Certified Coding Associate Exam Reimbursement and Compliance

Question 1

What does the acronym 'MS-DRG' stand for?

Accepted Answer

Medicare Severity Diagnosis Related Group

Answer

Medical-Surgical Diagnostic Resource Group

Answer

Multi-System Disease Reference Guide

Answer

Medical Standard Documentation Review Group

Question 2

Which federal law primarily governs healthcare privacy and the security of patient health information?

Accepted Answer

HIPAA

Answer

HITECH Act

Answer

ACA

Answer

COBRA

Question 3

What is a Remittance Advice (RA)?

Accepted Answer

A document sent by payers explaining payment or denial of claims

Answer

A physician's order for treatment

Answer

A patient's insurance card

Answer

A document authorizing a procedure

Question 4

The Outpatient Prospective Payment System (OPPS) uses which payment unit?

Accepted Answer

APC

Answer

DRG

Answer

RBRVS

Answer

RUG

Question 5

Which of the following is an example of upcoding?

Accepted Answer

Billing for a higher-level service than what was actually provided

Answer

Submitting a claim with a lower-level E/M code than documented

Answer

Reporting secondary diagnoses correctly

Answer

Using modifiers to indicate bilateral procedures

Question 6

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

Accepted Answer

To prevent improper payment of procedure codes that should not be billed together

Answer

To assign DRGs for inpatient stays

Answer

To validate ICD-10-CM codes on claims

Answer

To identify fraudulent provider billing