of diag-
noses 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 con-
sidered justifiable by responsible medical opinion con-
sidering special circumstances of the particular case in
question
28. relative value a list of 5 digit procedure codes for services with unit
studies (rvs) values that indicate the value for each procedure
29. Capitation physician has a contract with an insurance company to be
paid whether he sees the patient of not
30. precertification
Answers Graded A+
1. Chief Complaint History of present illness,
(element 1 of his- Review symptom,
tory) Past, Family, and Social history
2. History Levels Problem focused,
(Element 2 of his- expanded problem focused,
tory) and Exami- detailed,
nation Levels (El- Comprehensive
ement 3 of Histo-
ry)
3. Medical Decision Straightforward,
Making Com- Low,
plexity Levels (el- Moderate,
ement 4 of histo- High
ry)
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. truncated coding using diagnosis codes that are not as specific as possible
(error in coding)
9. assumption cod- reporting items of services that are not actually docu-
ing (fraudulent mented
coding)
, Medical Billing and Coding Certificate exam with Verified
Answers Graded A+
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
codes a single code should be used
12. Upcoding using a procedural code that provides a higher reimburse-
ment 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
audits
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
Audits advice has been received
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 com-
panies
24. Fee schedule Payment is predetermined according to a table of diag-
noses 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 con-
sidered justifiable by responsible medical opinion con-
sidering special circumstances of the particular case in
question
28. relative value a list of 5 digit procedure codes for services with unit
studies (rvs) values that indicate the value for each procedure
29. Capitation physician has a contract with an insurance company to be
paid whether he sees the patient of not
30. precertification
