If Providers Submit a Claim for a Simple Procedure When

question 36

Multiple Choice

If providers submit a claim for a simple procedure when in fact a more complicated procedure was documented in the medical record, ____ may occur.

• A) no payment
• B) underpayment
• C) overpayment
• D) denial of claim
• E) recovery audit

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Definitions:

R-chart

A type of control chart used for monitoring the range of variation within a sample.

Sampling Distribution

The probability distribution of a given statistic based on a random sample, used to make inferences about the population.

R-chart

A control chart used for monitoring the variability of a process.

Control Limits

Boundaries in process control, within which a process operates efficiently, used to detect signals or causes of variations that could indicate a problem.