CCS CERTIFIED CODING SPECIALIST
EXAM /CCS EXAM 2 LATEST VERSIONS
2024 AND PRACTICE QUESTION MOST
QUESTIONS AND
DETAILED ANSWERS (VERIFIED CORRECT
ANSWERS) |ALREADY GRADED A+
What are Medical Ethics? - Correct answer - Standards of
conduct based on moral principle. they are generally accepted
as a guide for behavior towards pt's, dr's, coworkers, the gov,
and ins co's
What does acting within ethical behavior boundaries mean? -
Correct answer - Carrying out one's responsibilities with
integrity, dignity, respect, honesty, competence, fairness, and
trust
Compliance regulations - Correct answer - Most billing-
related cases are based on HIPAA and False Claims Act
Health Insurance Portability & Accountability Act (HIPAA) -
Correct answer - 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 2 provisions of HIPAA? - Correct answer - Title 1:
Insurance Reform
Title 2: Administrative Simplification
What is Title 1 of HIPAA? - Correct answer - Insurance
Reform-primary purpose is to provide continuous coverage for
workers & their dependents when they change or lose jobs.
Also Limits the use of pre-existing conditions exclusions
Prohibits discrimination from past or present poor health
Guarantees certain employees/ individual the right to
purchase new health insurance coverage after losing job
Allows renewal of health insurance coverage regardless of an
individuals health condition that is covered under the
particular policy
What is Title 2 of HIPAA? - Correct answer - Administrative
Simplification- goal is to focus on the health care practice
setting to reduce administrative cost & burdens.
Has 2 parts
,1) development and implementation 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)? - Correct answer -
Federal law that prohibits submitting a fraudulent claim or
making a false statement or representation in connection with
a claim. Also protects & rewards whistle-blowers
What is the National Correct Coding Initiative (NCCI)? -
Correct answer - Developed by CMS to promote the national
correct coding methodologies & to control improper coding
that lead to inappropriate payment of Part B health insurance
claims
How many edits does NCCI include? - Correct answer - 2:
1.Column 1/ Column 2 (previously called Comprehensive/
Component) Edits
2.Mutually Exclusive Edits
Column 1/ Column 2 edits (NCCI) - Correct answer -
Identifies code pairs that should not be billed together
, because 1 code (Column 1) includes all the services described
by another code (Column 2)
Mutually Exclusive Edits (NCCI) - Correct answer - ID's code
pairs that, for clinical reasons, are unlikely to be preformed on
the same patient on the same day
What are the possible consequences of inaccurate coding and
incorrect billing? - Correct answer - 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 medicine
Who has the task of investigate and prosecuting health care
fraud & abuse? - Correct answer - The Office of Inspector
General (OIG)
Fraud - Correct answer - 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? - Correct answer - State & Federal
agencies as well as private insurance companies
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