WGU D254 Final Assessment Frequently Tested Questions Complete Exam Questions with Correct Solutions||<<Updated >>Already Graded!!!

WGU D254 Final Assessment Frequently Tested Questions Complete Exam Questions with Correct Solutions||&lt;&lt;Updated &gt;&gt;Already Graded!!! 1) Phantom billing - ANSWER when services that were never performed are billed to the insurance provider. 2) Down coding - ANSWER Assigns the pt a lesser diagnosis and shows false pt improvement to allow for extended hospital stays or allotment of recovery benefits. 3) Unbundling - ANSWER Fragmenting a services is reporting separate codes for services that are included in one procedure code. 4) integrity - ANSWER consistency of values, actions and methods. 5) ethics - ANSWER dealing with what is right and wrong 6) values - ANSWER the degree of importance of an action 7) morals - ANSWER the differentiations of intentions 8) Charge capture - ANSWER mid-cycle 9) Documentation - ANSWER is mid cycle 10) claim f/u - ANSWER back end process 11) within how many days should corrective action be taken after a violation has been reported? - ANSWER 60 days 12) What areas should be examined in an organizations to ensure compliance? - ANSWER Coding and billing patterns, billing denials along with coding updates 13) Abuse - ANSWER is unintentional coding and billing errors 14) ACA - ANSWER affordable care act 15) What is the organizations that enforces the false claims act? - ANSWER OIG 16) How often is the OIG work plan website updated? - ANSWER monthly 17) Why is it important for an organization to review the OIG red flags on a regular basis? - ANSWER the OIG work plan gives a list of areas where the oig is looking to audit 18) If an employee has concerns about compliance, how would this be reported? - ANSWER supervisor, human resources or call the compliance line 19) When did the health fraud and abuse control program come into inception? - ANSWER 1997 20) How much money has been saved just in 2016? - ANSWER 3.3 billion 21) Which organizations came together to form the heat program? - ANSWER HHS,OIG, DOJ 22) Why is it important to utilize a compliance hotline? - ANSWER main reason is to allow anonymous reporting 23) Principal diagnosis - ANSWER reason found after the study that brought the patient in 24) How do secondary diagnosis affect reimbursement? - ANSWER When they qualify as complications or comorbid conditions. 25) CPT codes and HCPCS level 2 - ANSWER are both used for outpt procedures 26) How is the principal diagnosis designated in the outpt setting? - ANSWER First listed diagnosis 27) Which organization is responsible for the development and maintenance of ICD-10-cm codes? - ANSWER WHO 28) The OIG - ANSWER provides a compliance work plan 29) AMA is responsible for? - ANSWER CPT codes 30) When did transition of ICD-9 to ICD-10 - ANSWER 2015 31) What type of updates must be done on an annual basis to cpt codes? - ANSWER code additions, deletions and revisions 32) When are ICD-10 code set updates released each year? - ANSWER October 33) Why would ICD cm/pcs cods be updated mid-year? - ANSWER new technology 34) Cpt codes are - ANSWER 5 digits and usually only contain numbers 35) AMA updates - ANSWER CPT codes 36) CPT codes are updated - ANSWER annually 37) What is an evaluation and management code? - ANSWER Evaluation and management codes are used to bill for physician and hospital services. 38) What is an additional step that would be performed when locating an evaluation and management code? - ANSWER Is pt new or established 39) Bullseye - ANSWER moderate sedation bundled 40) Plus symbol - ANSWER Add on code 41) Vaccine pending approval - ANSWER lightning bolt 42) Triangle - ANSWER description revision 43) Hashtag - ANSWER codes out of sequence 44) -50 - ANSWER Cpt level 1 modifier 45) When will modifier be necessary? - ANSWER Procedure is done on both sides 46) Evaluation and mgmt cpt code - ANSWER 47) Anesthesia cpt code - ANSWER 00100-01999 48) surgery cpt code - ANSWER 49) radiology cpt code - ANSWER 50) Pathology and lab cpt code - ANSWER 51) medicine cpt code - ANSWER 52) category 2 cpt codes - ANSWER 0001F-6005F 53) Category 3 cpt code - ANSWER 0003T-0170T