Certified Medical Coding Specialist Technology & Digital Applications 3 — Questions and Answers
Question 1: What is the purpose of a 'scrubber' in medical billing software?
- To remove duplicate patient records from the database
- To automatically check claims for errors before submission to payers (Correct answer)
- To encrypt patient data for HIPAA compliance
- To convert ICD-10 codes to ICD-9 for legacy payers
Correct answer: To automatically check claims for errors before submission to payers
A claim scrubber analyzes claims for coding errors, missing information, and payer-specific rule violations before submission to reduce denials.
Question 2: Which HIPAA transaction standard is used for electronic eligibility and benefit inquiry?
- X12 270/271 (Correct answer)
- X12 835
- X12 837
- X12 276/277
Correct answer: X12 270/271
The X12 270 (inquiry) and 271 (response) transaction set is the HIPAA standard for verifying a patient's insurance eligibility and benefits electronically.
Question 3: A coder receives a remittance advice (ERA) with remark code CO-4. What does this typically indicate?
- Claim was paid in full
- The procedure code is inconsistent with the modifier used (Correct answer)
- Patient deductible not met
- Duplicate claim submission
Correct answer: The procedure code is inconsistent with the modifier used
CO-4 is a CARC (Claim Adjustment Reason Code) indicating the procedure code is inconsistent with the modifier or requires a different modifier for billing.
Question 4: What is the function of a 'superbill' in a medical practice's digital workflow?
- A monthly summary of all outstanding patient balances
- A document listing services rendered during a visit used to generate charges (Correct answer)
- An electronic prior authorization request form
- A payer-specific fee schedule
Correct answer: A document listing services rendered during a visit used to generate charges
A superbill (encounter form) is a structured document completed after a visit listing diagnoses and procedures, serving as the source for charge entry into the PMS.
Question 5: Which technology allows real-time data exchange between EHR systems using modern web standards, as mandated by ONC?
- HL7 v2 messaging
- FHIR (Fast Healthcare Interoperability Resources) (Correct answer)
- X12 EDI transactions
- DICOM imaging protocol
Correct answer: FHIR (Fast Healthcare Interoperability Resources)
FHIR is the modern ONC-endorsed standard using RESTful APIs to enable real-time, standardized data exchange between healthcare systems.
Question 6: When a provider's EHR system sends a lab result to a specialist's system, which interoperability framework is MOST commonly used?
- HIPAA EDI
- HL7 messaging (Correct answer)
- CMS-1500 form data
- NPI registry lookup
Correct answer: HL7 messaging
HL7 (Health Level 7) messaging standards, including v2 and FHIR, are the predominant frameworks for exchanging clinical data like lab results between systems.
Question 7: A computer-assisted coding (CAC) system assigns a code that the coder disagrees with after reviewing the documentation. The coder should:
- Accept the CAC code because the system is more accurate
- Override the code with the correct code and document the reason (Correct answer)
- Submit the claim with both codes and let the payer decide
- Flag the chart for a physician to choose the code
Correct answer: Override the code with the correct code and document the reason
Coders retain professional responsibility for final code assignment; CAC suggestions must be reviewed and overridden when incorrect, with the change documented.
Certified Medical Coding Specialist Technology & Digital Applications 3
What is the purpose of a 'scrubber' in medical billing software?