Certified Coding Associate (CCA) Exam Preparation Module IV - Compliance Questions & Answers

In a joint effort of the Department of Health and Human Services, Office of Inspector General, Centers for Medicare and Medicaid Services, and Administration on Aging, which program was released in 1995 to target fraud and abuse among healthcare providers? - Answer Operation Restore Trust All of the following should be part of the core areas of a coding compliance plan except: - Physician query process - Correct use of encoder software - Coding diagnoses supported by medical record documentation - tracking length of stay - Answer tracking length of stay Common forms of fraud and abuse include all of the following except: - Upcoding - Unbundling or "exploding" charges - Refiling claims after denials - Billing for services not furnished to patients - Answer Refiling claims after denials What is the primary use of the case-mix index? - Answer Defines how a hospital compares to peers and whether the facility is at risk What resource can managers use to discover current, hot areas of compliance? - Answer OIG Workplan This is a program unveiled in 1998 by the OIG that encourages healthcare providers to report fraudulent conduct affecting Medicare, Medicaid, and other federal healthcare programs: - Answer Voluntary Disclosure Program What is the process used to transform text into an unintelligible string of characters that can be transmitted via communications media with a high degree of security and then decrypted when it reaches a secure destination? - Answer Encryption Using uniform terminology is a way to improve: - Answer Data reliability The ___________ mandated the development of standards for electronic medical records. - Answer Health Insurance Portability and Accountability Act (HIPAA) of 1996 Messaging standards for electronic data interchange in healthcare have been developed by: - Answer HL7 What is the incentive to improve the quality of clinical outcomes using the electronic health record that could result in additional reimbursement or eligibility for grants or other subsidies to support for further HIT efforts? - Answer Pay for performance and quality A threat to data security is - Answer Malware Data security refers to - Answer Controlling access A record of all transactions in the computer system that is maintained and reviewed for unauthorized access is called a(n): - Answer Audit trail Which of the following is a true statement about data stewardship? - HIM professionals are not qualified to address data stewardship issues - Data stewardship addresses the needs of the healthcare organization but not the patient - HIM professionals have worked with many data stewardship issues for years - Data stewardship does not include privacy issues - Answer HIM professionals have worked with many data stewardship issues for years Performance counseling usually begins at which of the following? - submitting an action plan of steps the employee will do to resolve the issue and improve performance - job termination - informal counseling or verbal warning - put the coder on unpaid leave of absence - Answer informal counseling or verbal warning A health information technician (HIT) is hired as the chief compliance officer for a large group practice. In evaluating the current program, the HIT learns that there are written standards of conduct and policies and procedures that address specific areas of potential fraud as well as audits in place to monitor compliance. Which of the following should the compliance officer also ensure are in place? - Compliance program education and training programs for all employees in the organization - Establishment of a hotline to receive complaints and adoption of procedures to protect whistle-blowers from retaliation - Adopt procedures to adequately identify individuals who make complaints so that appropriate follow-up can be conducted - Establish a corporate compliance committee who report directly to the CEO - Answer Establishment of a hotline to receive complaints and adoption of procedures to protect whistle-blowers from retaliation In developing a coding compliance program, which of the following would not be ordinarily included as participants in coding compliance education? - Current coding personnel - Medical Staff - Newly hired coding personnel - Nursing staff - Answer Nursing staff Which of the following issues compliance program guidance? - AHIMA - CMS - Federal Register - HHS Office of Inspector General (OIG) - Answer HHS Office of Inspector General (OIG) 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 - Uneccessary service - Answer Upcoding 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: - Answer Compliance officer 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 report 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 - Answer Concurrent