Medical Billing Software Professional Standards & Competencies 3

Question 1

What does the term 'clean claim' mean in medical billing?

Accepted Answer

A claim submitted with all required data elements that can be adjudicated without additional information

Answer

A clean claim contains all necessary information for the payer to process and adjudicate it without requesting additional data or documentation.

Question 2

Under the Anti-Kickback Statute, which of the following arrangements would be considered a violation?

Accepted Answer

A laboratory paying a physician per referral for lab tests covered by Medicare

Answer

Paying physicians per referral for services covered by federal programs is a direct violation of the Anti-Kickback Statute.

Question 3

A billing professional is tasked with reducing the practice's days in accounts receivable (AR). Which action would most directly achieve this goal?

Accepted Answer

Following up on unpaid claims more aggressively and within payer timely filing deadlines

Answer

Proactive follow-up on unpaid claims before timely filing deadlines expire is the most direct strategy to reduce outstanding AR days.

Question 4

Which of the following best defines 'scope of practice' as it applies to a medical billing specialist?

Accepted Answer

The range of billing and administrative tasks a credentialed biller is qualified to perform

Answer

Scope of practice defines the duties, responsibilities, and limits within which a credentialed billing professional is competent and authorized to function.

Question 5

When auditing claims, a compliance officer finds a pattern of billing the highest-level E/M code for nearly all visits. This pattern suggests:

Accepted Answer

Potential upcoding that warrants further investigation

Answer

A consistent pattern of billing the highest E/M level regardless of visit complexity is a red flag for upcoding and should be investigated.

Medical Billing Software Practice Test

Medical Billing Software Practice Test

Medical Billing Software Professional Standards & Competencies 3