How Medical Coding Affects Payment Process

A claim can be denied if the medical codes are incorrect or incomplete.

• True

• False

A medical coder is rushing and enters a CPT code for a minor procedure instead of a more complex one that was actually performed. What is a possible consequence?

• Overpayment to the clinic.

• Legal action by the government.

• The clinic may receive less money than deserved.

• The patient will be billed directly.

A patient receives a series of related procedures that are typically billed together as a bundle (a group of related medical services that are combined and billed together as one package), but the provider bills each procedure separately. What is the possible impact of this action?

• Increased reimbursement for the provider

• Decreased reimbursement for the provider

• No change in reimbursement

• Medical claim could be denied

• Potential for audit and penalties

A patient visits a clinic for a routine check-up, but the provider bills for a comprehensive exam instead. What is the impact of this action?

• Increased reimbursement for the provider

• Reimbursement denied

• Potential for audit and penalties

• Decreased reimbursement for the provider

• No change in reimbursement

Using outdated code books is a problem because:

• It may lead to incorrect coding and affect payments.

• It ensures all payments are accurate.

• It has no impact on payment processing.

• It speeds up the payment process.