AAPC Billing Documentation & Compliance 3

Question 1

Which of the following best describes 'upcoding' in medical billing?

Accepted Answer

Billing for a higher-level or more expensive service than what was documented

Answer

Upcoding means billing a CPT or revenue code that reflects a higher level of service than what was actually documented and performed.

Question 2

A Coordination of Benefits (COB) error occurs when:

Accepted Answer

The primary and secondary payers are billed in the wrong order

Answer

COB errors occur when claims are not filed in the correct order of insurance responsibility, potentially resulting in incorrect payment or denial.

Question 3

The purpose of an Advance Beneficiary Notice (ABN) in Medicare billing is to:

Accepted Answer

Inform the beneficiary that Medicare may not pay and the patient may be responsible

Answer

An ABN notifies a Medicare beneficiary that a service may not be covered and allows the provider to bill the patient if Medicare denies the claim.

Question 4

Which form is used to bill Medicare Part B for professional (physician) services?

Accepted Answer

CMS-1500

Answer

The CMS-1500 is the standard claim form used by non-institutional providers, including physicians, to bill Medicare Part B.

Question 5

A provider who performs medically unnecessary services and bills for them may be liable under:

Accepted Answer

The False Claims Act

Answer

Billing for services that are not medically necessary constitutes a false claim and can result in FCA liability, including treble damages and penalties.

(AAPC) American Academy of Professional Coders Biller Certified Practice Test

(AAPC) American Academy of Professional Coders Biller Certified Practice Test

AAPC Billing Documentation & Compliance 3