CHC Healthcare Billing and Coding Compliance Questions and Answers 2

Question 1

What is the purpose of a 'charge master' (chargemaster) in hospital billing compliance?

Accepted Answer

A comprehensive list of all billable services, supplies, and fees used to generate claims

Answer

A list of all patients billed during the year

Answer

A record of all insurance contracts

Answer

A compliance training schedule for billing staff

Question 2

Which type of audit involves reviewing claims BEFORE they are submitted to payers to catch errors proactively?

Accepted Answer

Prospective audit

Answer

Retrospective audit

Answer

Concurrent audit

Answer

External audit

Question 3

Under the Medicare Fee Schedule, what does 'medical necessity' require for a claim to be reimbursable?

Accepted Answer

The service was reasonable and necessary for the diagnosis or treatment of illness or injury

Answer

The service was ordered by a board-certified specialist

Answer

The patient had prior authorization from their insurer

Answer

The service was performed in an accredited facility

Question 4

What is a Recovery Audit Contractor (RAC) and what is its role in billing compliance?

Accepted Answer

A CMS-contracted auditor that identifies and recovers improper Medicare payments

Answer

An internal hospital audit team focused on revenue cycle

Answer

A state agency that audits Medicaid billing

Answer

A private accreditation body for billing departments

Question 5

What is 'place of service' coding and why is it critical in Medicare billing compliance?

Accepted Answer

It indicates where a service was rendered and affects reimbursement rates and coverage rules

Answer

It identifies the city where the provider practices

Answer

It tracks which payer is responsible for the claim

Answer

It identifies the type of insurance the patient carries

Question 6

What is 'duplicate billing' and how does it constitute a compliance violation?

Accepted Answer

Submitting the same claim more than once for the same service rendered to the same patient on the same date

Answer

Sending the same claim to two different state agencies

Answer

Billing for a service twice in error during system migration

Answer

Charging a patient after insurance has already paid