HEIT 1240 - Chapter 12

Front

What term describes the act of assigning a procedure code that provides a higher reimbursement rate than the correct code?

Back

upcoding

Front

What term is used when a health care provider misuses codes on a claim, such as upcoding and coding errors, on a level that is widespread and ongoing?

Back

fraud

Front

Where are commercial insurance payers' guideline states for a quick reference (some of which may be the same as Medicare guidelines)? Options: plan summary sheet, bundling codes, CPT coding conventions, CCI edits

Back

plan summary sheet

Front

Which set of edits corrects coding mistakes based on anatomic considerations, CPT or HCPCS code descriptors, CPT coding instructions, Medicare policies, or questionable services?

Back

Medically Unlikely Edits

Front

Which type of audit has investigators that examine records and claims for compliance with regulations and guidelines by evaluating elements such as (but not limited to) code linkage and adherence to coding and documentation standards?

Back

external