CCA Exam Prep from AHIMA, Top Questions with accurate answers, 100% Accurate, Questions Bank. rated A+

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CCA Exam Prep from AHIMA, Top Questions with accurate answers, 100% Accurate, Questions Bank. rated A+ Mary Smith, RHIA, has been charged with the responsibility of designing a data collection fo... rm to be used on admission of a patient to the acute-care hospital in which she works. The first resource that she should use is: UHDDS UACDS MDS ORYX - ✔✔-a 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, Medicare will pay for: The component code but not the comprehensive code The comprehensive but not the component code The comprehensive and the component codes Neither the comprehensive nor the component codes - ✔✔-b When clean claims are submitted, they can be adjudicated in many ways through computer software automatically. Which statement is not one of the outcomes that can occur as part of auto-adjudication? Auto-pay Auto-suspend Auto-calculate Auto-deny - ✔✔-c Which of the following is not a way that ICD-10-CM improves coding accuracy? Reduces sequencing problems by combining conditions into one code Provides laterality options Captures more details for injuries, diabetes, and postoperative complications Increases cross-referencing - ✔✔-d Which of the following organizations is responsible for updating the procedure classification of ICD-10- PCS? Centers for Disease Control (CDC) Centers for Medicare and Medicaid Services (CMS) National Center for Health Statistics (NCHS) World Health Organization (WHO) - ✔✔-b This program was initiated by the Balanced Budget Act of 1997 and allows states to expand existing insurance programs to cover children up to age 19. Children's State Medicare Program (CSMP) State Children's Health Insurance Program (SCHIP) Children's State Healthcare Alliance (CSHA) Children's Aid to Healthcare (CAH) - ✔✔-b Which of the following provides a complete description to patients about how PHI is used in a healthcare facility? Notice of Privacy Practices Authorization Consent for treatment Minimum necessary - ✔✔-a The National Correct Coding Initiative was developed to control improper coding leading to inappropriate payment for: Part A Medicare claims Part B Medicare claims Medicaid claims Medicare and Medicaid claims - ✔✔-b The National Correct Coding Initiative was developed to control improper coding leading to inappropriate payment for: Part A Medicare claims Part B Medicare claims Medicaid claims Medicare and Medicaid claims - ✔✔-b Which of the following software applications would be used to aid in the coding function in a physician's office? Grouper Encoder Pricer Diagnosis calculator - ✔✔-b 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? 35 25 18 9 - ✔✔-b CMS identified conditions that are not present on admission and could be "reasonably preventable." Hospitals are not allowed to receive additional payment for these conditions when the condition is present on admission. What are these conditions called? Conditions of Participation Present on admission Hospital-acquired conditions Hospital-acquired infection - ✔✔-c Which of the following materials is not documented in an emergency care record? Patient's instructions at discharge Time and means of the patient's arrival Patient's complete medical history Emergency care administered before arrival at the facility - ✔✔-c Using uniform terminology is a way to improve: Validity Data timeliness Audit trails Data reliability - ✔✔-d When the physician does not specify the method used to remove a lesion during an endoscopy, what is the appropriate procedure? Assign the removal by snare technique code. Assign the removal by hot biopsy forceps code. Assign the ablation code. Query the physician as to the method used. - ✔✔-d Which of the following is not reimbursed according to the Medicare outpatient prospective payment system? CMHC partial hospitalization services Critical access hospitals Hospital outpatient departments Vaccines provided by CORFs - ✔✔-b The technology commonly used for automated claims processing (sending bills directly to third-party payers) is: Optical character recognition Bar coding Neural networks Electronic data interchange - ✔✔-d Timely and correct reimbursement is dependent on: Adjudication Clean claims Remittance advice Actual charge - ✔✔-b 27. Which answer is not required for assignment of the MS-DRG? Diagnoses and procedures (principal and secondary) Attending and consulting physicians Presence of major or other complications and comorbidities (MCC or CC) Discharge disposition or status - ✔✔-b In processing a bill under the Medicare outpatient prospective payment system (OPPS) in which a patient had three surgical procedures performed during the same operative session, which of the following would apply? Bundling of services Outlier adjustment Pass-through payment Discounting of procedures - ✔✔-d In the laboratory section of CPT, if a group of tests overlaps two or more panels, report the panel that incorporates the greatest number of tests to fulfill the code definition. What would a coder do with the remaining test codes that are not part of a panel? Report the remaining tests using individual test codes, according to CPT. Do not report the remaining individual test codes. Report only those test codes that are part of a panel. Do not report a test code more than once regardless whether the test was performed twice. - ✔✔-a Which document directs an individual to bring originals or copies of records to court? Summons Subpoena Subpoena duces tecum Deposition - ✔✔-c . Which of the following is not a function of the discharge summary? Providing information about the patient's insurance coverage Ensuring the continuity of future care Providing information to support the activities of the medical staff review committee Providing concise information that can be used to answer information requests - ✔✔-a The HIM department is planning to scan medical record documentation. The project includes the scanning of documentation such as history and physicals, physician orders, operative reports, and nursing notes. Which of the following methods of scanning would be best to help HIM professionals monitor the completeness of health records during a patient's hospitalization? Ad hoc Concurrent Retrospective Post discharge - ✔✔-b The practice of assigning a diagnosis or procedure code specifically for the purpose of obtaining a higher level of payment is called: Billing Unbundling Upcoding Unnecessary service - ✔✔-c . Exceptions to the consent requirement include: Medical emergencies Provider discretion Implied consent Informed consent - ✔✔-a 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 the Department of Health and Human Services (HHS) Improve the quality of care to its beneficiaries by increasing availability to healthcare Streamline