CDIP DOMAIN 6 COMPLIANCE EXAM QUESTIONS AND ANSWERS 2024.

Who sets the official Guidelines for coding and reporting (ICD-10)? American Hospital Associates (AHA) American Health information management association (AHIMA) National Center for Health Statistics (NCHS) Center for Medicare and Medicaid Services (CMS) AHA Serves as a clearing house for issues related to use of ICD-10 codes services in representation and advocacy role on national classification and data issues publisher of the AHA coding Clinic (updated quarterly AHIMA serves as a nonprofit association of health information professionals takes a lead in advancing health data and information management provides multiple resources NCHS serves as World Health Organization (WHO) collaboration center for family of international classification of North America coordinates all official disease classifications activities in the US CMS part of the US department of Health and Human Services (HHS) administers medicare and medicaid programs compares websites for healthcare data HAC Hospital Acquired Conditions PSI patient safety indicator Fraud and abuse The intentional and mistaken misrepresentation of reimbursement claims submitted to government-sponsored health programs Federal False Claims Act makes it an offense to submit a false claim to the government for payment of health care services Patient Protection and Affordable Care Act health care reform law passed in 2010 that includes incentives and penalties for employers providing health insurance as a benefit Title XI of the social security activities exclusion from the federal payer program if convicted of misconduct Compliance the tendency to agree to do things requested by others HIPAA The Health Insurance Portability and Accountability Act, a federal law protecting the privacy of patient-specific health care information and providing the patient with control over how this information is used and distributed. - 1996 DOJ Department of Justice; one of the entities, along with the Office of Inspector General (OIG), that coordinates fraud and abuse control. OIG Office of Inspector General in DHHS. Monitors compliance with reimbursement laws & regulations Developed in 1976 focuses on high dollar fraud and abuse Annual Coding updates CPT - on January 1st HCPCS Level 2 - on January 1st ICD-10-CM/PCS - On October First Coding Clinic Published quarterly by the Central Office on ICD-9-CM Coding of the American Hospital Association-AHA providing office ICD-9 coding guidelines CPT Assistant An online CPT coding journal, supported by the American Medical Association (AMA), that addresses subjects such as appealing insurance denials, validating coding to auditors, training staff members, and answering day-to-day coding questions. updated monthly Seven Characteristics of quality documentation legible reliable precise complete consistent clear timely SOI Severity of Illness - represents the patient's disease burden. uses APR-DRGs ROM risk of mortality - Risk of death, uses APR -DRG Observes Versus Expected mortality Rate Basics of Privacy Notice of Privacy Practice Patient access to information accounting of disclosures right to restrict information AHRQ Agency for Healthcare Research and Quality; one of the DHHS Operating Divisions patient safety indicators evidence-base reports fact sheets quality and disparity reports research studies Breach generally, an impermissible use or disclosure under the Privacy Rule that compromises the security or privacy of the protected health information. An impermissible use or disclosure of protected health information is presumed to be a breach unless the covered entity or business associate, as applicable, demonstrates that there is a low probability that the protected health information has been compromised bases on a risk assessment. Administrative safeguards Identify and analyze risks staff training limiting access contingency planning physical safeguards mechanisms required to protect electronic systems, equipment, and data from threats, environmental hazards, and unauthorized intrusion Facility access controls, workstation security, workstation policies Technical safeguards involve the hardware and software components of an information system Access controls to restrict PHI Audit controls integrity controls transmission security measures Hot Topics with Compliance Repeated provider errors Annual codes update New payer Requirements Reimbursement changes Which if the following should always be included in a compliant documentation query? Possible/likely diagnosis option Clinical indicators Risk factors Reimbursement impact Clinical indicators _____ is a comprehensive multilingual clinical healthcare terminology with scientifically validated clinical content. Systematized Nomenclature of Medicine-Clinical Terms International Classification of Diseases Continuity of Care Document Fast Healthcare Interoperability Resources Systematized Nomenclature of Medicine-Clinical Terms A psychiatrist repeatedly looked at health records of an acquaintance without permission. This is an example of what? Privacy violation Security violation Administrative safeguard No problem Privacy violation Which of the follow formats can be used in compliant query questions? Open-ended Multiple choice Yes/No All of the above All of the above Which of the following depicts what an audit trail checks for? Loss of data Unauthorized access to a system Presence of a virus Successful completion of a backup Unauthorized access to a system A CDI professional leaves their laptop unattended while reviewing records on the floor for clinical documentation and it is stolen. The laptop has the names of 500 patients on it. This is an example of: Privacy violation Security violation Neglect FOIA Security violation Previous encounter information may be used in queries in which of the following situation? To generate queries Lead the provider to the correct response Previous information is relevant to the current encounter None of the above Previous information is relevant to the current encounter