Question

17) เส) 19) In your onn 5. Dafferentiate Ietween fraud and abuse What can be the cossequences of coding fraud and abuse 16 17 How are changes to the ICD manual made public? IS. Discuss the effects of upcoding and downcoding 19. How can the medical assistant help prevent delays in reimburnement and denial of paymen 30. What is the parpose of "claim scrubbers 21. When a clearinghouse sends a confirnation report, what should the medical biller do? 233

Answer 1

14. Name 19 pieces of information required in Section 3 of the claim form
1. date of current illness
2. whether the patient has had same or similar symptoms
3. From-To dates if the patient has been unable to work
4. name of referring provider and NPI
5. From-To dates if patient encounter included inpatient hospital visit
6. additional claim information
7. whether an outside laboratory was used
8. ICD-10-CM diagnosis code
9. reference to possible prior Medicaid claim
10. prior authorization
11. From-To dates of current encounter
12. CPT/HCPCS codes, place of service, diagnosis reference, charge amount
13. NPI of provider
14. provider's EIN or SSN
15. patient's account number with treating provider
16. assignment accepted
17. total charges
18. address of the facility
19. provider signature

15
Fraud is the conscious intent to defraud an entity
Abuse is an inadvertant or unethical action
16.
nonpayment of claims
civil monetary penalties
exclusion from the payer program
criminal and civil liability
jail time
17.
the Federal Register announces the changes annually
18.
upcoding - coding to a higher specificity than necessary. Effects: fraud
downcoding - coding to a lower specificity than necessary. Effects: lower reimbursement
19.
by following third-party guidelines and auditing the claims before submission
20.
software that automatically corrects some common billing errors
21.
always reconcile the claims submitted through the software with the claims listed on the confirmation report
How many business days does it take for th