medical coding 2 final

100 terms by lspringfield3 

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The patient was admitted to the hospital with nausea, vomiting, and abdominal pain. The physician documents the following on the discharge summary: Acute cholecystitis
Nausea and vomiting
Abdominal pain

Acute cholecystitis

Which of the following is a minimum, common core of data on individual acute care, short-term hospital discharges in Medicare and Medicaid programs?

UHDDS

Why was the Uniform Hospital Discharge Data Set (UHDDS) implemented?

to improve the uniformity and comparability of hospital discharge data

According to the UHDDS, the Principal Diagnosis is:

the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.

A patient is admitted for a coronary artery bypass graft (CABG) because of arteriosclerotic heart disease (ASHD). Following admission, but prior to surgery, the patient slips and falls, suffering an intertrochanteric femoral neck fracture. The CABG was rescheduled for a later date and the patient was taken to the operative suite for a total hip replacement (THR). The patient was discharged three (3) days later, to return to the hospital in one month for the CABG.

What will be reported as the principal diagnosis?

ASHD

According to the UHDDS, the Principal Procedure is:

the procedure performed for definitive treatment, rather than one performed for diagnostic or exploratory purposes or to take care of a complication

What is the primary function of the UB-04?

Submission of hospital claims.

According to the UHDDS, which of the following is the definition of "Other Diagnoses?"

The conditions documented as either receiving clinical evaluation or therapeutic treatment or diagnostic procedures or extend the length of stay or increase nursing care and/or monitoring.

According to the UHDDS, a procedure that is either surgical in nature, requires specialized training, or carries an anesthetic or procedural risk is defined as a:

significant procedure

Which of the Cooperating Parties maintains and updates the procedure portion of ICD-9-CM?

CMS

What is the computer software program that is used to detect and report errors in the coding of claims data?

MCE

A 75-year-old female was admitted to the hospital for repair of a hiatal hernia, which was performed on the day of admission. While recovering from the surgery, she fell out of her hospital bed and sustained a fracture of the right humerus at the anatomical neck, which required open reduction and internal fixation. Further complications arose post-operatively when severe unstable angina required a trip to the Cardiac Cath lab for catheterization and percutaneous transluminal coronary angioplasty (PTCA) of the right main coronary artery (RCA).

The principal procedure is:

hiatal herniorrhaphy

Type I diabetic patient is admitted to the hospital with an acute hemorrhage due to a perforated intestinal ulcer. In this case, the diabetes would be:

a comorbid condition.

While coding guideline revisions are clarified through unanimous agreement by all four (4) of the Cooperating Parties, only one (1) of the four parties can issue official ICD-9-CM coding advice. Which of the four is charged with this responsibility?

AHA

What is the computer software program that is utilized to assign the appropriate DRGs according to the patient's principal and secondary diagnoses and principal procedure?

grouper

What phrase is used to indicate that a claim has been released as complete for submission to the insurer for payment?

bill drop

Questions 17 - 20 refer to the following case study.

The patient is admitted August 15 with a past history of hypertension, coronary artery disease, hypercholesterolemia, and previous cholecystectomy. He had an inferior wall myocardial infarction on June 27 with 100% occlusion of the right coronary artery and underwent coronary angioplasty of the right coronary artery with reduction of lesion to 10%. During cardiac rehabilitation, he was noted to have prolonged ventricular tachycardia, which was essentially asymptomatic. Repeat cardiac catheterization on an outpatient basis in mid-July revealed right coronary artery occlusion of 20%. During this current admission, EKG revealed right bundle branch block. Physical examination revealed blood pressure of 156/92, heart rate of 61, respiratory rate of 20, and oxygen saturation of 96% on room air. Patient is admitted for initiation of Amiodarone therapy and placement of an implantable cardioverter defibrillator for ventricular tachycardia. During this admission, the patient did well and had no episodes of ventricular tachycardia.

On August 17, the patient underwent placement of implantable cardioverter defibrillator without incident. A hematoma at the insertion site was noted the day after procedure, and an ultrasound was performed to determine the severity of it. After the hematoma was diagnosed as non-serious, the patient was discharged home on August 20.

Identify the principal diagnosis.

Ventricular tachycardia

The patient is admitted August 15 with a past history of hypertension, coronary artery disease, hypercholesterolemia, and previous cholecystectomy. He had an inferior wall myocardial infarction on June 27 with 100% occlusion of the right coronary artery and underwent coronary angioplasty of the right coronary artery with reduction of lesion to 10%. During cardiac rehabilitation, he was noted to have prolonged ventricular tachycardia, which was essentially asymptomatic. Repeat cardiac catheterization on an outpatient basis in mid-July revealed right coronary artery occlusion of 20%. During this current admission, EKG revealed right bundle branch block. Physical examination revealed blood pressure of 156/92, heart rate of 61, respiratory rate of 20, and oxygen saturation of 96% on room air. Patient is admitted for initiation of Amiodarone therapy and placement of an implantable cardioverter defibrillator for ventricular tachycardia. During this admission, the patient did well and had no episodes of ventricular tachycardia.

