Medical Billing Software Quality Control & Assurance 4

Question 1

Under HIPAA, when a billing staff member accidentally sends an EOB to the wrong patient, the organization must:

Accepted Answer

Document the breach, notify the affected patient, and report to HHS if required

Answer

HIPAA's Breach Notification Rule requires covered entities to notify affected individuals and, for breaches affecting 500+ individuals, report to HHS and media within 60 days.

Question 2

Which of the following best describes 'concurrent coding' in a quality assurance context?

Accepted Answer

Reviewing and coding records while the patient is still receiving care

Answer

Concurrent coding involves reviewing and assigning codes during an inpatient stay, which improves accuracy, captures charges in real-time, and reduces post-discharge backlogs.

Question 3

A billing quality audit reveals a high rate of 'timely filing' denials. The BEST systemic fix is to:

Accepted Answer

Implement automated claim submission tracking with filing deadline alerts

Answer

Automated tracking with deadline alerts prevents timely filing denials by ensuring staff are alerted before payer-specific deadlines pass, addressing the root cause systemically.

Question 4

In the context of medical billing QA, what does 'unbundling' refer to?

Accepted Answer

Billing individual component codes instead of a comprehensive bundled procedure code

Answer

Unbundling is the improper practice of billing separately for procedures that should be billed together under a single comprehensive code, violating NCCI bundling edits.

Question 5

A medical billing software's reporting module shows a sudden spike in 'patient not eligible' denials. The QA response should begin with:

Accepted Answer

Reviewing the eligibility verification workflow to identify where the breakdown occurred

Answer

A sudden spike suggests a process breakdown — reviewing the eligibility verification workflow identifies whether the issue is timing, system connectivity, or staff adherence to protocols.

Medical Billing Software Practice Test

Medical Billing Software Practice Test

Medical Billing Software Quality Control & Assurance 4