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Using outdated codes - correct answer ✔✔Most common billing errors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