CBCS EXAM WITH 100%
ACCURATE SOLUTIONS
Medical Billing & Coding as a Career - Precise Answer ✔✔*Claims
assistant professional or claims manager, *Coding Specialist, *
Collection Manager, *Electronic Claims Processor, *Insurance Billing
Specialist, * Insurance Coordinator, *Insurance Counselor, *Medical
Biller, *Medical & Financial Records Manager, * Billing & Coding
Specialist
What are Medical Ethics? - Precise Answer ✔✔Standards of conduct
based on moral principle. They are generally accepted as a guide for
behavior towards pt's, dr's, co-workers, the gov, and ins co's.
What does acting within ethical behavior boundaries mean? - Precise
Answer ✔✔carrying out one's responsibilities w/ integrity, dignity,
respect, honesty, competence, fairness, & trust.
Legal Aspects of of Medical Billing & Coding: - Precise Answer ✔✔...
Compliance regulations: - Precise Answer ✔✔Most billing-related cases
are based on HIPPA and False Claims Act
Health Insurance Portability & Accountability Act (HIPPA) - Precise
Answer ✔✔Enacted in 1996, created by the Health Care Fraud & Abuse
,Control Program-enacted to check for fraud and abuse in the
Medicare/Medicaid Programs and private payers
What are the 2 provisions of HIPPA? - Precise Answer ✔✔Title I:
Insurance Reform
Title II: Administrative Simplification
What is Title I of HIPPA? - Precise Answer ✔✔Insurance Reform-
primary purpose is to provide continuous ins coverage for worker &
their dependents when they change or lose jobs. Also *Limits the use of
preexisting conditions exclusions *Prohibits discrimination from past or
present poor health *Guarantees certain employees/indv the right to
purchase new health ins coverage after losing job *Allows renewal of
health ins cov regardless of an indv's health cond. that is covered under
the particular policy.
What is Title II of HIPPA? - Precise Answer ✔✔Administrative
Simplification-goal is to focus on the health care practice setting to
reduce administrative cost & burdens. Has 2 parts- 1) development and
implementation of standardized health-related financial & administrative
activities electronically 2) Implementation of privacy & security
procedures to prevent the misuse of health info by ensuring
confidentiality
What is the False Claims Act (FCA)? - Precise Answer ✔✔Federal law
that prohibits submitting a fraudulent claim or making a false statement
or representation in connection w/ a claim. Also protects & rewards
whistle-blowers.
,What is the National Correct Coding Initiative (NCCI)? - Precise
Answer ✔✔Developed by CMS to promote the national correct coding
methodologies & to control improper coding that lead to inappropriate
payment of Part B health ins claims.
How many edits does NCCI include? - Precise Answer ✔✔2: 1)Column
1/Column 2 (prev called Comprehensive/Component) Edits
2) Mutually Exclusive Edits
Column 1/Column 2 edits (NCCI) - Precise Answer ✔✔Identifies code
pairs that should not be billed together b/c 1 code (Column 1) includes
all the services described by another code (Column 2)
Mutually Exclusive Edits (NCCI) - Precise Answer ✔✔ID's code pairs
that, for clinical reasons, are unlikely to be performed on the same pt on
the same day
What are the possible consequences of inaccurate coding and incorrect
billing? - Precise Answer ✔✔*delayed processing & payment of claims
*reduced payments, denied claims *fine and/or imprisonment
*exclusion from payer's programs, loss of dr's license to practice med
Who has the task of investigate and prosecuting health care fraud &
abuse? - Precise Answer ✔✔The Office of Inspector General (OIG)
, Fraud - Precise Answer ✔✔knowingly & intentionally deceiving or
misrepresenting info that may result in unauthorized benefits. It is a
felony and can result in fines and/or prison.
Who audits claims? - Precise Answer ✔✔State & federal agencies as
well as private ins co's
What are common forms of fraud? - Precise Answer ✔✔billing for
services not furnished, unbundling, & misrepresenting diagnosis to
justify payment
Abuse - Precise Answer ✔✔incidences or practices, not usually
considered fraudulent, that are inconsistent w/ the accepted medical
business or fiscal practices in the industry.
What are examples of Abuse? - Precise Answer ✔✔submitting a claim
for services/procedures performed that is not medically necessary, and
excessive charges for services, equipment or supplies.
What is a method use to minimize danger, hazards, & liabilities
associated w/ abuse? - Precise Answer ✔✔Risk Management
Patient Confidentiality - Precise Answer ✔✔All pt's have right to
privacy & all info should remain privileged. Only discuss pt info when
necessary to do job. Obtain a signed consent form to release medical
info to ins co or other individual.
