CBCS Exam Study Guide, Get Easy
Reading Masterpiece. Guaranteed
Comprehension.
Medical Billing & Coding as a Career - Ans-*Claims assistant professional or claims manager, *Coding
Specialist, * Collection Manager, *E
...
CBCS Exam Study Guide, Get Easy
Reading Masterpiece. Guaranteed
Comprehension.
Medical Billing & Coding as a Career - Ans-*Claims assistant professional or claims manager, *Coding
Specialist, * Collection Manager, *Electronic Claims Processor, *Insurance Billing Specialist, *
Insurance Coordinator, *Insurance Counselor, *Medical Biller, *Medical & Financial Records
Manager, * Billing & Coding Specialist
What are Medical Ethics? - Ans-Standards of conduct based on moral principle. They are generally
accepted as a guide for behavior towards pt's, dr's, co-workers, the gov, and ins co's.
What does acting within ethical behavior boundaries mean? - Ans-carrying out one's responsibilities
w/ integrity, dignity, respect, honesty, competence, fairness, & trust.
Compliance regulations: - Ans-Most billing-related cases are based on HIPPA and False Claims Act
Health Insurance Portability & Accountability Act (HIPPA) - Ans-Enacted in 1996, created by the
Health Care Fraud & Abuse Control Program-enacted to check for fraud and abuse in the
Medicare/Medicaid Programs and private payers
What are the 2 provisions of HIPPA? - Ans-Title I: Insurance Reform
Title II: Administrative Simplification
What is Title I of HIPPA? - Ans-Insurance Reform-primary purpose is to provide continuous ins
coverage for worker & their dependents when they change or lose jobs. Also *Limits the use of
preexisting conditions exclusions *Prohibits discrimination from past or present poor health
*Guarantees certain employees/indv the right to purchase new health ins coverage after losing job
*Allows renewal of health ins cov regardless of an indv's health cond. that is covered under the
particular policy.
What is Title II of HIPPA? - Ans-Administrative Simplification-goal is to focus on the health care
practice setting to reduce administrative cost & burdens. Has 2 parts- 1) development andimplementation of standardized health-related financial & administrative activities electronically 2)
Implementation of privacy & security procedures to prevent the misuse of health info by ensuring
confidentiality
What is the False Claims Act (FCA)? - Ans-Federal law that prohibits submitting a fraudulent claim or
making a false statement or representation in connection w/ a claim. Also protects & rewards
whistle-blowers.
What is the National Correct Coding Initiative (NCCI)? - Ans-Developed by CMS to promote the
national correct coding methodologies & to control improper coding that lead to inappropriate
payment of Part B health ins claims.
How many edits does NCCI include? - Ans-2: 1)Column 1/Column 2 (prev called
Comprehensive/Component) Edits
2) Mutually Exclusive Edits
Column 1/Column 2 edits (NCCI) - Ans-Identifies code pairs that should not be billed together b/c 1
code (Column 1) includes all the services described by another code (Column 2)
Mutually Exclusive Edits (NCCI) - Ans-ID's code pairs that, for clinical reasons, are unlikely to be
performed on the same pt on the same day
What are the possible consequences of inaccurate coding and incorrect billing? - Ans-*delayed
processing & payment of claims *reduced payments, denied claims *fine and/or imprisonment
*exclusion from payer's programs, loss of dr's license to practice med
Who has the task of investigate and prosecuting health care fraud & abuse? - Ans-The Office of
Inspector General (OIG)
Fraud - Ans-knowingly & intentionally deceiving or misrepresenting info that may result in
unauthorized benefits. It is a felony and can result in fines and/or prison.
Who audits claims? - Ans-State & federal agencies as well as private ins co's
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