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Medical Billing And Coding Exam Questions With Verified Solutions 100% 2024
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Medical Billing And Coding Exam Questions With Verified Solutions 100% 2024
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Medical Billing And Coding Exam Questions With Verified Solutions 100% 2024Which of the following activities is an example of abuse rather
than fraud?
A. upcoding
B. misrepresenting the diagnosis
C. inadvertent coding errors
D. billing for services not rendered - CORRECT ANSWERS-Inadvertent Coding Errors
Which of the following legislation prohibits physicians from
referring patients to an entity if the physician or a member of her immediate family has a
financial relationship with the entity?
A. Anti-kickback Statute
B. Federal False Claims Act
C. Exclusion Statute
D. Stark Law - CORRECT ANSWERS-Stark Law
Which of the following is an example of a Stark Law violation?
A. A physician using self-referral.
B. Unbundling procedures.
C. Asking for payment from a minor.
D. A physician receiving kickbacks. - CORRECT ANSWERS-A physician using self-
referral.
A specialist gives a general practitioner concert tickets every
time he refers a patient to him. This is illegal according to
A. anti-trust law.
B. HIPAA.
C. the Stark law.
D. the Anti-Kickback law. - CORRECT ANSWERS-the Anti-Kickback law
5.Which of the following laws pertains to an insurance and coding
specialist who knowingly presents an incorrect CMS 1500 for payment
to a payer?
A. Federal Civil False Claim Act
B. OMNIBUS Act
C. Stark Law
D. Administrative Law - CORRECT ANSWERS-Federal Civil False Claim Act Which of the following regulations prohibits a physician from
referring a patient to a facility in which the physician holds a
financial interest?
A. HIPAA
B. Federal False Claims Act
C. Stark Law
D. Affordable Care Act - CORRECT ANSWERS-Stark Law
A local laboratory sent a physician two tickets to the football
game, as a thank you for referring patients to its testing center. Which of the following has been violated?
A. False Claim Act
B. Anti-Kickback Act
C. HIPAA
D. Fraud and Abuse Act - CORRECT ANSWERS-B. Anti-Kickback Act
A lawyer has called and demanded information about a patient in
the office. The insurance and coding specialist can share the
information if
A. she calls the patient and obtains permission.
B. the lawyer tells her that he has permission from the
patient.
C. the lawyer provides his identification number.
D. the patient has signed an authorization form. - CORRECT ANSWERS-the patient has signed an authorization form
The HITECH Act was created to promote the use of
A. better physician documentation.
B. electronic claims submissions.
C. EHR meaningful use.
D. written consent for medical procedures. - CORRECT ANSWERS-EHR meaningful use.
Which of the following meets the definition of a covered
entity that must comply with HIPAA?
A. clearing house
B. all answers are
correct
C. pharmacies
D. nursing home facility - CORRECT ANSWERS-all answers are correct
Which of the following requires that a medical practice
informs the patients in advance interest will be charged on
delinquent accounts?
A. Stark Law
B. Truth in Lending Act C. Fair Debt Collection Practices Act
D. Omnibus Act - CORRECT ANSWERS-Truth in Lending Act
The insurance and coding specialist called the patient at
7:30 AM to discuss an outstanding balance. Which of the
following acts did the specialist violate?
A. Truth in Lending
B. Fair Debt Collection Practices
C. Fair Credit Billing
D. Equal Credit Opportunity - CORRECT ANSWERS-Fair Debt Collection Practices
Which of the following laws requires full written disclosure
about the finance charges for large payment plans involving four
or more installments, excluding a down payment?
A. Fair Debt Collections
Practice
B. Truth In Lending Act
C. Equal Credit Opportunity Act
D. Fair Credit Billing Act - CORRECT ANSWERS-B. Truth In Lending Act
Which of the following should the insurance and coding
specialist do first when she suspects illegal practices under the
Federal Civil False Claims Act?
A. Continue to bill the claims and look for another job
immediately.
B. Correct the claim codes and submit the claims to OIG once
updated.
C. Make copies of the claims to use as evidence and contact the
insurance carrier.
D. Stop billing the claims and contact the facility's compliance
officer - CORRECT ANSWERS-Stop billing the claims and contact the facility's compliance officer
The insurance and coding specialist is training a new employee on collection procedures. Which of the following should she tell the new employee? A. You may not say they could be dismissed as a patient for
non-payment.
B. You must identify yourself and the reason for your call.
C. You may call between 8 am 9 pm.
D. All answers are correct - CORRECT ANSWERS-All answers are correct
The physician that the insurance and coding specialist
works for is fraudulently billing for services that were not
performed. The specialist has previously tried to talk to him
about this, but he continues with these practices. Which of the
following should the specialist contact? A. AMA
B. OIG
C. The Joint Commission
D. NCQA - CORRECT ANSWERS-OIG (Office of Inspector General)
A patient calls the physician's office and indicates that the
provider is a friend of a friend who referred her and wants the
provider to waive the routine office visit copay of $30. Which of
the following statements should the insurance and coding
specialist use in response?
A. "We will waive the copay per the physician's instructions."
B. "Waiving the copay would violate the anti-kickback law."
C. "The practice attorney will review this situation and contact
you."
D. "I will need approval from the manager." - CORRECT ANSWERS-"Waiving the copay would violate the anti-kickback law."
Which of the following are considered standard
responsibilities for an insurance and coding specialist? (Select
the three (3) correct answers.)
A. Complete the insurance claim
accurately.
B. Apply credit and collection laws
C. Submit claims to third party payer.
D. All answers are correct - CORRECT ANSWERS-All answers are correct
Which of the following actions will help to protect an
insurance and coding specialist from being charged with
fraudulent behavior?
A. Follow current billing and coding practices.
B. Abstract data from the patient EHR Summary Page.
C. Ask for clarification when documentation does not support
coding.
D.all answers are correct - CORRECT ANSWERS-All answers are correct
A clinical laboratory receives orders from a physician for a
specific clinical laboratory test. The lab performs and bills for the
tests indicated on the order, but also bills for additional tests that
were not ordered or rendered. This illegal practice is considered
A. kickbacks.
B. malpractice.
C. upcoding.
D. fraud. - CORRECT ANSWERS-Fraud
An intentional tort in which unconsented, harmful, or
unwarranted physical contact occurs is an example of
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