Title: Explain the effect of contractual agreements and forms, including the CMS 1500 and UB-04 forms.
Course: Medical Coding and Billing II (14151-IV) > Section: Applying Coding and Billing to Medical Diagnosis and Procedures

Explanation should include

- participation vs. nonparticipation
- reimbursement agreements
- interpretation of remittance advice
- criminal consequences
- role of the Office of the Inspector General and complete background checks.

Process/Skill Questions:

- How does reimbursement differ between participating and nonparticipating programs?
- What safety mechanisms are in place to alert employers to fraudulent activities?