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CBCS MOD #1
The Revenue Cycle And Regulatory Compliance
| Question | Answer |
|---|---|
| Which of the following is a claim that is possible to adjudicate and includes all required data elements? | Clean claim |
| A billing and coding specialist is processing claims. Which of the following should the specialist identify as an example of fraud? | Upcoding for increased reimbursement |
| A billing and coding specialist should identify that which of the following documents assists providers in determining whether there are any outstanding claims ? | Aging report |
| During which of the following steps of the revenue cycle does effective communication begin? | Registration and scheduling |
| A billing and coding specialist is speaking with a patient on the telephone about their plan benefits. Which of the following actions should the specialist take when communicating with the patient? | Explain patient financial responsibility. |
| Which of the following is an effective tool for collecting a patient's payment for health care services? | Communication |
| Which of the following terms describes a patient's right to have their protected health information safeguarded and not disclosed to others without their permission? | Privacy |
| Which of the following requires a patient's authorization prior to disclosure? | Protected health information (PHI) |
| Which of the following actions by a billing and coding specialist represents a breach of confidentiality? | Discussing patient information in the elevator where other patients are present |
| Which of the following refers to the act of controlling access to records, protecting patient health information from destruction or loss, and providing employee training? | Security |
| A billing and coding specialist is preparing to code an anesthesiologist's portion of a procedure. The specialist must be able to identify the correct start/stop times to code the claim correctly. Which of the following regulates this activity? | CPT® guidelines |
| A billing and coding specialist notices that a provider is reporting the same code for all new patient visits to get higher reimbursements. The specialist should identify this as which of the following? | Fraud |
| A billing and coding specialist should identify that a Medicare Recovery Audit Contractor (RAC) can review medical records for which of the following reasons? | To investigate potential improper Medicare payments |
| A billing and coding specialist should identify that the Office of Inspector General (OIG) has which of the following roles? | To identify Medicare fraud and abuse |
| Which of the following describes the practice of routinely submitting claims that have the same coding or modifier errors? | Abusive billing pattern |
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