Insurance And Medical Coding Test Prep

1. Which of the following rightly defines Medical billing fraud?

Billing for services that were not performed

Billing for services that are not medically necessary

Billing for services at a reduced level

Billing correctly for services performed

Medical billing fraud is defined as the act of billing for services that were not actually performed. This means that healthcare providers or billing companies are falsely claiming payment for services that were never provided to patients. This type of fraud can involve submitting claims for procedures, tests, or treatments that never took place, leading to illegal financial gain for the fraudulent party. It is a serious offense and can result in legal consequences for those involved.

Explanation

Medical billing fraud is defined as the act of billing for services that were not actually performed. This means that healthcare providers or billing companies are falsely claiming payment for services that were never provided to patients. This type of fraud can involve submitting claims for procedures, tests, or treatments that never took place, leading to illegal financial gain for the fraudulent party. It is a serious offense and can result in legal consequences for those involved.

2. What was HIPAA created to do?

Create standards of electronic transactions

Protect patient privacy

Enact ways to uncover fraud and abuse

All of the above

HIPAA, or the Health Insurance Portability and Accountability Act, was created to achieve multiple objectives. Firstly, it aimed to establish standards for electronic transactions in healthcare, ensuring efficient and secure exchange of health information. Secondly, it aimed to protect patient privacy by setting guidelines for the confidentiality and security of personal health information. Lastly, it aimed to combat fraud and abuse within the healthcare system by implementing measures to detect and prevent fraudulent activities. Therefore, the correct answer is "All of the above".

Explanation

HIPAA, or the Health Insurance Portability and Accountability Act, was created to achieve multiple objectives. Firstly, it aimed to establish standards for electronic transactions in healthcare, ensuring efficient and secure exchange of health information. Secondly, it aimed to protect patient privacy by setting guidelines for the confidentiality and security of personal health information. Lastly, it aimed to combat fraud and abuse within the healthcare system by implementing measures to detect and prevent fraudulent activities. Therefore, the correct answer is "All of the above".

3. An internal audit has a purpose for which it done. What is that purpose?

It allows patients to make sure they were not overcharged for their office visit co pays

It allows Medicare to go through your charges to make sure that they are reasonable

It allows the coders and billers in your office to make sure your claims were billed correctly

It allows an outside agency to see your records to make sure that the patients were billed correctly

Internal audit is conducted within an organization to ensure that the claims made by the coders and billers are accurate and billed correctly. It helps in identifying any errors or discrepancies in the billing process and ensures compliance with coding and billing regulations. The purpose of an internal audit is not related to patients checking their co-pays, Medicare reviewing charges, or an outside agency verifying billing accuracy.

Explanation

Internal audit is conducted within an organization to ensure that the claims made by the coders and billers are accurate and billed correctly. It helps in identifying any errors or discrepancies in the billing process and ensures compliance with coding and billing regulations. The purpose of an internal audit is not related to patients checking their co-pays, Medicare reviewing charges, or an outside agency verifying billing accuracy.

4. When should Tricare Prime patients see physicians?

At their typical private practice doctor’s office

Whenever their commander asks them to

At their military treatment facility

Whenever they feel like it

Tricare Prime patients should see physicians at their military treatment facility. This is because Tricare Prime is a managed care option offered to active duty service members and their families, and it requires patients to receive most of their care from military treatment facilities. These facilities are specifically designed to cater to the healthcare needs of military personnel and their dependents, ensuring that they receive appropriate and specialized care. Therefore, it is recommended for Tricare Prime patients to seek medical attention at their military treatment facility.

Explanation

Tricare Prime patients should see physicians at their military treatment facility. This is because Tricare Prime is a managed care option offered to active duty service members and their families, and it requires patients to receive most of their care from military treatment facilities. These facilities are specifically designed to cater to the healthcare needs of military personnel and their dependents, ensuring that they receive appropriate and specialized care. Therefore, it is recommended for Tricare Prime patients to seek medical attention at their military treatment facility.

5. Which of the following refers to a radiographic image of the interior of a colon?

Colonoscopy

Colonography

Cholangiography

Duodenoscopy

Colonography refers to a radiographic image of the interior of a colon. This procedure is used to detect abnormalities, such as polyps or tumors, in the colon. It involves the use of a contrast agent and specialized imaging techniques to create detailed images of the colon. Colonography is often used as a less invasive alternative to colonoscopy for screening and diagnosing colon-related conditions. Cholangiography is a procedure used to visualize the bile ducts, while duodenoscopy is used to examine the duodenum.

