Ophthalmic Coding Specialist Study Questions

Category - Opthalmological Coding Certification Practice Test

Medical billing fraud is:
  1. Billing for services at a reduced level
  2. Billing correctly for services performed
  3. Billing for services that are not medically necessary
  4. Billing for services that were not performed
Explanation
Answer: D - Medical billing fraud is billing for services that were not performed in the office. An example would be billing for an office visit for a patient who never came into the office. Medical billing abuse is billing for services that were not medically necessary. An example of medical billing abuse would be billing a high-level E&M service when only a low-level E&M service was performed.
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