CCT Billing and Coding Compliance 3

Question 1

What is a chargemaster (charge description master) in a hospital setting?

Accepted Answer

A comprehensive listing of all services, procedures, and items a facility may bill for along with their standard charges

Answer

A list of credentialed physicians and their contracted billing rates

Answer

A government-issued fee schedule for Medicare facility reimbursement

Answer

A database of all Medicare and Medicaid beneficiaries served by the facility

Question 2

What is 'downcoding' in medical billing?

Accepted Answer

Billing for a lower level of service than was actually provided, often due to insufficient documentation

Answer

Billing for a higher level of service than was actually documented or provided

Answer

Converting diagnosis codes from ICD-9 format to ICD-10 format

Answer

Assigning procedure codes based on the patient's age rather than the service rendered

Question 3

Which of the following best describes 'medical necessity' in the context of billing compliance?

Accepted Answer

Services that are reasonable and necessary for the diagnosis or treatment of illness or injury, meeting accepted standards of care

Answer

Services provided only in response to a documented medical emergency

Answer

Services ordered by a licensed physician regardless of their clinical justification

Answer

Services that are covered by all insurance plans regardless of the patient's diagnosis

Question 4

What is a 'remittance advice' (RA) in medical billing?

Accepted Answer

A notice from a payer explaining how a claim was processed, including payment amounts or denial reasons

Answer

A document advising a provider of upcoming regulatory or coding changes

Answer

A letter from the OIG warning a provider of a potential compliance investigation

Answer

A form used to authorize a patient's treatment before services are rendered

Question 5

Why is the routine waiver of patient copayments considered a compliance risk?

Accepted Answer

It is fraudulent because it artificially inflates effective reimbursement and may induce overutilization, potentially violating anti-kickback statutes

Answer

It is an acceptable practice whenever patients demonstrate documented financial hardship

Answer

It is required under the ACA for all Medicare preventive services

Answer

It is a legal right patients have to waive cost-sharing in emergency service situations

Question 6

What is a 'credit balance' in healthcare billing and how does it relate to compliance?

Accepted Answer

An amount a provider owes back to Medicare because they received more payment than they were entitled to

Answer

Funds that a patient owes the provider after insurance has paid its portion

Answer

A favorable payment adjustment made by a payer on a corrected claim

Answer

Reserve funds set aside in a compliance program escrow account

Question 7

What is 'place of service' (POS) coding in medical billing?

Accepted Answer

A two-digit code on a claim that identifies the setting where the medical service was actually provided

Answer

The geographic location where the provider's corporate billing department is physically located

Answer

A code indicating the physician's medical specialty on the claim form

Answer

The specific department within a hospital where an inpatient was housed during treatment