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

The chargemaster is the hospital's master price list containing every billable item with associated codes and charges, forming the basis for all claims submitted to payers.

Question 2

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

Accepted Answer

Prospective audit

Answer

Prospective audits review claims before submission to identify and correct coding or documentation errors, preventing improper payments from occurring.

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

Medicare requires that services be 'reasonable and necessary' for the diagnosis or treatment of illness or injury as a fundamental condition for reimbursement.

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

RACs are private contractors authorized by CMS to review Medicare claims and recover improper payments, working on a contingency fee basis.

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

Place of service codes on claims tell Medicare where the service was provided (e.g., office, hospital, telehealth), which directly affects applicable payment rates and coverage determinations.

CHC - Certified in Healthcare Compliance Practice Test

CHC - Certified in Healthcare Compliance Practice Test

CHC Healthcare Billing and Coding Compliance Questions and Answers 2