Reimbursement and Compliance Flashcards
6 cards from real Certified Coding Associate Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Reimbursement and Compliance flashcards as text
What is the primary purpose of the Medicare Physician Fee Schedule (MPFS)?
Answer: To set payment rates for physician services under Medicare Part B
The MPFS establishes the payment rates for physician and other professional services billed under Medicare Part B.
A compliance program in a healthcare organization is primarily designed to:
Answer: Prevent, detect, and correct non-compliance with laws and regulations
A compliance program is designed to prevent, detect, and correct violations of healthcare laws, regulations, and standards.
Which of the following best describes the concept of 'unbundling' in medical billing?
Answer: Reporting individual components of a procedure when a comprehensive code exists
Unbundling means billing individual components of a procedure separately when a single comprehensive CPT code already covers all components.
What does 'clean claim' mean in medical billing?
Answer: A claim submitted without any errors that can be processed for payment
A clean claim is one that is free of errors and contains all required information so it can be processed for payment without delay.
The False Claims Act imposes liability for which of the following?
Answer: Knowingly submitting fraudulent claims to government healthcare programs
The False Claims Act imposes civil liability on those who knowingly submit false or fraudulent claims to federal healthcare programs like Medicare.
What is a Coordination of Benefits (COB) situation?
Answer: When a patient has more than one insurance plan covering the same services
COB occurs when a patient is covered by more than one insurance plan, and the plans coordinate to avoid overpayment.