CCA Exam Prep from AHIMA Flashcards

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Questions and Answers

What process determines how a claim will be reimbursed based on the insurance benefit?

Allowance

Transaction

Processing

Adjudication (correct)

What part of Medicare covers physician services, outpatient care and home healthcare?

Part A

Part C

Part B (correct)

Part D

The case mix can be figured by multiplying the relative weight of each MS-DRG by the number of ________ within that MS-DRG.

Admissions

Computer software programs that assist in the assignment of codes used with diagnostic and procedural classifications are called:

Encoders Signup and view all the answers

Common forms of fraud and abuse include all of the following except:

Refiling claims after denials Signup and view all the answers

Where would information on treatment given on a particular encounter be found in the health record?

Progress notes Signup and view all the answers

To comply with HIPAA, under usual circumstances, a covered entity must act on a patient's request to review or copy his or her health information within ________ days.

30 Signup and view all the answers

What is the name of the organization that develops the billing form that hospitals are required to use?

National Uniform Billing Committee (NUBC) Signup and view all the answers

What is the expectation of the hospital in relation to the OIG work plan?

Hospitals should plan their compliance and auditing projects around the OIG work plan to ensure they are in compliance with the target areas in the plan. Signup and view all the answers

Calling out patient names in a physician's office is:

An incidental disclosure Signup and view all the answers

The following is documented in an acute-care record: 'Atrial fibrillation with rapid ventricular response, left axis deviation, left bundle branch block.' Where would this documentation be found?

ECG report Signup and view all the answers

Which of the following situations would be identified by the NCCI edits?

Billing for two services that are prohibited from being billed on the same day Signup and view all the answers

An advantage of computer-assisted coding (CAC) is:

Increased coding productivity Signup and view all the answers

A patient is admitted for chest pain with cardiac dysrhythmia to Hospital A. The appropriate ICD-10-CM codes and sequencing for both hospitalizations must be determined.

Hospital A: I21.19, I48.91; Hospital B: I22.1, I48.91, 021209W Signup and view all the answers

A patient requests copies of her personal health information on CD. What should the hospital respond?

Provide the medical records in paper format Signup and view all the answers

The ________ is a type of coding that is a natural outgrowth of the EHR.

Computer-assisted coding Signup and view all the answers

What does data definition refer to?

Meaning of data Signup and view all the answers

The CIA of security includes confidentiality, data integrity, and data ________.

Availability Signup and view all the answers

Written or spoken permission to proceed with care is classified as:

Expressed consent Signup and view all the answers

Who is responsible for ensuring the quality of health record documentation?

Provider Signup and view all the answers

What quality element is missing from Mrs. Smith's health record regarding her birth date?

Data consistency Signup and view all the answers

HIT professionals must have knowledge of:

Laws affecting the use of disclosure of health information Signup and view all the answers

Documentation in the history of use of drugs, alcohol, and tobacco is considered as part of the:

Social history Signup and view all the answers

Which character in an ICD-10-CM diagnosis code provides information regarding encounter of care?

Seventh Signup and view all the answers

This document includes a microscopic description of tissue excised during surgery:

Pathology report Signup and view all the answers

Assignment of benefits is a contract between a physician and Medicare in which the physician agrees to bill Medicare directly for covered services and the beneficiary for ________.

Coinsurance or deductible Signup and view all the answers

To help clarify terms that currently have overlapping meaning, ICD-10-PCS has defined root operations. What is an example of the root operation of Excision?

Partial nephrectomy Signup and view all the answers

Patient data collection requirements vary according to healthcare setting. One would expect which of the following data elements would be collected in the MDS, but would not be collected in the UHDDS?

Cognitive patterns Signup and view all the answers

Which part of the problem-oriented medical record is used by many facilities that have not adopted the whole problem-oriented format?

SOAP form of progress notes Signup and view all the answers

Which of the following contains the physician's findings based on an examination of the patient?

