Missed Practice Questions Flashcards
What organization is responsible for updating procedure classification of ICD-10-PCS?
Centers for Medicare and Medicaid Services (CMS)
In ICD-10-CM, a condition that is produced by another illness or an injury and remains after the acute phase of the illness or injury is called?
Sequela
What does the forth character of an ICD-10-CM diagnosis code capture?
Etiology
If a procedure is performed on a body part that does not have a specific value in ICD-10-PCS, what two resources can be used to identify the correct body part character to assign?
ICD-10-PCS alphabetic index and ICD-10-PCS body part key
What are the purposes and goals of ICD-10-PCS?
Improve accuracy and efficiency of coding; Reduce training efforts; and Improve communication with physicians
The assignment of a diagnosis code is based on what?
The providers statement that the patient has a particular condition
What does Medicare require to identify a wound closed with tissue adhesives?
A Level II HCPCS code
What type of hospital is excluded from Medicare inpatient prospective payment system?
Children’s hospitals
What hospital is not reimbursed according to the Medicare outpatient prospective payment system?
Critical access hospitals
What form would a health record technician use to perform the billing function for a physician’s office?
CMS-1500
When a provider accepts assignment, this means the ….?
Provider agrees to accept as payment in full the allowed charge from the fee schedule
What is the goal of coding compliance?
To reduce liability in regards to fraud and abuse
What are NCCI automated prepayment edits based on?
Coding conventions defined in CPT book; National and local policies and coding edits; and analysis of standard medical and surgical practice
What is the NCCI editing system used in processing OPPS claims called?
Outpatient code editor (OCE)
Denials of outpatient claims are often generated from what edits?
National Correct Coding Initiative (NCCI); Outpatient code editor (OCE); and national and local policies
What are essential data elements for healthcare insurance claims?
Revenue code; Procedure name; and Provider name
CMS has made significant advances to link quality to reimbursement using …… programs, which provide accountability by healthcare providers?
Value-based purchasing (VBP)
What is the pre-MDC assignment based on?
A defined set of ICD-10-PCS procedures
What is the government sponsored program that provides expanded coverage of many healthcare services including HMO plans, PPO plans, special needs plans, and Medical Savings accounts?
Medicare Advantage
What system reimburses hospitals a predetermined amount for each Medicare inpatient admission?
MS-DRG
What did CMS implement in 2004 to provide fair and accurate payments while rewarding efficiency and high-quality care for Medicare’s chronically ill population?
Hierarchical condition categories (CMS-HCCs)
Reviewing the health record for missing signatures, missing medical reports, and ensuring that all documents belong in the health record is an example of what type of review?
Quantitative
What is a defining characteristic of an integrated health record format?
Components are arranged in strict chronological order
What is a goal of a CDI program?
Identify and clarify missing, conflicting, or nonspecific physician documentation related to diagnoses and procedures
What doe using uniform terminology improve?
Data reliability
What is a record of all transactions in the computer system that is maintained and reviewed for unauthorized access called?
Audit trail
Who issues compliance program guidance?
OIG (Office of the Inspector General)
The charge description master coordinator’s tasks include planning for a review of payment system rules and ….?
Incorporation of CMS rule changes into the CDM
What was created in 2009 to prevent waste, fraud and abuse, reduce healthcare costs, and improve the quality of care provided to Medicare patient?
The Health Care Fraud Prevention Team (HEAT)