CHC Healthcare Billing and Coding Compliance Questions and Answers 1

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

The False Claims Act prohibits knowingly submitting false or fraudulent claims for payment to any federal program, including Medicare and Medicaid.

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

Upcoding involves intentionally billing a more expensive procedure code than the one actually performed to receive higher reimbursement.

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

Unbundling means billing individual components of a procedure separately when a single bundled CPT code should be used, resulting in higher total reimbursement than intended.

Question 4

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

Accepted Answer

CMS

Answer

CMS developed and publishes the NCCI to promote national correct coding methodologies and prevent improper payment of Part B claims.

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

Medicare and Medicaid require that all billed services be supported by clinical documentation in the medical record; absent documentation, claims may be denied or subject to recoupment.

CHC - Certified in Healthcare Compliance Practice Test

CHC - Certified in Healthcare Compliance Practice Test

CHC Healthcare Billing and Coding Compliance Questions and Answers 1