Physical examination Signup and view all the answers

Which of the following is not an accepted accrediting body for behavioral healthcare organizations?

American Psychological Association Signup and view all the answers

Dr. Jones has signed a statement that all of her dictated reports should be automatically considered approved and signed unless she makes corrections within 72 hours of dictating. What is this called?

Autoauthentication Signup and view all the answers

What reimbursement system uses the Medicare fee schedule?

RBRVS Signup and view all the answers

A notation for a hypertensive patient in a physician ambulatory care progress note reads: 'Blood pressure adequately controlled.' Which part of a POMR progress note would this notation be written?

Assessment Signup and view all the answers

This person designs, implements, and maintains a program that ensures conformity to all types of regulatory and voluntary accreditation requirements governing the provision of healthcare products or services:

Compliance Officer Signup and view all the answers

What penalties can be enforced against a person or entity that willfully and knowingly violates the HIPAA Privacy Rule with the intent to sell, transfer, or use PHI for commercial advantage, personal gain, or malicious harm?

A fine of not more than $250,000, not more than 10 years in jail, or both Signup and view all the answers

In hospitals, automated systems for registering patients and tracking their encounters are commonly known as ________ systems.

ADT Signup and view all the answers

Which statement fails to be true for Medicare coverage?

Medicare pays for healthcare services provided to Social Security beneficiaries for new moms 65 years and younger and their newborn babies. Signup and view all the answers

A 7-year-old patient was admitted to the emergency department for treatment of shortness of breath. What diagnosis should be suspected?

Asthma with status asthmaticus Signup and view all the answers

The right of an individual to keep information about himself or herself from being disclosed to anyone is a definition of:

Privacy Signup and view all the answers

The OIG believes that compliance programs have benefits in addition to submitting accurate claims. This includes all of the following except:

Increased potential for criminal and unethical conduct Signup and view all the answers

Which of the following fails to meet the CMS classification of a hospital-acquired condition?

Gram-negative pneumonia Signup and view all the answers

Data security refers to:

Controlling access Signup and view all the answers

MS diagnostic-related groups are organized into:

Major diagnostic categories Signup and view all the answers

An encoder that takes a coder through a series of questions and choices is called a(n):

Logic-based encoder Signup and view all the answers

What is the first resource Mary Smith, RHIA, should use to design a data collection form for patient admission?

UHDDS Signup and view all the answers

When the CCI editor flags that a comprehensive code and a component code are billed together for the same beneficiary on the same date of service, which will Medicare pay for?

The component code but not the comprehensive code Signup and view all the answers

Which statement is not one of the outcomes that can occur as part of auto-adjudication?

Auto-calculate Signup and view all the answers

Which of the following is not a way that ICD-10-CM improves coding accuracy?

Increases cross-referencing Signup and view all the answers

Which organization is responsible for updating the procedure classification of ICD-10-PCS?

Centers for Medicare and Medicaid Services (CMS) Signup and view all the answers

This program was initiated by the Balanced Budget Act of 1997 to cover children up to age 19.

State Children's Health Insurance Program (SCHIP) Signup and view all the answers

Which document provides a complete description to patients about how PHI is used in a healthcare facility?

Notice of Privacy Practices Signup and view all the answers

The National Correct Coding Initiative was developed to control improper coding leading to inappropriate payment for which claims?

Part B Medicare claims Signup and view all the answers

Which software application would be used to aid in the coding function in a physician's office?

Encoder Signup and view all the answers

What is the maximum number of diagnosis codes that can appear on the UB-04 paper claim form locator 67 for a hospital inpatient principal and secondary diagnoses?

18 Signup and view all the answers

What are the conditions identified by CMS that are not present on admission and could be 'reasonably preventable' called?

Hospital-acquired conditions Signup and view all the answers

Which material is not documented in an emergency care record?

Patient's complete medical history Signup and view all the answers

Using uniform terminology helps improve which of the following?