On August 17, the patient underwent placement of implantable cardioverter defibrillator without incident. A hematoma at the insertion site was noted the day after procedure, and an ultrasound was performed to determine the severity of it. After the hematoma was diagnosed as non-serious, the patient was discharged home on August 20.

Identify the principal procedure.

Implantable cardioverter defibrillator placement

The patient is admitted August 15 with a past history of hypertension, coronary artery disease, hypercholesterolemia, and previous cholecystectomy. He had an inferior wall myocardial infarction on June 27 with 100% occlusion of the right coronary artery and underwent coronary angioplasty of the right coronary artery with reduction of lesion to 10%. During cardiac rehabilitation, he was noted to have prolonged ventricular tachycardia, which was essentially asymptomatic. Repeat cardiac catheterization on an outpatient basis in mid-July revealed right coronary artery occlusion of 20%. During this current admission, EKG revealed right bundle branch block. Physical examination revealed blood pressure of 156/92, heart rate of 61, respiratory rate of 20, and oxygen saturation of 96% on room air. Patient is admitted for initiation of Amiodarone therapy and placement of an implantable cardioverter defibrillator for ventricular tachycardia. During this admission, the patient did well and had no episodes of ventricular tachycardia.

On August 17, the patient underwent placement of implantable cardioverter defibrillator without incident. A hematoma at the insertion site was noted the day after procedure, and an ultrasound was performed to determine the severity of it. After the hematoma was diagnosed as non-serious, the patient was discharged home on August 20.

c.
Myocardial infarction

The patient is admitted August 15 with a past history of hypertension, coronary artery disease, hypercholesterolemia, and previous cholecystectomy. He had an inferior wall myocardial infarction on June 27 with 100% occlusion of the right coronary artery and underwent coronary angioplasty of the right coronary artery with reduction of lesion to 10%. During cardiac rehabilitation, he was noted to have prolonged ventricular tachycardia, which was essentially asymptomatic. Repeat cardiac catheterization on an outpatient basis in mid-July revealed right coronary artery occlusion of 20%. During this current admission, EKG revealed right bundle branch block. Physical examination revealed blood pressure of 156/92, heart rate of 61, respiratory rate of 20, and oxygen saturation of 96% on room air. Patient is admitted for initiation of Amiodarone therapy and placement of an implantable cardioverter defibrillator for ventricular tachycardia. During this admission, the patient did well and had no episodes of ventricular tachycardia.

On August 17, the patient underwent placement of implantable cardioverter defibrillator without incident. A hematoma at the insertion site was noted the day after procedure, and an ultrasound was performed to determine the severity of it. After the hematoma was diagnosed as non-serious, the patient was discharged home on August 20.

Identify the complication.

Insertion site hematoma

Max is admitted to the hospital with pain in the lower left leg. He stated that he fell into a hole in his backyard. X-ray revealed a displaced left lower leg fracture of the tibial shaft. Open reduction and internal fixation of the left tibial fracture was performed, followed by application of a short leg fiberglass cast.

Which of the following codes will be assigned:
729.5 Pain in limb
823.20 Fracture, tibia; shaft, closed
823.30 Fracture, tibia; shaft, open
E883.9 Accidental fall into hole or other surface opening
E849.0 Place of occurrence; home
79.06 Closed reduction of fracture without internal fixation; tibia and fibula
79.16 Closed reduction of fracture with internal fixation; tibia and fibula
79.26 Open reduction of fracture without internal fixation; tibia and fibula
79.36 Open reduction of fracture with internal fixation; tibia and fibula
95.53 Application of cast

823.20, E883.9, E849.0; 79.36

Crystal has been vomiting for 24 hours with complaint of right lower quadrant pain. Examination is suspicious for acute appendicitis. Crystal is taken to surgery and laparoscopic appendectomy is carried out. Pathological diagnosis is consistent with acute appendicitis. Crystal developed post-operative paralytic ileus. The ileus was monitored and did not subside and therefore Crystal required insertion of a nasogastric tube.

Which of the following codes will be assigned:
540.0 Acute appendicitis with generalized peritonitis
540.9 Acute appendicitis, without generalized peritonitis
560.1 Paralytic ileus
997.4 Digestive system complication, NOS
47.01 Laparoscopic appendectomy
47.09 Other appendectomy
47.11 Incidental appendectomy, laparoscopic

540.9, 997.4, 560.1; 47.01

Six-year-old Alex attended a birthday party where hot dogs and potato salad were served for lunch. Several hours after returning home, Alex began vomiting and having severe diarrhea. Alex was admitted to the hospital for treatment of his vomiting and diarrhea and was diagnosed with Salmonella food poisoning. Alex was given IV fluids for dehydration. Alex also has asthma, so he was given respiratory treatments while in the hospital.

