Billing and Coding Compliance Flashcards
7 cards from real CCT practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Billing and Coding Compliance flashcards as text
What is 'upcoding' in medical billing?
Answer: Billing for a more complex or expensive service than was actually provided
Upcoding involves billing for a higher-level or more expensive service than was actually rendered, which constitutes fraud against payers.
What does the acronym 'CPT' stand for in medical coding?
Answer: Current Procedural Terminology
CPT stands for Current Procedural Terminology, a code set maintained by the AMA used to report medical procedures and services to payers.
What is 'unbundling' in medical billing?
Answer: Billing each component of a procedure separately when a single comprehensive code exists
Unbundling involves billing separately for individual components of a service that should be reported under one comprehensive code, artificially increasing reimbursement.
Which federal agency administers the Medicare and Medicaid programs?
Answer: Centers for Medicare & Medicaid Services (CMS)
The Centers for Medicare & Medicaid Services (CMS) is the federal agency responsible for administering Medicare, Medicaid, CHIP, and other federal health programs.
What is the primary purpose of the National Correct Coding Initiative (NCCI)?
Answer: To prevent improper code combinations that result in inappropriate Medicare payment
The NCCI was developed by CMS to promote correct coding methodologies and prevent improper bundling or unbundling of codes that lead to inappropriate reimbursement.
What does Modifier 25 indicate when appended to an Evaluation and Management (E/M) code?
Answer: A significant, separately identifiable E/M service was provided on the same day as a procedure
Modifier 25 signals that on the day a procedure was performed, the patient's condition required a significant and separately identifiable E/M service beyond the pre/post-procedure care.
What is the primary purpose of ICD-10-CM codes in medical billing?
Answer: To identify the diagnoses, symptoms, and conditions that justify services provided
ICD-10-CM codes are diagnosis codes that describe the patient's condition or reason for the encounter, establishing the medical necessity for the services billed.