Certified Medical Coding Specialist Quality Control & Assurance 4

Question 1

Which of the following best describes 'unbundling' in the context of coding quality?

Accepted Answer

Billing component procedures separately when a comprehensive code exists

Answer

Unbundling involves billing component parts of a procedure individually rather than using the single comprehensive code, resulting in higher reimbursement.

Question 2

A quality assurance program should include which of the following to be compliant with OIG guidelines?

Accepted Answer

Written standards, training, internal auditing, and a mechanism to report concerns

Answer

The OIG's seven elements of an effective compliance program include written standards, education and training, internal auditing, and a confidential reporting mechanism.

Question 3

What is the primary purpose of a charge capture audit?

Accepted Answer

To ensure all services rendered are accurately billed and not missed or duplicated

Answer

A charge capture audit ensures that all services provided are documented, coded, and billed accurately, preventing revenue leakage or overbilling.

Question 4

When an outpatient facility reports a diagnosis 'confirmed' during a visit that was only suspected, this violates which coding guideline?

Accepted Answer

Outpatient coding guidelines (OGCR) Section IV

Answer

OGCR Section IV states that outpatient coders should report the condition to the highest degree of certainty, coding signs/symptoms rather than unconfirmed diagnoses.

Question 5

A concurrent coding audit differs from a retrospective audit in that it:

Accepted Answer

Reviews records and codes while the patient is still receiving care

Answer

A concurrent audit reviews coding while the patient is still admitted, allowing real-time corrections before the claim is submitted.

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Quality Control & Assurance 4