Data reliability Signup and view all the answers

When the physician does not specify the method used to remove a lesion during an endoscopy, what is the appropriate procedure?

Query the physician as to the method used. Signup and view all the answers

Which of the following is not reimbursed according to the Medicare outpatient prospective payment system?

Critical access hospitals Signup and view all the answers

The technology commonly used for automated claims processing is called?

Electronic data interchange Signup and view all the answers

Timely and correct reimbursement is dependent on which factor?

Clean claims Signup and view all the answers

Which answer is not required for assignment of the MS-DRG?

Attending and consulting physicians Signup and view all the answers

In processing a bill under the Medicare outpatient prospective payment system (OPPS) where a patient had three surgical procedures performed during the same operative session, which of the following would apply?

Discounting of procedures Signup and view all the answers

In the laboratory section of CPT, if a group of tests overlaps two or more panels, what should a coder do with the remaining test codes?

Report the remaining tests using individual test codes, according to CPT. Signup and view all the answers

Which document directs an individual to bring records to court?

Subpoena Signup and view all the answers

Which of the following is not a function of the discharge summary?

Providing information about the patient's insurance coverage Signup and view all the answers

The HIM department is planning to scan medical record documentation. Which of the following methods of scanning would best help HIM professionals monitor the completeness of health records during a patient's hospitalization?

Concurrent Signup and view all the answers

The practice of assigning a diagnosis or procedure code specifically for the purpose of obtaining a higher level of payment is called?

Upcoding Signup and view all the answers

Exceptions to the consent requirement include:

Medical emergencies Signup and view all the answers

One objective of the Balanced Budget Act (BBA) of 1997 was to?

Improve program integrity for Medicare by educating beneficiaries to report errors noticed on their explanation of benefits (EOBs) to HHS Signup and view all the answers

Before healthcare organizations can provide services, they usually must obtain what by government entities?

Licensure Signup and view all the answers

The protection measures and tools for safeguarding information and information systems is a definition of?

Data security Signup and view all the answers

Both HEDIS and the Joint Commission's ORYX programs are designed to collect data to be used for?

Performance-improvement programs Signup and view all the answers

When a provider accepts assignment, this means?

Provider agrees to accept the allowed charge from the fee schedule as payment in full Signup and view all the answers

Which of the following threatens the 'need-to-know' principle?

Blanket authorization Signup and view all the answers

Which ethical principle is followed when an HIT professional ensures that patient information is only released to those who have a legal right to access it?

Beneficence Signup and view all the answers

A patient was scheduled for a colonoscopy, but it was canceled because of a sudden drop in blood pressure. How should this procedure be coded by the hospital?

Do not assign a code because no procedure was performed. Signup and view all the answers

Identify where the following information would be found in the acute-care record: 'CBC: WBC 12.0, RBC 4.65, HGB 14.8, HCT 43.3, MCV 93.'

Medical laboratory report Signup and view all the answers

The ________ mandated the development of standards for electronic medical records.

Health Insurance Portability and Accountability Act (HIPAA) of 1996 Signup and view all the answers

The ________ may contain information about diseases among relatives in which heredity may play a role.

History Signup and view all the answers

Which personnel should be authorized to take a physician's verbal order for the administration of medication?

Nurse working on the unit where the patient is located Signup and view all the answers

Medicare's newest claims processing payment contract entities are referred to as?

Medicare administrative contractors (MACs) Signup and view all the answers

To improve compliance related to medical record completion, what is the next step after deactivating the parking garage keycard of any physician in poor standing?

Discuss the problem with the hospital CEO. Signup and view all the answers

Which key principle requires appropriate physician documentation to secure payment from the insurer?

Documenting the charges and services on the itemized bill. Signup and view all the answers

When coding benign neoplasm of the breast, what should the coder do according to the noted section?

Use category D24 for fibroadenoma of breast. Signup and view all the answers

Which is a feature of managed care?

