chapter 10 coding compliance

Question 1

ASSESSMENT

Answer 1

CONTAINS THE DIAGNOSTIC STATEMNT AND MAY INCLUDE THE PROVIC=DERS RATIONALE FOR DIAGNOSIS

Question 2

AUDITING PROCESS

Answer 2

REVIEW OF PATIENT RECORDS AND CMS 1500 CLAIMS TO ASSESS CODING ACCURACY AND WHETHER DOCUMENTATION IS COMPLETE

Question 3

CLINICAL DOCUMENTATION IMPROVEMENT

Answer 3

ENSURES ACCURATE AND THORIUGH DOCUMENTATION IN PATIENT RECORDS THROUGH THE IDENIFICATION OF DISCREPANCIES BETWEEN PROVIDER DOCUMENTATION AND CODES TO BE ASSIGNED

Question 4

CLINICAL DOCUMENTATION INTEGRITY

Answer 4

ENSURES ACCURATE AND THOROUGH DOCUMENTATION IN PATIENT RECORDS THROUGH THE IDENTIFICATION OF DISCREPANCIES BETWEEN PROVIDER DOCUMENTATION AND CODES TO BE ASSIGNED

Question 5

CODING COMPLIANCE

Answer 5

CONFORMITY TO ESTABLISHED CODING GUIDELINES AND REGULATIONS

Question 6

CODING COMPLIANCE PROGRAM

Answer 6

DEVELOPED BY HEALTH INFORMATION MANAGEMENT DEPARTMENTS AND SIMILAR AREAS SUCH AS THE CODING AND BILLING SECTION OF A PHYSICIANS PRACTICE TO ENSURE CODING ACCURACY AND CONFORMANCE WITH GUIDELINES AND REGULATIONS

Question 7

CODING FOR MEDICAL NECESSITY

Answer 7

INVOLVES ASSSIGING ICD 10 CM CODES TO DIAGNOSES AND CPT HCPCS LEVEL II CODES TP PROCEDURE SERVICES AND THEN MATHCHING AN APPROPRIATE ICD 10 CM CODE WITH EACH CPT OR HCPCS LEVEL II CODE

Question 8

COMPLIANCE PROGRAM GUIDANCE

Answer 8

DOCUMENTS PUBLISHED BY THE DHHS OIG TO ENCOURAGE THE DEVELOPMENT AND USE OF INTERNAL CONTROLS BY HEALTH CARE ORGANIZATIONS

Question 9

LOCAL COVERAGE DETERMINATION

Answer 9

FORMERLY CALLED LOCAL MEDICAL REVIEW POLICY MEDICARE ADMINISTRRAVIE CONTRACTORS CREATE EDITS FOR NATIONAL COVERAGE DETERMINATION RULES THA TARE CALED LCDS

Question 10

MEDICALLY MENAGED

Answer 10

PARTICULAR DIAGNOSIS MAY NOT RECEIVE DIRECT TREATMENT DURING AN OFFICE VISIT BUT THE PROVIDER HAD TO CONSIDER THAT DIAGNOSIS WHEN CONSIDERING TREATMENT FOR OTHE CONDITIONS

Question 11

MEDICALLY UNLIKELY EDIT

Answer 11

UDED TO COMPARE UNITS OF SERVICE UOS WITH CPT AND HCPCSLEVEL II CODES REPORTED ON CLAIMS INDICATES THE MAXIMUM NUMBER OF UOS ALLOWABLE BY THE SAME PROVIDER FOR THE SAME BENFICIARY ON THE SAME DATE OF SERVICE UNER MOST CIRCUMSTANCES

Question 12

MEDICARE COVERAGE DATABASE

Answer 12

USED BY MEDICARE ADMINISTRATIVE CONTRACORS PROVIDERS AND OTHER HEALTH CARE INDUSTRY PROFESSIONALS TO DETERMINE WHETHER A PROCEDURE OR SERVICE IS REASONABLE AND NECCESSARY FOR TEH DIAGNOSIS OR TREATMETN OF AN ILLNESS OR INJURY

Question 13

MEDICARE CODE EDITOR

Answer 13

SOFEWORE PROGRAM USED TO DETECT AND REPORT ERRORS IN ICD 10 CM CODED DATA DURING PROCESSING OF INPATIENT HOSPITAL MEDICARE CLAIMS

