NHA Module 1: The Revenue Cycle and
Regulatory Compliance Questions
1. A billing and coding professional is getting ready to code an anesthesiologist's part of a
system. The professional need to be able to identify the best begin/prevent instances to
code the claim efficiently. Which of the subsequent regulated this activity? - ANS-CPT
Guidelines
2. A billing and coding specialist is processing claims. Which of the following must the
expert perceive for instance of fraud? - ANS-Upcoding for multiplied repayment
3. A billing and coding professional is speaking with a affected person on the phone about
their plan blessings. Which of the subsequent movements ought to the expert take while
communicating with the patient? - ANS-Explain affected person economic obligation
4. A billing and coding specialist notices that a issuer is reporting the equal code for all new
patient visits to her higher reimbursements. The specialist need to identify this as which
of the subsequent? - ANS-Fraud
5. A billing and coding professional must perceive that a Medicare Recovery Audit
Contractor (RAC) Can evaluate medical statistics for which of the following motives? -
ANS-To investigate capacity flawed Medicare bills
6. A billing and coding specialist have to identify that the Office of Inspector General (OIG)
has which of the following roles? - ANS-To discover Medicare fraud and abuse
7. A billing and coding expert should discover that which if the following files assists
carriers in determining whether or not there are any amazing claims? - ANS-Aging report
8. An insurance plan is issued to which of the subsequent entities? - ANS-policyholder
9. During which of the following steps of the sales cycle does effective verbal exchange
start? - ANS-Registration and Scheduling
10. HIPPA pointers consist of that PHI can't be used or disclosed without patient permission.
What are three instances whilst affected person information may be disclosed? -
ANS-Treatment, fee, and fitness care operations
11. How can a compliance program help an organisation? - ANS-By supplying the steering
and shape had to meet the goals of compliance.
12. The venture of passwords to legal customers to permit get entry to to medical records is
a form of which of the subsequent? - ANS-security
13. The False Claims Act addresses which if the following sorts of sports? - ANS-Fraudulent
14. What are the differences between fraud and abuse? - ANS-Fraud is intentionally looking
ahead to a fee on a declare whilst the company is aware about wrongdoing, billing for
services that were not provided. Abuse is when the issuer unknowingly or by accident
misrepresented statistics on a claim for compensation.
15. What does the time period adjudication imply in health care? - ANS-The act of
determining financial obligation of declare costs a number of the stakeholders
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