CHC Healthcare Billing and Coding Compliance Questions and Answers

Question 1

Which federal statute prohibits submitting claims for services that were not actually rendered to Medicare or Medicaid?

Accepted Answer

False Claims Act

Answer

Anti-Kickback Statute

Answer

Stark Law

Answer

HITECH Act

Question 2

What is 'upcoding' in the context of healthcare billing compliance?

Accepted Answer

Billing for a service with a higher-value code than the service actually performed

Answer

Using outdated CPT codes on claims

Answer

Submitting duplicate claims for the same service

Answer

Assigning codes before a procedure is completed

Question 3

What does 'unbundling' refer to in healthcare billing?

Accepted Answer

Billing component services separately when a bundled code should be used to reduce reimbursement inflation

Answer

Splitting one patient encounter into multiple claims

Answer

Combining multiple patients' charges on one claim

Answer

Separating physician and facility fees incorrectly

Question 4

Which organization publishes the National Correct Coding Initiative (NCCI) edits used to prevent improper Medicare billing?

Accepted Answer

CMS

Answer

AMA

Answer

OIG

Answer

AHA

Question 5

In medical documentation for billing, what does the principle of 'if it wasn't documented, it wasn't done' mean for compliance?

Accepted Answer

Services billed must be supported by clinical documentation in the medical record

Answer

Electronic records are preferred over paper

Answer

Verbal orders are not billable

Answer

Physicians must personally document all billable services

Question 6

What is a 'Comparative Billing Report' (CBR) issued by CMS used for in compliance?

Accepted Answer

To show a provider how their billing patterns compare to peers, flagging potential outliers

Answer

To compare hospital accreditation scores

Answer

To audit payroll records for compliance

Answer

To compare state Medicaid billing rules