Question 14

NARRATICE CLINIC NOTE

Answer 14

USE PARAGRAPGH FORMATE TO DOCUMENT HEALTH CARE

Question 15

NATIONAL COVERAGE DETERMINATION

Answer 15

RULES DEVELOPED BY CMS THAT SPECIFY UNDER WHAT CLINICAL CIRCUMSTANCES CONSIDERED RESONABLE AND NECCESSARY AND CORRECTLY CODED

Question 16

OBJECTIVE

Answer 16

DOCUMENTATION OF MEASURABLE OR OBJECTIVE OBSERVATIONS MADE DURING PHYSICAL EXAMINATION AND DIAGNOSTIC TESTING

Question 17

OPERATIVE REPORT

Answer 17

CARIES FORM A SHORT NARRATIVE DESCRIPTION OF A MINOR PROCEDURE THAT IS PERFORMED IN THE PHYISCIANS OFFICE TO A MORE FORMAL REPORT DICTED BY THE SURGEON IN A FORMAT E REQUIRED BY THE HOSPITALS AND AMMBULATORY SURGICAL CENTERS

Question 18

OUTPATIENT CODE EDITOR

Answer 18

SOFTWARE THAT EDITS OUTPATIENT CLAIMS SUBMITTED BY HOSPITALS COMMUNITY MENTAL HEALTH CENTERS COMPREHENSIVE OUTPATIENT REHABILITATION FACILITIES AND HOME HEALTH AGENCIES

Question 19

PLAN

Answer 19

STATEMENT OF THE PHYSICIANS FUTURE PLANS FOR THE WORK UP AND MEDICAL MANAGEMENT OF THE CASE

Question 20

PROCEDURE TO PROCEDDURE CODE PAIR EDITS

Answer 20

AUTOMATED PREPAYEMNT NCCI EDITS THAT PREVENT IMPROPER PAYMENT WHEN CERTAIN CODES ARE SUBMITTED TOGETHER FOR MEDICARE PART B COVERVED SERVICES

Question 21

SOAP NOTE

Answer 21

OUTLINE FORMATE FOR DOCUMENTING HEALTH CARE SOAP IS AN ACRONYM DERIVED FROM THE FIRST LETTER OF THE HEADINGS USED IN THE NOTE`

Question 22

SUBECTIVE

Answer 22

PART OF THE NOTE TAHT CONTAINS THE CHIEF COMPLAINT AND THE PATIENTS DESCRIPTION OF THE PRESENTING PROBLEM

Question 23

CODING COMPLIANCE PROGRAMS

Answer 23

DEVELOPED BY HEALTH INFORMATION MANAGEMENT DEPARTMENTS AND SIMILARE AREAS SUCH AS CODING AND DILLING SECITON OF A PHYSICANS PRACTICE TO ENSURE CODING ACCURACY

Question 24

NATIONAL COVERAGE DETERMAINATIONS

Answer 24

RULES DEVELOPED BY CMS THAT SPECIFY UNDER WHAT CLINICAL CIRCUMSTANCES A SERVICE OR PROCEDURE IS COVERED

Question 25

LOCAL COVERAGE DETERMINATIONS

Answer 25

MEDICARE ADMINSTRATIVE CONTRACTORS CREATE EDITS FOR NATIONAL COVERAGE DETERMINATIONS

Question 26

MEDICALLY UNLIKELY EDITS

Answer 26

USED TO COMPARE UNITS OF SERVICE UOS WITH CPT AND HCPCS LEVEL III CODES REPORED ON CLAIMS

Question 27

CLINICLA DOCUMENTATION IMPROVEMENT

Answer 27

ENSURES ACCURATE AND THORUGH DOCUMENTATAION IN PATIENT RECOREDS THROUGH THE IDENIFICATIONS OF DISCREPANCIES BETWEEEN PROVIDER DOCUMENTATION AND CODES TO BE ASSIGNED

Question 28

OPERATAIVE REPORTS

Answer 28

VARIES FORM A SHORT NARRATIVE DESCRIOTION OF A MINOR PROCEDURE THAT IS PERFORMED INA PHYSICIANS OFFICE TO A MORE FORMAL REPORT DICATED BY THE SURGEON IN A FORMAT REQUIRED BY THE HOSPITALS AND AMBULATORY SURGICLA CENTERS