CCT Billing and Coding Compliance

Question 1

What is 'upcoding' in medical billing?

Accepted Answer

Billing for a more complex or expensive service than was actually provided

Answer

Upcoding involves billing for a higher-level or more expensive service than was actually rendered, which constitutes fraud against payers.

Question 2

What does the acronym 'CPT' stand for in medical coding?

Accepted Answer

Current Procedural Terminology

Answer

CPT stands for Current Procedural Terminology, a code set maintained by the AMA used to report medical procedures and services to payers.

Question 3

What is 'unbundling' in medical billing?

Accepted Answer

Billing each component of a procedure separately when a single comprehensive code exists

Answer

Unbundling involves billing separately for individual components of a service that should be reported under one comprehensive code, artificially increasing reimbursement.

Question 4

Which federal agency administers the Medicare and Medicaid programs?

Accepted Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

The Centers for Medicare & Medicaid Services (CMS) is the federal agency responsible for administering Medicare, Medicaid, CHIP, and other federal health programs.

Question 5

What is the primary purpose of the National Correct Coding Initiative (NCCI)?

Accepted Answer

To prevent improper code combinations that result in inappropriate Medicare payment

Answer

The NCCI was developed by CMS to promote correct coding methodologies and prevent improper bundling or unbundling of codes that lead to inappropriate reimbursement.

(CCT) Certified Compliance Technician Practice Test

(CCT) Certified Compliance Technician Practice Test

CCT Billing and Coding Compliance