Explanation

Colonography refers to a radiographic image of the interior of a colon. This procedure is used to detect abnormalities, such as polyps or tumors, in the colon. It involves the use of a contrast agent and specialized imaging techniques to create detailed images of the colon. Colonography is often used as a less invasive alternative to colonoscopy for screening and diagnosing colon-related conditions. Cholangiography is a procedure used to visualize the bile ducts, while duodenoscopy is used to examine the duodenum.

6. Meningitis and encephalitis are terms that seem similar but are different What is that difference?

Meningitis is the inflammation of the lining of the brain and encephalitis is the swelling of the spinal cord

Meningitis is a respiratory infection and encephalitis is the inflammation of the nervous system

Meningitis is the inflammation of the spinal cord, and encephalitis is the inflammation of the lining of the brain

Meningitis is the inflammation of the lining of the brain and encephalitis is the inflammation of the brain

not-available-via-ai

Explanation

not-available-via-ai

7. What does the GPCI take into account when it involves the RBRVS calculation?

The malpractice risk of a procedure

The overhead cost of the practice

The type of provider specialty

The geographic location of a practice or provider

The GPCI (Geographic Practice Cost Index) takes into account the geographic location of a practice or provider when it involves the RBRVS (Resource-Based Relative Value Scale) calculation. This means that the cost of practicing medicine can vary depending on the location, as certain areas may have higher overhead costs or different malpractice risk levels. Therefore, the GPCI considers the geographic location as an important factor in determining the reimbursement rates for medical services.

Explanation

The GPCI (Geographic Practice Cost Index) takes into account the geographic location of a practice or provider when it involves the RBRVS (Resource-Based Relative Value Scale) calculation. This means that the cost of practicing medicine can vary depending on the location, as certain areas may have higher overhead costs or different malpractice risk levels. Therefore, the GPCI considers the geographic location as an important factor in determining the reimbursement rates for medical services.

8. On a claim, it is neccessary to include ICD-9 codes. What is the reason for this?

They are the services that are charged for on the claim

They indicate the medical necessity of the service

They indicate the code linkage on the claim

They report the procedures performed on the patient

ICD-9 codes are necessary to include on a claim because they indicate the medical necessity of the service. These codes provide specific information about the diagnosis or condition for which the service was provided. By including the ICD-9 codes, it helps to justify why the service was necessary and supports the claim for reimbursement. It also helps in ensuring accurate and appropriate coding and billing practices.

Explanation

ICD-9 codes are necessary to include on a claim because they indicate the medical necessity of the service. These codes provide specific information about the diagnosis or condition for which the service was provided. By including the ICD-9 codes, it helps to justify why the service was necessary and supports the claim for reimbursement. It also helps in ensuring accurate and appropriate coding and billing practices.

9. The dividing of the repair codes of Diaphragmatic hernia are based on which of the following?

The age of the patient and the site of the hernia

The stage of the hernia and the site of the hernia

The age of the patient and whether or not the hernia is acute or chronic

The age of the patient and whether or not mesh was used

The correct answer is the age of the patient and whether or not the hernia is acute or chronic. This is because the repair codes for diaphragmatic hernia are divided based on the age of the patient and the acuteness or chronicity of the hernia. This classification helps in determining the appropriate treatment approach and surgical procedure for the patient.

Explanation

The correct answer is the age of the patient and whether or not the hernia is acute or chronic. This is because the repair codes for diaphragmatic hernia are divided based on the age of the patient and the acuteness or chronicity of the hernia. This classification helps in determining the appropriate treatment approach and surgical procedure for the patient.

10. What is the correct code for a procedure carried out by a physician by excising the head of the humeral bone and replacing it with the neccessary or right implant?

23470

23195

23472

23195, 23470

The correct code for the procedure described is 23470. This code specifically refers to the excision of the head of the humeral bone and the replacement with the necessary or appropriate implant. The other codes listed, 23195 and 23472, do not specifically mention the excision and replacement of the head of the humeral bone, making them incorrect choices. The combination of codes 23195 and 23470 is also not necessary, as 23470 alone covers the entire procedure.

Explanation

The correct code for the procedure described is 23470. This code specifically refers to the excision of the head of the humeral bone and the replacement with the necessary or appropriate implant. The other codes listed, 23195 and 23472, do not specifically mention the excision and replacement of the head of the humeral bone, making them incorrect choices. The combination of codes 23195 and 23470 is also not necessary, as 23470 alone covers the entire procedure.