Which of the following codes will be assigned:
003.9 Salmonella infection, unspecified, including food poisoning
005.9 Food poisoning, unspecified
276.51 Dehydration
493.90 Asthma, unspecified
787.03 Vomiting
787.91 Diarrhea

003.9, 276.51, 493.90

John is a 96-year-old nursing home resident who is admitted for malnutrition. John has suffered a previous stroke that has left him with dysphagia. John is treated for malnutrition with hyperalimentation (feeding more nutrients than normally required). John was also found to have hypokalemia that was treated with IV potassium replacement. On the day prior to discharge, John underwent a PEG tube insertion.

Which of the following codes will be assigned:
263.9 Malnutrition
276.8 Hypokalemia
438.82 Dysphagia, late effect of CVA
787.20 Dysphagia, unspecified
43.11 PEG insertion

263.9, 276.8, 438.82; 43.11

Use the following codes to answer the next question.

721.90 Osteoarthritis, spine
733.01 Senile osteoporosis
733.13 Pathological fracture of vertebrae
03.90 Insertion of catheter into spinal canal for infusion of therapeutic substances
03.91 Injection of anesthetic into spinal canal for analgesia

An 82-year-old woman had been treated by her family physician for chronic low back pain. One morning upon awakening she could not get out of bed due to severe back pain. She was brought to the emergency department and admitted. X-rays showed a severe fractures of the L5 vertebrae as a result of senile osteoporosis. An injection of anesthetic agents is administered into the spinal canal to help alleviate her pain.

733.13, 733.01; 03.91

Which of the following is a false statement about physician queries?

Physician queries should not include clinical indicators.

A patient presents to the ED with dehydration. While in the ED, the patient is overloaded with fluid, which pulls the patient into CHF. At this point it is decided to admit the patient to the hospital. The diagnoses on discharge are CHF, and dehydration due to gastroenteritis.

Using the codes listed, what is the correct code sequencing and POA assignments for this case:

276.51
Dehydration

428.0
CHF

558.9
Gastroenteritis

428.0-Y, 276.51-Y, 558.9-Y

The Initial Database section of health records consists of:

the emergency department record and the history and physical.

A patient with severe cough and difficulty breathing is admitted to the hospital from a private physician's office. Following hospital work-up, a malignant neoplasm of the patient's right main bronchus is diagnosed.

What is the POA indicator assignment for the malignant neoplasm of the right main bronchus?

Y

Grandpa Joe suffered a traumatic fracture of his L5 vertebrae and was admitted for surgery. He has several chronic conditions, including CHF and rheumatoid arthritis. A scan of his lower back and pelvic area performed before surgery showed enlargement of his prostate. The attending physician documented probable benign prostatic hypertrophy (BPH) in the discharge summary.

What POA indicator should be assigned to the BPH diagnosis code?

The POA indicator should be "Y" because even though the BPH was diagnosed after admission it is a chronic condition that had to be present before admission.

A patient is admitted to the hospital for a coronary artery bypass surgery. Postoperatively, he develops a pulmonary embolism.

Which of the following would be the correct POA indicator for the pulmonary embolism?

N = Not present at the time of inpatient admission

A patient undergoes an inpatient procedure and has a postoperative complication. The insurance company will not pay for the entire amount requested.

Which POA indicator is likely part of the cause?

N

Which component of the health record will help the coder identify the coordination of patient care?

Physician orders

A patient undergoes outpatient surgery. During the recovery period, the patient develops atrial fibrillation, necessitating inpatient admission to the hospital.

Which of the following would be the correct POA indicator for the atrial fibrillation?

Y = Present at the time of inpatient admission

The primary purpose of the present on admission (POA) indicator is to:

differentiate between conditions present on admission and conditions that develop during inpatient encounters.

The initial nursing assessment upon admission documents the presence of a decubitus ulcer. There is no mention of the decubitus ulcer in the physician documentation until several days after admission.

Which of the following would be the correct POA indicator for the decubitus ulcer?

U = Documentation is insufficient to determine if condition was present at the time of inpatient admission

A patient was admitted to the hospital with symptoms of a stroke and secondary diagnoses of COPD and hypertension. The patient was subsequently discharged from the hospital with a principal diagnosis of cerebral vascular accident and secondary diagnoses of catheter-associated UTI, COPD, and hypertension.

Catheter-associated UTI

CMS-identified "hospital acquired conditions" mean that when a particular diagnosis is not "present on admission," CMS determines it to be reasonably preventable. The outcome will be that the hospital:

will not receive additional payment.