Control and reduce the costs of care Signup and view all the answers

A system that provides alerts and reminders to clinicians is a(n):

Clinical decision support system Signup and view all the answers

What security mechanisms should be implemented to prevent snooping through the clinical information system?

Information access controls Signup and view all the answers

According to HIPAA regulations, was the HIM clerk's action correct in removing copies of the patient's records from another hospital where the patient was previously treated?

No; the records from the previous hospital are considered part of the designated record set and should be given to the patient. Signup and view all the answers

If a provider believes a service may be denied by Medicare because it could be considered unnecessary, what must the provider notify the patient with?

Advance beneficiary notice (ABN) Signup and view all the answers

What error has the coder made by using the codes for a patient who had a total abdominal hysterectomy with a bilateral salpingo-oophorectomy?

Unbundling Signup and view all the answers

Notices of privacy practices must be available at the treatment site and must be posted where?

Must be posted in a prominent place where it is reasonable to expect that patients will read them Signup and view all the answers

What is the function of physician's orders?

Document the physician's instructions to other parties involved in providing care to a patient Signup and view all the answers

Which of the following provides macroscopic and microscopic information about tissue removed during an operative procedure?

Pathology report Signup and view all the answers

Tissue transplanted from one individual to another of the same species, but different genotype is called a(n):

Allograft or allogeneic graft Signup and view all the answers

In what form of health information exchange are data centrally located but physically separated?

Consolidated federated Signup and view all the answers

Fee schedules are updated by third-party payers how often?

Annually Signup and view all the answers

Under which part of Medicare is a Medicare Advantage Plan (like an HMO or PPO) classified?

Part C Signup and view all the answers

Study Notes

Data Collection and Coding

To design a data collection form for patient admission, utilize UHDDS (Uniform Hospital Discharge Data Set) as a primary resource.
ICD-10-CM improves coding accuracy by capturing detailed information, providing laterality options, and reducing sequencing issues. Increased cross-referencing is not a benefit of ICD-10-CM.
National Correct Coding Initiative (NCCI) was established to prevent improper billing by addressing problems like bundled coding and proper service claims.

Claims Processing and Reimbursement

Medicare only covers the component code when both comprehensive and component codes are billed for the same service on the same day.
Auto-adjudication processes include outcomes like auto-pay, auto-suspend, and auto-deny, but not auto-calculate.
The maximum number of diagnosis codes on the UB-04 form for inpatient care is 25.
Hospitals do not receive additional payments for hospital-acquired conditions not present on admission.

Ethical Considerations and Patient Information

The Notice of Privacy Practices informs patients about the usage of their Protected Health Information (PHI) in healthcare settings.
Exceptions to consent requirements include medical emergencies, which allow healthcare providers to act quickly without prior consent.
The principle of confidentiality is vital for safeguarding patient information and must be adhered to by healthcare professionals.

Health Insurance Programs

The State Children's Health Insurance Program (SCHIP) focuses on extending healthcare coverage to children up to age 19, initiated by the Balanced Budget Act of 1997.
Physician orders specify instructions for care and are a key component of a patient's health record, ensuring clarity in treatment protocols.

Medicare and Payment Systems

Medicare Advantage Plans are categorized under Part C of Medicare and offer different coverage options to beneficiaries.
The adjudication process involves determining how much a insurance claim will be reimbursed based on patient benefits.
Reimbursement structures like the outpatient prospective payment system (OPPS) include techniques for bundling services and managing costs.

Compliance and Security

Healthcare organizations must use accreditation, certification, and licensure to confirm their ability to provide services.
Security measures are critical to prevent unauthorized access to patient information, and appropriate access controls are necessary.
HIPAA mandates that a patient’s request to access their health information is acted upon within 30 days.

Documentation and Coding Errors

Coding errors such as unbundling occur when separate codes are incorrectly assigned for components of a bundled service.
For benign neoplasm of the breast, specific coding guidelines direct coders to utilize the D24 category for proper coding.
Inaccuracies in medical record documentation can jeopardize compliance with standards set by regulatory bodies like the Joint Commission.