ACCURATE SOLUTIONS
Medical Billing & Coding as a Career - Precise Answer ✔✔*Claims
assistant professional or claims manager, *Coding Specialist, *
Collection Manager, *Electronic Claims Processor, *Insurance Billing
Specialist, * Insurance Coordinator, *Insurance Counselor, *Medical
Biller, *Medical & Financial Records Manager, * Billing & Coding
Specialist
What are Medical Ethics? - Precise Answer ✔✔Standards of conduct
based on moral principle. They are generally accepted as a guide for
behavior towards pt's, dr's, co-workers, the gov, and ins co's.
What does acting within ethical behavior boundaries mean? - Precise
Answer ✔✔carrying out one's responsibilities w/ integrity, dignity,
respect, honesty, competence, fairness, & trust.
Legal Aspects of of Medical Billing & Coding: - Precise Answer ✔✔...
Compliance regulations: - Precise Answer ✔✔Most billing-related cases
are based on HIPPA and False Claims Act
Health Insurance Portability & Accountability Act (HIPPA) - Precise
Answer ✔✔Enacted in 1996, created by the Health Care Fraud & Abuse
,Control Program-enacted to check for fraud and abuse in the
Medicare/Medicaid Programs and private payers
What are the 2 provisions of HIPPA? - Precise Answer ✔✔Title I:
Insurance Reform
Title II: Administrative Simplification
What is Title I of HIPPA? - Precise Answer ✔✔Insurance Reform-
primary purpose is to provide continuous ins coverage for worker &
their dependents when they change or lose jobs. Also *Limits the use of
preexisting conditions exclusions *Prohibits discrimination from past or
present poor health *Guarantees certain employees/indv the right to
purchase new health ins coverage after losing job *Allows renewal of
health ins cov regardless of an indv's health cond. that is covered under
the particular policy.
What is Title II of HIPPA? - Precise Answer ✔✔Administrative
Simplification-goal is to focus on the health care practice setting to
reduce administrative cost & burdens. Has 2 parts- 1) development and
implementation of standardized health-related financial & administrative
activities electronically 2) Implementation of privacy & security
procedures to prevent the misuse of health info by ensuring
confidentiality
What is the False Claims Act (FCA)? - Precise Answer ✔✔Federal law
that prohibits submitting a fraudulent claim or making a false statement
or representation in connection w/ a claim. Also protects & rewards
whistle-blowers.
,What is the National Correct Coding Initiative (NCCI)? - Precise
Answer ✔✔Developed by CMS to promote the national correct coding
methodologies & to control improper coding that lead to inappropriate
payment of Part B health ins claims.
How many edits does NCCI include? - Precise Answer ✔✔2: 1)Column
1/Column 2 (prev called Comprehensive/Component) Edits
2) Mutually Exclusive Edits
Column 1/Column 2 edits (NCCI) - Precise Answer ✔✔Identifies code
pairs that should not be billed together b/c 1 code (Column 1) includes
all the services described by another code (Column 2)
Mutually Exclusive Edits (NCCI) - Precise Answer ✔✔ID's code pairs
that, for clinical reasons, are unlikely to be performed on the same pt on
the same day
What are the possible consequences of inaccurate coding and incorrect
billing? - Precise Answer ✔✔*delayed processing & payment of claims
*reduced payments, denied claims *fine and/or imprisonment
*exclusion from payer's programs, loss of dr's license to practice med
Who has the task of investigate and prosecuting health care fraud &
abuse? - Precise Answer ✔✔The Office of Inspector General (OIG)
, Fraud - Precise Answer ✔✔knowingly & intentionally deceiving or
misrepresenting info that may result in unauthorized benefits. It is a
felony and can result in fines and/or prison.
Who audits claims? - Precise Answer ✔✔State & federal agencies as
well as private ins co's
What are common forms of fraud? - Precise Answer ✔✔billing for
services not furnished, unbundling, & misrepresenting diagnosis to
justify payment
Abuse - Precise Answer ✔✔incidences or practices, not usually
considered fraudulent, that are inconsistent w/ the accepted medical
business or fiscal practices in the industry.
What are examples of Abuse? - Precise Answer ✔✔submitting a claim
for services/procedures performed that is not medically necessary, and
excessive charges for services, equipment or supplies.
What is a method use to minimize danger, hazards, & liabilities
associated w/ abuse? - Precise Answer ✔✔Risk Management
Patient Confidentiality - Precise Answer ✔✔All pt's have right to
privacy & all info should remain privileged. Only discuss pt info when
necessary to do job. Obtain a signed consent form to release medical
info to ins co or other individual.
