Information

Question 1

NCCI

Answer 1

National Correct Coding Initiative

Question 2

NCCI purpose

Answer 2

To promote national correct coding of Medicare Part B claims

Question 3

Coding policies based on…

Answer 3

coding conventions defined in the American Medical Association’s Current Procedural Terminology (CPT) Manual
national and local policies and edits
coding guidelines developed by national societies
analysis of standard medical and surgical practices
and a review of current coding practices

Question 4

APC

Answer 4

Ambulatory Payment Classifications
the government’s method of paying facilities for outpatient services for the Medicare program; only applicable to hospitals outpatient services
-similar to DRGs which is the prospective payment system for hospital inpatients

Question 5

Federal Balanced Budget Act of 1997

Answer 5

required CMS to create a new Medicare “Outpatient Prospective Payment System” (OPPS) for hospital outpatient services

Question 6

Hard coding

Answer 6

Codes are assigned by CDM(charge description master) not an actual person

Question 7

Soft coding

Answer 7

Codes are manually assigned by coding professional

Question 8

HCCs

Answer 8

Hierarchical Condition Categories
sets of medical codes that are linked to specific clinical diagnoses

Question 9

HCCs use

Answer 9

to calculate payments to healthcare organizations for patients who are insured by Medicare Advantage (MA) plans, Accountable Care Organizations (ACOs), some Affordable Care Act (ACA) plans and many more

Question 10

RAF

Answer 10

Risk Adjustment Factor
measure of the estimated cost of an individual’s care based on their disease burden and demographic information

Question 11

SOAP

Answer 11

Subjective-information you collect directly from your patient
Objective-information the doctor collects from the encounter
Assessment-where the doctor diagnosis the patient’s condition
Plan-treatment for the patient’s concerns

Question 12

Health Level 7 (HL7)

Answer 12

set of international standards used to provide guidance with transferring and sharing data between various healthcare providers

Question 13

Clinical Data Repository/Warehouse

Answer 13

aggregates patient healthcare data from multiple locations

Question 14

Information Governance Principles for Healthcare(IGPHC)

Answer 14

A TIP CARD
-Accountability: accountable member shall oversee the program and delegate responsibility for information management to appropriate individuals
-Transparency: organization’s processes and activities should be documented in an open and verifiable manner
-Integrity: information generated by, managed for, or provided to the organization has a reasonable and suitable guarantee of authenticity and reliability
-Protection: ensure that the appropriate levels of protection from breach, corruption, and loss are provided for information that is private, confidential, secret, classified, or essential to business continuity
-Compliance: comply with applicable laws, regulations, standards, and organizational policies
-Availability: maintain information in a manner that ensures timely, accurate, and efficient retrieval
-Retention: maintain its information for an appropriate time, taking into account its legal, regulatory, fiscal, operational, and historical requirements
-Disposition: provide secure and appropriate disposition for information no longer required to be maintained by applicable laws and the organization’s policies

Question 15

CDI

Answer 15

Clinical Documentation Improvement
the process of reviewing medical record documentation for completeness and accuracy; includes a review of disease process, diagnostic findings, and what the documentation might be missing

Question 16

Clinical documentation

Answer 16

entries made by a provider or clinical staff member who is responsible for the patient’s care during a face-to-face visit