healthcare costs into one type of payment system for Medicare and Medicaid Educate hospital providers how to manage quality care with less reimbursement - ✔✔-a Before healthcare organizations can provide services, they usually must obtain _____ by government entities such as the state in which they are located. Accreditation Certification Licensure Permission - ✔✔-c The protection measures and tools for safeguarding information and information systems is a definition of: Confidentiality Data security Informational privacy Informational access control - ✔✔-b Both HEDIS and the Joint Commission's ORYX programs are designed to collect data to be used for: Performance-improvement programs Billing and claims data processing Developing hospital discharge abstracting systems Developing individual care plans for residents - ✔✔-a When a provider accepts assignment, this means the: Patient authorizes payment to be made directly to the provider Provider agrees to accept as payment in full the allowed charge from the fee schedule Balance billing is allowed on patient accounts, but at a limited rate Participating provider receives a fee-for-service reimbursement - ✔✔-b Which of the following threatens the "need-to-know" principle? Backdating progress notes Blanket authorization HIPAA regulations Surgical consent - ✔✔-b Which of the following ethical principles is being followed when an HIT professional ensures that patient information is only released to those who have a legal right to access it? Autonomy Beneficence Justice Nonmaleficence - ✔✔-b 46. A patient is scheduled for a colonoscopy, but due to sudden drop in blood pressure, the procedure is canceled just as the scope is introduced into the rectum. Because of moderately severe mental retardation, the patient is given a general anesthetic prior to the procedure. How should this procedure be coded by the hospital? Assign the code for a colonoscopy with modifier -74. Assign the code for a colonoscopy with modifier -52. Assign an anesthesia code only. Do not assign a code because no procedure was performed. - ✔✔-a 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 Pathology report Physical examination Physician orders - ✔✔-a The ________ mandated the development of standards for electronic medical records. Medicare and Medicaid legislation of 1965 Prospective Payment Act of 1983 Health Insurance Portability and Accountability Act (HIPAA) of 1996 Balanced Budget Act of 1997 - ✔✔-c The ________ may contain information about diseases among relatives in which heredity may play a role. Physical examination History Laboratory report Administrative data - ✔✔-b Which of the following personnel should be authorized, per hospital policy, to take a physician's verbal order for the administration of medication? Unit secretary working on the unit where the patient is located Nurse working on the unit where the patient is located Health information director Admissions registrars - ✔✔-b Medicare's newest claims processing payment contract entities are referred to as: Recovery audit contractors (RACs) Medicare administrative contractors (MACs) Fiscal intermediaries (FIs) Office of Inspector General contractors (OIGCs) - ✔✔-b Medical record completion compliance is a problem at Community Hospital. The number of incomplete charts often exceeds the standard set by the Joint Commission, risking a type I violation. Previous HIM committee chairpersons tried multiple methods to improve compliance, including suspension of privileges and deactivating the parking garage keycard of any physician in poor standing. To improve compliance, which of the following would be the next step to overcome noncompliance? Discuss the problem with the hospital CEO. Call the Joint Commission. Contact other hospitals to see what methods they use to ensure compliance. Drop the issue because noncompliance is always a problem. - ✔✔-c . Several key principles require appropriate physician documentation to secure payment from the insurer. Which answer (listed here) fails to impact payment based on physician responsibility? The health record should be complete and legible. The rationale for ordering diagnostic and other ancillary services should be documented or easily inferred. Documenting the charges and services on the itemized bill. The patient's progress and response to treatment and any revision in the treatment plan and diagnoses should be documented. - ✔✔-c 5. When coding benign neoplasm of the breast, the section noted here directs the coder to: D24 Benign neoplasm of breast Includes: Benign neoplasm of connective tissue of breast Benign neoplasm of soft parts of breast Fibroadenoma of breast Excludes 2: Adenofibrosis of breast (N60.2) Benign cyst of breast (N60.-) Benign mammary dysplasia (N60.-) Benign neoplasm of skin of breast (D22.5, D23.5) Fibrocystic disease of breast (N60.-) Use category D24 for fibroadenoma of breast Use category D24 for malignant melanoma of the breast Use category D24 for malignant neoplasm of the breast Use category D24 for benign neoplasm of skin of breast - ✔✔-a Which is a feature of managed care? Control and reduce the costs of care Monitor the activity of physician supervision Provide incentive for prospective payment Allow the patient to choose several primary physicians - ✔✔-a A system that provides alerts and reminders to clinicians is a(n): Clinical decision support system Electronic data interchange Point of care charting system Knowledge database - ✔✔-a An employee in the physical therapy department arrives early every morning to snoop through the clinical information system for potential information about neighbors and friends. What security mechanisms should be implemented to prevent this security breach? Audit controls Information access controls Facility access controls Workstation security - ✔✔-b . A hospital receives a valid request from a patient for copies of his or her medical records. The HIM clerk who is preparing the records removes copies of the patient's records from another hospital where the patient was previously treated. According to HIPAA regulations, was this action correct? Yes; HIPAA only requires that current records be produced for the patient. Yes; this is hospital policy over which HIPAA has no control. No; the records from the previous hospital are considered part of the designated record set and should be given to the patient. No; the records from the previous hospital are not included in the designated record set but should be released anyway. - ✔✔-c If a provider believes a service may be denied by Medicare because it could be considered unnecessary, the provider must notify the patient before the treatment begins by using a(n): Advance beneficiary notice (ABN) Advance notice of coverage (ANC) Notice of payment (NOP) Consent for payment (CFP) - ✔✔-a [Show More]

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