Upcoding - Study guides, Class notes & Summaries

The overutilization or inappropriate utilization of services and misuse of resources, typically not a criminal or intentional act is called which of the following? a. Fraud b. Abuse c. Waste d. Audit (Ans- c Waste is the overutilization or inappropriate utilization of services and misuse of resources, and typically is not a criminal or intentional act. Waste includes practice like over prescribing and ordering tests inappropriately (Foltz et al. 2016, 448). Examples of high-risk bill...

When coding a benign neoplasm of skin of the left upper eyelid, which of the following codes should be used? a. D23.12 - Other benign neoplasm of skin of left eyelid, including canthus b. D17.0 c. D23.121 - Other benign neoplasm of skin of left upper eyelid, including canthus d. D23.122 - Other benign neoplasm of skin of left lower eyelid, including canthus correct answersc. D23.121 - Other benign neoplasm of skin of left upper eyelid, including canthus A Clinical Documentation Improvem...

WCC Exam 2| 106 Questions with Verified Answers Most healthcare complaints - CORRECT ANSWER physchologist/psychiatrist bc no physical proof medicare - CORRECT ANSWER elderly medicaid for poor fraud - CORRECT ANSWER intentional criminal acts by physicians abuse - CORRECT ANSWER unintentional misuse of program funds health insurance portability act of 1996 - CORRECT ANSWER made HC fraud a federal offense 10yr-life required creation of national standards to protect patient he...

CPMA EXAM PREP TESTED QUESTIONS WITH REVISED ANSWERS When providing a prescription for a patient, the education of the patient (including side effects and supporting documentation) in the medical record that the information was reviewed is based on which of the following standards? A. Privacy standards B. OSHA standards C. Joint Commission standards D. PHI standards - ANSWER C. Joint Commission standards A deliberate misrepresentation of facts to gain unauthorized b...

B: Stand alone - There are two types of CPT codes one is add on the other is: A: Adjustment B: Stand alone C: Additions D: Single digit D: 5 digits - Basic CPT codes use how many digits: A: 2 digits B: 3 digits C: 4 digits D: 5 digits C: Tertiary care - Services provided by a specialist such as neurosurgeons and intensive care units would be termed as what type of care: A: Skilled care B: Binary care C: Tertiary care D: Primary care A: Blue shield - Which of the ...

B: Stand alone - correct answer There are two types of CPT codes one is add on the other is: A: Adjustment B: Stand alone C: Additions D: Single digit D: 5 digits - correct answer Basic CPT codes use how many digits: A: 2 digits B: 3 digits C: 4 digits D: 5 digits C: Tertiary care - correct answer Services provided by a specialist such as neurosurgeons and intensive care units would be termed as what type of care: A: Skilled care B: Binary care C: Tertiary care D: Primary ca...

Medical Billing and Coding Lesson 1: Reimbursement, HIPAA, and Compliance Already Passed The Medical Coder's Responsibility Each coding system plays a critical role in reimbursement. The role of the medical coder is to optimize payment while adhering to coding guidelines. The coder must accurately code the services, procedures, and diagnosis rendered so that the office is properly reimbursed. Coders may encounter ethical issues about upcoding a procedure or changing a diagnosis to ob...

HMO plans require the enrollee to: - To have referrals to see a specialist that is generated by the patient's PCP What are PPOs (preferred provider organizations)? - Organizations in which medical professionals and facilities provide services to subscribed clients at reduced rates. What is a covered entity? - Health plans, clearinghouses, and any entity transmitting health information is considered to be as is stated by the Privacy Rule. What are the three steps to be taken when there is a br...

There are two types of CPT codes one is add on the other is: A: Adjustment B: Stand alone C: Additions D: Single digit - Answer-B: Stand alone Basic CPT codes use how many digits: A: 2 digits B: 3 digits C: 4 digits D: 5 digits - Answer-D: 5 digits Services provided by a specialist such as neurosurgeons and intensive care units would be termed as what type of care: A: Skilled care B: Binary care C: Tertiary care D: Primary care - Answer-C: Tertiary care Which of the following is ...

RHIA domain 4 Exam with Complete Solutions The coder assigned separate codes for individual tests when a combination code exists. This is an example of which of the following? a. Upcoding b. Complex coding c. Query d. Unbundling - Answer-d. Unbundling Community Hospital implemented a clinical document improvement (CDI) program six months ago. The goal of the program was to improve clinical documentation to support quality of care, data quality, and HIM coding accuracy. Which of the follo...