Certified Medical Coding Specialist Quality Control & Assurance 2

Question 1

A coding audit reveals that a coder consistently upcodes evaluation and management services. What is the MOST appropriate corrective action?

Accepted Answer

Provide targeted education and reaudit within 90 days

Answer

Targeted education followed by a reaudit is the standard corrective action for identified coding errors, allowing the coder to improve while confirming the issue is resolved.

Question 2

Which statistical sampling method selects every nth record from a list to create a representative audit sample?

Accepted Answer

Systematic sampling

Answer

Systematic sampling selects every nth record from a population, providing an even distribution across the dataset.

Question 3

A hospital's compliance program identifies a pattern of billing for services not documented. Under the False Claims Act, what is the potential penalty per false claim?

Accepted Answer

$2,587 to $25,868

Answer

The False Claims Act imposes civil monetary penalties of $2,587 to $25,868 per false claim (adjusted annually for inflation), plus treble damages.

Question 4

Which document outlines the standards and expectations for coding accuracy and serves as the benchmark during internal audits?

Accepted Answer

Coding policies and procedures manual

Answer

The coding policies and procedures manual establishes the standards against which coding accuracy is measured during internal audits.

Question 5

A quality review finds that 8 out of 40 audited records contain coding errors. What is the error rate?

Accepted Answer

20%

Answer

8 errors divided by 40 records equals 0.20, or a 20% error rate.

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Quality Control & Assurance 2