MEDICAL BILLING AND CODING
CERTIFICATE
LATEST EXAM QUESTIONS WITH VERIFIED
ANSWERS
Chief Complaint (element 1 of history) - CORRECT ANSWER ✔- History of
present illness,
Review symptom,
Past, Family, and Social history
History Levels (Element 2 of history) and Examination Levels (Element 3 of
History) - CORRECT ANSWER ✔- Problem focused,
Expanded problem focused,
Detailed,
Comprehensive
Medical Decision Making Complexity Levels (element 4 of history) - CORRECT
ANSWER ✔- Straightforward,
Low,
Moderate,
High
Straightforward - CORRECT ANSWER ✔- Minimal diagnosis
Minimal risk
Minimal complexity of data
Low - CORRECT ANSWER ✔- Limited diagnosis
Limited/low risk to patient
Limited data
Moderate - CORRECT ANSWER ✔- Multiple diagnosis
Moderate risk to patient
Moderate amount and complexity of data
High - CORRECT ANSWER ✔- Extensive diagnosis
High risk to patient
Extensive amount and complexity of data
1
,Truncated coding (error in coding) - CORRECT ANSWER ✔- using diagnosis
codes that are not as specific as possible
Assumption coding (fraudulent coding) - CORRECT ANSWER ✔- reporting
items of services that are not actually documented
Errors of the coding process - CORRECT ANSWER ✔- -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
Unbundling codes - CORRECT ANSWER ✔- when multiple codes are used to
code a procedure when a single code should be used
Upcoding - CORRECT ANSWER ✔- using a procedural code that provides a
higher reimbursement rate than the correct code
Downcoding - CORRECT ANSWER ✔- the document does not justify the level
of service
Most common billing errors - CORRECT ANSWER ✔- Billing non-covered
services
Billing over limit services
Upcoding
Downcoding
Billing without signatures
Using outdated codes
External Audits
Internal Audits
Retrospective audits - CORRECT ANSWER ✔- Types of Audits done to avoid
billing and coding errors
External Audits - CORRECT ANSWER ✔- a private payer or government
investigator's review of selected records of a practice for compliance
2
, Internal Audits - CORRECT ANSWER ✔- self-audit conducted by a staff member
or consultant
Retrospective Audits - CORRECT ANSWER ✔- conducted after the claim has
been send the remittance advice has been received
Adjustments - CORRECT ANSWER ✔- amounts added to or taken away from the
balance of an account
Two methods to determine rates to be paid to providers - CORRECT ANSWER
✔- Charge; Resource
Charge - CORRECT ANSWER ✔- based fees are established using the fees of
providers providing similar services
Resource - CORRECT ANSWER ✔- -how difficult is it for the provider to do the
procedure
-how much office overhead is involved
-the relative risk the procedure presents to the patient and the provider
Clearing Houses - CORRECT ANSWER ✔- Edits and transmits batches of claims
to insurance companies
Fee schedule - CORRECT ANSWER ✔- Payment is predetermined according to a
table of diagnoses and their eligible fees
Usual - CORRECT ANSWER ✔- fee normally charged for a given service
Customary fee - CORRECT ANSWER ✔- fee in the range of usual fees charged
by physicians of similar training experience for the same service within the same
specific and limited socioeconomic are
Resonable fee - CORRECT ANSWER ✔- fee that meets both usual or customary
fees or is considered justifiable by responsible medical opinion considering special
circumstances of the particular case in question
3
CERTIFICATE
LATEST EXAM QUESTIONS WITH VERIFIED
ANSWERS
Chief Complaint (element 1 of history) - CORRECT ANSWER ✔- History of
present illness,
Review symptom,
Past, Family, and Social history
History Levels (Element 2 of history) and Examination Levels (Element 3 of
History) - CORRECT ANSWER ✔- Problem focused,
Expanded problem focused,
Detailed,
Comprehensive
Medical Decision Making Complexity Levels (element 4 of history) - CORRECT
ANSWER ✔- Straightforward,
Low,
Moderate,
High
Straightforward - CORRECT ANSWER ✔- Minimal diagnosis
Minimal risk
Minimal complexity of data
Low - CORRECT ANSWER ✔- Limited diagnosis
Limited/low risk to patient
Limited data
Moderate - CORRECT ANSWER ✔- Multiple diagnosis
Moderate risk to patient
Moderate amount and complexity of data
High - CORRECT ANSWER ✔- Extensive diagnosis
High risk to patient
Extensive amount and complexity of data
1
,Truncated coding (error in coding) - CORRECT ANSWER ✔- using diagnosis
codes that are not as specific as possible
Assumption coding (fraudulent coding) - CORRECT ANSWER ✔- reporting
items of services that are not actually documented
Errors of the coding process - CORRECT ANSWER ✔- -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
Unbundling codes - CORRECT ANSWER ✔- when multiple codes are used to
code a procedure when a single code should be used
Upcoding - CORRECT ANSWER ✔- using a procedural code that provides a
higher reimbursement rate than the correct code
Downcoding - CORRECT ANSWER ✔- the document does not justify the level
of service
Most common billing errors - CORRECT ANSWER ✔- Billing non-covered
services
Billing over limit services
Upcoding
Downcoding
Billing without signatures
Using outdated codes
External Audits
Internal Audits
Retrospective audits - CORRECT ANSWER ✔- Types of Audits done to avoid
billing and coding errors
External Audits - CORRECT ANSWER ✔- a private payer or government
investigator's review of selected records of a practice for compliance
2
, Internal Audits - CORRECT ANSWER ✔- self-audit conducted by a staff member
or consultant
Retrospective Audits - CORRECT ANSWER ✔- conducted after the claim has
been send the remittance advice has been received
Adjustments - CORRECT ANSWER ✔- amounts added to or taken away from the
balance of an account
Two methods to determine rates to be paid to providers - CORRECT ANSWER
✔- Charge; Resource
Charge - CORRECT ANSWER ✔- based fees are established using the fees of
providers providing similar services
Resource - CORRECT ANSWER ✔- -how difficult is it for the provider to do the
procedure
-how much office overhead is involved
-the relative risk the procedure presents to the patient and the provider
Clearing Houses - CORRECT ANSWER ✔- Edits and transmits batches of claims
to insurance companies
Fee schedule - CORRECT ANSWER ✔- Payment is predetermined according to a
table of diagnoses and their eligible fees
Usual - CORRECT ANSWER ✔- fee normally charged for a given service
Customary fee - CORRECT ANSWER ✔- fee in the range of usual fees charged
by physicians of similar training experience for the same service within the same
specific and limited socioeconomic are
Resonable fee - CORRECT ANSWER ✔- fee that meets both usual or customary
fees or is considered justifiable by responsible medical opinion considering special
circumstances of the particular case in question
3
