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
Which Medicare part covers inpatient hospital services?
Answer: Medicare Part A
Medicare Part A covers inpatient hospital, skilled nursing facility, hospice, and some home health services.
What is the purpose of a modifier in CPT coding?
Answer: To provide additional information about a service without changing its definition
Modifiers provide additional information about a service or procedure without altering its basic definition or changing the code itself.
Which organization publishes the ICD-10-CM Official Guidelines for Coding and Reporting?
Answer: CMS and NCHS
The ICD-10-CM Official Guidelines are published jointly by CMS (Centers for Medicare and Medicaid Services) and NCHS (National Center for Health Statistics).
What does the acronym 'EOB' stand for in medical billing?
Answer: Explanation of Benefits
EOB stands for Explanation of Benefits, a document sent to patients explaining what the insurance paid and what the patient owes.
What is the significance of the 'discharge status' code in inpatient coding?
Answer: It indicates where the patient went after being discharged from the hospital
The discharge status code indicates the patient's disposition upon leaving the hospital, such as home, skilled nursing facility, or expired.
Which law established the federal healthcare fraud and abuse statutes known as the 'Anti-Kickback Statute'?
Answer: The Social Security Act
The Anti-Kickback Statute is part of the Social Security Act and prohibits offering or receiving payment to induce referrals for federal healthcare program services.