CCA Exam Review #8, Questions with accurate answers, graded A+

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CCA Exam Review #8, Questions with accurate answers, graded A+ What is the best reference tool to determine how CPT codes should be assigned? LCD from Medicare AHA's Coding Clinic AMA's CPT Assi ... stant newsletter CMS website - ✔✔-AMA's CPT Assistant newsletter All documentation entered in the medical record relating to the pt's dx and treatment is considered as this type of data clinical identification secondary Financial - ✔✔-clinical An accounting of disclosures must include disclosures _____ to any pt family member who makes a request made for public health reporting purposes to any individual who requested the information for use in law enforcement requests - ✔✔-made for public health reporting purposes Code: Chondromalacia of left patella M22.42 M94.262 M22.92 M22.8X2 - ✔✔-M22.42 Identify the chapter in which certain S/S of breast disease, such as mastodynia, induration of breast, and nipple discharge, are included Chap 14 Chap 2 Chap 12 Chap 18 - ✔✔-chap 14 According to the Joint Commission Accreditation Standards, which document must be placed in the pt's record before a surgical procedure may be performed? discharge summary admission record report of H & P physician's order - ✔✔-report of H & P What system reimburses hospitals a predetermined amount for each Medicare inpt admission? DRG RUG APC APR-DRG - ✔✔-DRG A denial of a claim is possible for all of the following reasons except unbundling billing too many units of a specific service approved precertification not meeting medical necessity - ✔✔-approved precertification The following is documented in an acute-care record: "Admit to 3C. Diet: NPO. Meds: Compazine 10 mg IV Q 6 PRN." Where would this documentation be found? progress notes physical exam history admission order - ✔✔-admission order A record of all transactions in the computer system that is maintained and reviewed for unauthorized access is called a(n) ____ security breach privacy trail audit trail unauthorized access - ✔✔-audit trail In a managed fee-for-service arrangement, which of the following would be used as a cost-control process for inpt surgical services? Require the pt to pay 20% of the inpt bill determine what services can be bundled pay only 80% of the inpt bill prospectively precertify the necessity of inpt services - ✔✔-prospectively precertify the necessity of inpt services The OIG has identified risk areas for physician practices. One type of risk is "clustering." Identify its definition billing for a more expensive service than the one actually performed assigning additional codes inherent to the main code coding or charge one or two middle levels of service codes exclusively billing for noncovered services as if they are covered - ✔✔-coding or charge one or two middle levels of service codes exclusively All of the following should be part of the core areas of a coding compliance plan except tracking LOS physician query process correct use of encoder software coding dx supported by medical record documentation - ✔✔-tracking LOS One form of _____ uses software to aid the physician in selecting the correct code with processes such as drop-down boxes or the use of touch-screen terminals computer-assisted coding speech recognition system integrated workflow processes electronic document mgmt. system - ✔✔-computer-assisted coding Which one of the following statements is true? The lower the relative weight, the sicker the patient the higher the relative weight, the less reimbursement due the facility the lower the relative weight, the higher the payment rates the higher the relative weight, the higher the payment rates - ✔✔-the higher the relative weight, the higher the payment rates Which of the following best describes the type of coding utilized when a CPT/HCPCS code is assigned directly through the charge description master for claim submission and bypasses the record review and code assignment by the facility coding staff? Soft coding encoder coding natural-language processing coding hard coding - ✔✔-hard coding Two pts were hospitalized w/ bacterial pneumonia. One pt was hospitalized for 3 days, and the other pt was hospitalized for 30 days. Both cases result in the same DRG w/ different LOS. Which answer most closely describes how the hospital will be reimbursed? The hospital can appeal the payment for the pt who was in the hospital for 30 days b/c the cost of care was significantly higher than the ALOS for the DRG payment. The hospital will receive the same reimbursement for the same DRG regardless of the LOS. The hospital will receive a day outlier for the pt who was hospitalized for 30 days. The hospital will receive the same DRG for both pts but additional reimbursement will be allowed for the pt who stayed 30 days b/c the LOS was greater than the geometric LOS for this DRG - ✔✔-The hospital will receive the same reimbursement for the same DRG regardless of the LOS. Even though state laws may be more stringent, CMS requires acute healthcare records to be maintained by the acute health care organization for permanently at least 5 years at least 25 years 10 years - ✔✔-at least 5 years Reviewing the health record for missing signatures, missing medical reports, and ensuring that all documents belong in the health record is an example of ____ review. Qualitative outcomes quantitative statistical - ✔✔-quantitative Code: A pt who arrives at the hospital for outpt lab services ordered by the physician to monitor the pt's Coumadin levels. A prothrombin time is [Show More]

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