Certified Coding Associate Exam Reimbursement and Compliance 1

Question 1

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

Accepted Answer

Medicare Severity Diagnosis Related Group

Answer

MS-DRG stands for Medicare Severity Diagnosis Related Group, used by Medicare for inpatient hospital reimbursement.

Question 2

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

Accepted Answer

HIPAA

Answer

HIPAA (Health Insurance Portability and Accountability Act) governs the privacy and security of protected health information.

Question 3

What is a Remittance Advice (RA)?

Accepted Answer

A document sent by payers explaining payment or denial of claims

Answer

A Remittance Advice is sent by payers to explain how claims were processed, including payment amounts or denial reasons.

Question 4

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

Accepted Answer

APC

Answer

OPPS uses Ambulatory Payment Classifications (APCs) to reimburse hospitals for outpatient services.

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

Upcoding is the fraudulent practice of billing for a higher-level or more expensive service than what was actually performed.

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