Clinical Decision Support and Systems

Clinical decision support systems (CDSS) are utilized to alert healthcare providers about critical patient data and necessary interventions.
Encoders are software applications that assist in the accurate coding of diagnoses and procedures, ensuring proper reimbursement.

Important Legal and Ethical Principles

The “need-to-know” principle safeguards patient information, and blanket authorizations can undermine this confidentiality.
Providers must notify patients about the potential non-coverage of services by Medicare, using an Advance Beneficiary Notice (ABN) when necessary.

These notes encapsulate pertinent information for effective preparation for the CCA exam aligned with AHIMA guidelines.### Healthcare Organizations and Compliance

American Academy of Billing Forms (AABF): Key organization involved in standardizing billing practices.
National Uniform Billing Committee (NUBC): Establishes standards for electronic claims processing in hospitals.
National Uniform Claims Committee (NUCC): Focuses on standardizing claim forms for all healthcare providers.
American Billing and Claims Academy (ABCA): Offers education and resources related to billing and claims management.

OIG Work Plan and Hospital Compliance

Hospitals must align their auditing projects with the OIG work plan.
It's vital for hospitals to pinpoint high-risk areas beyond the OIG plan.
Compliance with state-specific laws is necessary, but independent audits are also recommended.

HIPAA Regulations on Patient Information

Calling out patient names in a physician's office is regarded as incidental disclosure and not a HIPAA violation.
Patient rights include requesting health information in accessible formats.

Documentation and Medical Records

"Atrial fibrillation with rapid ventricular response" is documented in an ECG report.
Documentation quality in health records is assessed by consistency, completeness, and accessibility.

Coding and Billing Practices

NCCI edits help identify prohibited simultaneous billing for services.
Computer-assisted coding (CAC) enhances coding productivity through automated processes.
Accurate procedure codes are essential for billing, such as coding for myocardial infarction and CABG.

Written or spoken permission to proceed with care is termed as expressed consent.
The right to confidentiality and privacy safeguards patient information.

Healthcare Records and Quality

The quality of health record documentation is ensured by healthcare providers and health information managers.
Quality elements in records include consistency, completeness, and comprehensiveness.

Compliance and Ethical Standards

The role of the compliance officer is to uphold healthcare regulations and standards.
Violations of HIPAA can lead to stringent penalties, including fines and imprisonment.

Data Management and Security

The CIA triad of security emphasizes confidentiality, integrity, and accessibility of data.
Data definition relates to the meaning and detail encompassed within health data, ensuring professionals understand information accuracy.

Medicare Coverage and Reimbursement Systems

Medicare covers various services for distinct beneficiary groups, but specific restrictions apply.
RBRVS is a reimbursement system based on the Medicare fee schedule relevant to physician services.

Medical History and Assessments

Documentation related to drug, alcohol, and tobacco use is classified under social history.
Physician findings during examinations are typically recorded in the physical examination reports.

Accreditation and Regulatory Compliance

Various accrediting bodies oversee behavioral healthcare, ensuring standards are met.
Autoauthentication of dictated reports streamlines documentation process and approval.

Diagnosis and Patient Care

Status asthmaticus is suspected when standard treatments do not alleviate severe wheezing.
Hospital-acquired conditions are categorized based on severity and regulatory definitions, impacting healthcare performance metrics.

Summary of Important Concepts

Healthcare professionals must remain knowledgeable about laws, compliance, and ethical practices to maintain quality and safety in patient care.
Understanding coding, billing practices, and patient rights ensures efficient healthcare delivery and adherence to regulations.

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Description

Prepare for the CCA exam with these informative flashcards created based on AHIMA guidelines. Each card presents a question related to data collection forms and coding principles essential for healthcare professionals. Test your knowledge and readiness for the certification exam.