Certified Billing and Coding Specialist
(CBCS) Study Guide
Which of the following accurately describes the difference between informed and
implied consent?
A) Informed consent is required after a procedure, while implied consent is required
before a procedure.
B) Informed consent only refers to electronic documents, while implied consent refers to
written and electronic documents.
C) Informed consent is required in writing after explanation of a procedure, with time to
ask questions, while implied consent is assumed.
D) Informed consent applies to hospitals, while implied consent applies to physicians''
offices. - CORRECT ANSWER C) Informed consent is required in writing after
explanation of a procedure, with time to ask questions, while implies consent is
assumed.
The correct distinction between informed consent, which requires the patients'
signature, and implied consent
What is documentation? - CORRECT ANSWER Documentation is a complete,
accurate, up-to-date record of care a patient receives at a health care facility.
Disclosure refers to the way health information is:
A) Handled by doctors
B) Given to an outside person or organization
C) Stored
D) Organized - CORRECT ANSWER B) Given to an outside person or Organization
Disclosure refers to the dissemination of personal health information, which is covered
by the HIPAA Privacy Rule
What is the difference between consent and authorization? - CORRECT ANSWER
Authorization: Permission granted by the patient or the patient's representative to
release information for reasons other than treatment, payment, or health care
operations
Consent: Is used only when the permission is for treatment, payment, or health care
operations
True or False: Physicians have the option to decide whether to explain privacy rules to
their patients. - CORRECT ANSWER False
Physicians are legally obligated to explain privacy rules to their patients
Auditing refers to which of the following?
A) Writing claims
B) Signing off on claims
C) Sending claims to third-party payers
D) Reviewing claims for accuracy and completeness - CORRECT ANSWER D)
Reviewing claims for accuracy and completeness
, Many facilities have internal auditing systems to review claims for accuracy and
completeness. One of the main things an audit looks for is nonspecific or inaccurate use
of diagnosis and procedure codes.
True or False: Fraud is intentional misrepresentation of information for the purposes of
receiving higher payments, while abuse happens unintentionally, often because of poor
business practices. - CORRECT ANSWER True
An example of fraud is knowingly billing for services or supplies that were not provided.
Abuse includes any practice that is not consistent with the goals of providing patients
with services that are medically necessary, meet professionally recognized standards,
and are fairly priced.
Which of the following accurately defines upcoding?
A) Assigning a code that will deliberately result in a higher payment
B) Using a shorthand code system
C) Including more than one procedure in one code
D) Using multiple codes when a comprehensive code is available - CORRECT
ANSWER A) Assigning a code that will deliberately result in a higher payment
Assigning a cough with the code for pneumonia is an example of upcoding, and it is
fraud
The Stark Law states that:
A) Debt collection agencies can't use abusive or unfair practices to collect payment
B) The government can't be charged for substandard goods or services
C) Physicians can't refer patients to practitioners with whom they have a financial
relationship
D) Private health information must be kept secure - CORRECT ANSWER C)
Physicians can't refer patients to practitioners with whom they have a financial
relationship
Also referred to as the Physician Self-Referral Law, the Stark Law also prohibits the
referred practitioner from presenting claims to Medicare
The Office of the Inspector General is responsible for
A) Protecting health information
B) Fighting fraud
C) Helping health care professionals stay compliant with the laws
D) Disclosing health information - CORRECT ANSWER B) Fighting fraud
HIPAA established a comprehensive programs to combat fraud called the Health Care
Fraud and Abuse Control (HCFAC) program, which is run by the OIG
What is a claim? - CORRECT ANSWER Claims are a complete record of the services
provided by the health care professional, along with appropriate insurance information
Identify two items of information that need to be on a claim - CORRECT ANSWER
Patient name, Patient's health record number, Patient's account number, Patient's
demographic information, Subscribe, Subscriber (member) number, Group or plan
number, Prior approval number, Provider name, National Provider Identifier (NPI),
Provider's address and telephone number, Date(s) of service, Diagnosis code,
(CBCS) Study Guide
Which of the following accurately describes the difference between informed and
implied consent?
