CCS Testing and Quality Assurance 2

Question 1

Which auditing method involves reviewing a sample of medical records AFTER the claim has been submitted and paid?

Accepted Answer

Retrospective audit

Answer

Retrospective audits review records and claims after payment has been made to identify errors and overpayments.

Question 2

A coding quality audit reveals a coder consistently assigns codes without referencing the Alphabetic Index first. This violates which ICD-10-CM guideline?

Accepted Answer

Use the Alphabetic Index to locate a code before verifying in the Tabular List

Answer

Official ICD-10-CM guidelines require coders to use the Alphabetic Index to locate a code, then verify it in the Tabular List.

Question 3

What is the PRIMARY purpose of a charge capture audit in a healthcare facility?

Accepted Answer

To ensure all billable services are captured and coded accurately

Answer

Charge capture audits ensure that all services rendered are accurately documented, coded, and billed to prevent revenue loss or overbilling.

Question 4

During a CCS quality review, an auditor finds a principal diagnosis was selected that is not supported by physician documentation. This represents which type of error?

Accepted Answer

Unsupported code assignment

Answer

An unsupported code assignment occurs when codes are selected without adequate physician documentation to substantiate them.

Question 5

When evaluating CPT coding accuracy, which resource serves as the AUTHORITATIVE source for bundling edits?

Accepted Answer

National Correct Coding Initiative (NCCI) edits

Answer

CMS's National Correct Coding Initiative (NCCI) edits define which CPT procedure codes cannot be billed together for the same patient on the same date.

(CCS) Certified Coding Specialist Practice Test

(CCS) Certified Coding Specialist Practice Test

CCS Testing and Quality Assurance 2