MDCA 1343 - CH. 6 QUIZ QUESTIONS WITH CORRECT ANSWERS LATEST UPDATE 2026
Although anyone who comes into contact with a medical record is responsible for the accuracy of his
or her own entry, who in the medical practice is ultimately responsible for proper documentation and
correct coding? - Answers physician
Some possible consequences of inaccurate coding and incorrect billing in a medical practice are -
Answers All of the above
Which is not a characteristic of correctly linked codes? - Answers The procedure code are truncated.
In the CCI, which type of code cannot be billed together with a column 1 code for the same patient on
the same day of service? - Answers Column 2
In the CCI, which type of codes cannot both be billed for a patient on the same day of service? -
Answers Mutually exclusive
The Correct Coding Initiative (CCI) is a program of - Answers Medicare
Medically Unlikely Edits (MUE's) are a program of - Answers Medicare
If a payer judges that a code level assigned by a practice is too high for a reported service, the usual
action is to - Answers downcode the reported procedure code.
What type of coding uses diagnoses that are not as specific as possible? - Answers truncated coding
What type of coding uses a procedure code that provides a higher reimbursement rate than the
correct code? - Answers Upcoding
What type of coding uses a lower level code? - Answers Downcoding
Professional courtesy refers to providing free services to - Answers other physicians and their
families.
What type of audit is performed internally before claims are reported? - Answers Prospective audit
What type of audit is performed internally after claims are submitted? - Answers Retrospective audit
What type of external audit is performed by payers before claims are processed? - Answers
Prospective
What type of audit do payers routinely conduct to ensure that claims are compliant with the
provisions of their contracts? - Answers Postpayment
The CMS/AMA Documentation Guidelines set up the rules for the selection of - Answers Evaluation
and Management codes.
What type of fees are defined as those that physicians charge to most of their patients most of the
time under typical conditions? - Answers Customary fees
The three parts of an RBRVS fee are - Answers uniform value, GPCI, and conversion factor.
Under RBRVS, the nationally uniform relative value is based on - Answers the provider's work,
practice cost, and malpractice insurance costs.
The purpose of the GPCI is to account for - Answers regional differences in costs.
Which of these payment methods is the basis for Medicare's fees? - Answers RBRVS
The Medicare conversion factor is set - Answers annually
In an allowed charges payment method, if a provider's charge is higher than the allowed amount, the
provider's reimbursement is based on - Answers the amount allowed.
In an allowed charges payment method, if the provider's charge is lower than the allowed amount,
the reimbursement is based on - Answers the amount billed.
The Medicare allowed charge for a procedure is $80. What amount does the participating provider
receive from Medicare, and what amount from the patient, assuming the patient deductible has been
met? - Answers $64/$16
The Medicare allowed charge for a procedure is $150, and a PAR provider's usual charge is $200.
What amount must the provider write off? - Answers $50
The Medicare allowed charge is $240 and the participating (PAR) provider's usual charge is $600.
What amount does the patient pay, if the deductible has already been paid? - Answers $48
If a nonparticipating provider's usual fee is $600, the allowed amount is $300, and balance billing is
permitted, what amount is written off? - Answers $0
What are the main methods payers use to pay providers? - Answers allowed charges, contracted fee
schedule, and capitation.
What is the fixed prepayment for each plan member in a capitation contract called? - Answers
capitation rate
Medical insurance specialists help ensure maximum appropriate reimbursement for services by -
Answers submitting claims that are correct and compliant
Although anyone who comes into contact with a medical record is responsible for the accuracy of his
or her own entry, who in the medical practice is ultimately responsible for proper documentation and
correct coding? - Answers physician
Some possible consequences of inaccurate coding and incorrect billing in a medical practice are -
Answers All of the above
Which is not a characteristic of correctly linked codes? - Answers The procedure code are truncated.
In the CCI, which type of code cannot be billed together with a column 1 code for the same patient on
the same day of service? - Answers Column 2
In the CCI, which type of codes cannot both be billed for a patient on the same day of service? -
Answers Mutually exclusive
The Correct Coding Initiative (CCI) is a program of - Answers Medicare
Medically Unlikely Edits (MUE's) are a program of - Answers Medicare
If a payer judges that a code level assigned by a practice is too high for a reported service, the usual
action is to - Answers downcode the reported procedure code.
What type of coding uses diagnoses that are not as specific as possible? - Answers truncated coding
What type of coding uses a procedure code that provides a higher reimbursement rate than the
correct code? - Answers Upcoding
What type of coding uses a lower level code? - Answers Downcoding
Professional courtesy refers to providing free services to - Answers other physicians and their
families.
What type of audit is performed internally before claims are reported? - Answers Prospective audit
What type of audit is performed internally after claims are submitted? - Answers Retrospective audit
What type of external audit is performed by payers before claims are processed? - Answers
Prospective
What type of audit do payers routinely conduct to ensure that claims are compliant with the
provisions of their contracts? - Answers Postpayment
The CMS/AMA Documentation Guidelines set up the rules for the selection of - Answers Evaluation
and Management codes.
What type of fees are defined as those that physicians charge to most of their patients most of the
time under typical conditions? - Answers Customary fees
The three parts of an RBRVS fee are - Answers uniform value, GPCI, and conversion factor.
Under RBRVS, the nationally uniform relative value is based on - Answers the provider's work,
practice cost, and malpractice insurance costs.
The purpose of the GPCI is to account for - Answers regional differences in costs.
Which of these payment methods is the basis for Medicare's fees? - Answers RBRVS
The Medicare conversion factor is set - Answers annually
In an allowed charges payment method, if a provider's charge is higher than the allowed amount, the
provider's reimbursement is based on - Answers the amount allowed.
In an allowed charges payment method, if the provider's charge is lower than the allowed amount,
the reimbursement is based on - Answers the amount billed.
The Medicare allowed charge for a procedure is $80. What amount does the participating provider
receive from Medicare, and what amount from the patient, assuming the patient deductible has been
met? - Answers $64/$16
The Medicare allowed charge for a procedure is $150, and a PAR provider's usual charge is $200.
What amount must the provider write off? - Answers $50
The Medicare allowed charge is $240 and the participating (PAR) provider's usual charge is $600.
What amount does the patient pay, if the deductible has already been paid? - Answers $48
If a nonparticipating provider's usual fee is $600, the allowed amount is $300, and balance billing is
permitted, what amount is written off? - Answers $0
What are the main methods payers use to pay providers? - Answers allowed charges, contracted fee
schedule, and capitation.
What is the fixed prepayment for each plan member in a capitation contract called? - Answers
capitation rate
Medical insurance specialists help ensure maximum appropriate reimbursement for services by -
Answers submitting claims that are correct and compliant