A) Informed consent is required after a procedure, while implied consent is required
before a procedure.
B) Informed consent only refers to electronic documents, while implied consent refers to
written and electronic documents.
C) Informed consent is required in writing after explanation of a procedure, with time to
ask questions, while implied consent is assumed.
D) Informed consent applies to hospitals, while implied consent applies to physicians''
offices. - CORRECT ANSWER C) Informed consent is required in writing after
explanation of a procedure, with time to ask questions, while implies consent is
assumed.
The correct distinction between informed consent, which requires the patients'
signature, and implied consent
What is documentation? - CORRECT ANSWER Documentation is a complete,
accurate, up-to-date record of care a patient receives at a health care facility.
Disclosure refers to the way health information is:
A) Handled by doctors
B) Given to an outside person or organization
C) Stored
D) Organized - CORRECT ANSWER B) Given to an outside person or Organization
Disclosure refers to the dissemination of personal health information, which is covered
by the HIPAA Privacy Rule
What is the difference between consent and authorization? - CORRECT ANSWER
Authorization: Permission granted by the patient or the patient's representative to
release information for reasons other than treatment, payment, or health care
operations
Consent: Is used only when the permission is for treatment, payment, or health care
operations
True or False: Physicians have the option to decide whether to explain privacy rules to
their patients. - CORRECT ANSWER False
Physicians are legally obligated to explain privacy rules to their patients
Auditing refers to which of the following?
A) Writing claims
B) Signing off on claims
C) Sending claims to third-party payers
D) Reviewing claims for accuracy and completeness - CORRECT ANSWER D)
Reviewing claims for accuracy and completeness
, Many facilities have internal auditing systems to review claims for accuracy and
completeness. One of the main things an audit looks for is nonspecific or inaccurate use
of diagnosis and procedure codes.
True or False: Fraud is intentional misrepresentation of information for the purposes of
receiving higher payments, while abuse happens unintentionally, often because of poor
business practices. - CORRECT ANSWER True
An example of fraud is knowingly billing for services or supplies that were not provided.
Abuse includes any practice that is not consistent with the goals of providing patients
with services that are medically necessary, meet professionally recognized standards,
and are fairly priced.
Which of the following accurately defines upcoding?
A) Assigning a code that will deliberately result in a higher payment
B) Using a shorthand code system
C) Including more than one procedure in one code
D) Using multiple codes when a comprehensive code is available - CORRECT
ANSWER A) Assigning a code that will deliberately result in a higher payment
Assigning a cough with the code for pneumonia is an example of upcoding, and it is
fraud
The Stark Law states that:
A) Debt collection agencies can't use abusive or unfair practices to collect payment
B) The government can't be charged for substandard goods or services
C) Physicians can't refer patients to practitioners with whom they have a financial
relationship
D) Private health information must be kept secure - CORRECT ANSWER C)
Physicians can't refer patients to practitioners with whom they have a financial
relationship
Also referred to as the Physician Self-Referral Law, the Stark Law also prohibits the
referred practitioner from presenting claims to Medicare
The Office of the Inspector General is responsible for
A) Protecting health information
B) Fighting fraud
C) Helping health care professionals stay compliant with the laws
D) Disclosing health information - CORRECT ANSWER B) Fighting fraud
HIPAA established a comprehensive programs to combat fraud called the Health Care
Fraud and Abuse Control (HCFAC) program, which is run by the OIG
What is a claim? - CORRECT ANSWER Claims are a complete record of the services
provided by the health care professional, along with appropriate insurance information
Identify two items of information that need to be on a claim - CORRECT ANSWER
Patient name, Patient's health record number, Patient's account number, Patient's
demographic information, Subscribe, Subscriber (member) number, Group or plan
number, Prior approval number, Provider name, National Provider Identifier (NPI),
Provider's address and telephone number, Date(s) of service, Diagnosis code,