Regarding conflicting diagnoses in the health record, which of the following statements about physician query forms is false?

None of the statements are false.

During analysis of the inpatient record for a patient admitted for open appendectomy, the coder discovers an extremely low potassium level on a laboratory report. Turning to physician's orders, the coder notes that IV potassium was ordered. Checking the Medication Administration Record (MAR), it is noted that IV potassium was given on the same day it was ordered. The physician has not documented any indication of an abnormal potassium level or any related condition on the discharge summary or anywhere else in the record.

The best course of action for the coder to take is to:

confer with the physician, asking him/her to include the condition as a final diagnosis if he/she considers the abnormal potassium level to be clinically significant.

Which of the following statements is false?

According to Official Coding Guidelines, a diagnosis is not required to be included on the final diagnostic statement to be coded and reported.

In what section of the health record does the physician assess the patient's status chronologically?

Progress notes

A patient is admitted for possible meningitis. A lumbar puncture was done at admission and cerebrospinal fluid was sent for culture. Three days later, culture grew streptococcal bacteria. The final diagnosis was Streptococcal Meningitis (320.2). What is the correct POA indicator for this diagnosis code?

Y

Present on admission is defined as

Present at the time the order for inpatient admission occurs.

Which of the following will always have a POA indicator of Y?

Congenital condition

A patient is admitted for syncope. After study, the symptom is attributed to new onset of ventricular fibrillation.

Why is the POA indicator on the "ventricular fibrillation" code a Y

Condition was clearly present before admission but not diagnosed until after admission.

What may be affected if the POA indicator "N" is assigned to a complication code?

Reimbursement

A patient is admitted with shortness of breath. Results of a thoracotomy with lung biopsy indicate lung cancer. Following the thoracotomy, the patient develops acute pulmonary insufficiency.

Which POA indicators are assigned to the diagnoses in this case?

Assign POA indicator "Y" to the lung cancer diagnosis and POA indicator "N" to the acute pulmonary insufficiency diagnosis.

Progress notes will not show:

hourly temperature and blood pressure readings.

A patient admitted for an emergency appendectomy undergoes preliminary laboratory tests after admission. The pregnancy test is positive, and the surgeon documents "incidental pregnancy" as a secondary diagnosis. The patient states she was not aware she is pregnant.

Which POA indicator is assigned for the pregnancy in this case?

POA indicator "Y" is assigned. The patient was pregnant on admission.

A computer software program that assigns MS-DRGs is called a/an:

grouper

A patient who is admitted with chest pain and discharged with a final diagnosis of acute myocardial infarction of the inferolateral wall (410.21) would group into which of the following MDCs?

MDC 5 - Diseases and Disorders of the Circulatory System

In which of the following payment systems can the amount of payment be calculated before the service is actually delivered?

prospective

After each inpatient case is classified into an MDC, the encounter is then partitioned based on which of the following criteria?

medical / surgical

How frequently does CMS revise the IPPS to implement necessary changes?

annually

What does the acronym "MDC" mean?

Major Diagnostic Categories

The postacute care transfer policy was put into effect to prevent inappropriate early transfers from an acute care hospital that would still receive the full MS-DRG reimbursement amount. For patients transferring from one acute care facility to another acute care facility, the hospital that transfers the patient is paid a MS-DRG-based per diem rate. The receiving facility will:

receive a full MS-DRG payment.

What was the original goal of implementing a DRG-based reimbursement methodology for Medicare inpatient care?

To reduce spending on the Medicare inpatient population.

In the original IPPS, each DRG could have two payment tiers based on patient severity as determined by the presence or absence of a CC. How many payment tiers at a maximum may an MS-DRG be split based on the presence or absence of an MCC/CC?

Three

Payment rates for each MS-DRG are calculated by utilizing two factors: the CMS assigned relative weighting factor of the MS-DRG and the:

individual hospital's payment rate

The MS-DRG relative weight in a case is .5631; the hospital base payment rate is $3,027.00. Calculate the amount of money the hospital will receive as reimbursement for the case.

1,704.50

When a facility receives an MS-DRG payment that is greater than the cost incurred by the facility to treat the patient, the facility:

retains the surplus funds.

Which coding system(s) is/are utilized in the methodology of MS-DRG assignment and IPPS reimbursement?

ICD-9-CM codes

The common phrase used to describe the diagram which depicts grouper logic in assigning MS-DRGs is:

decision tree

A special reimbursement provision of the MS-DRG system aims at making up the shortfall hospitals experience when a specified percentage of care is provided to large populations of low-income patients. What is the name of this provision?

disproportionate share

The sum of a hospital's relative DRG rates for a year was 15,192 and the hospital had 10,471 discharges. Given this information, what would be the hospital's case-mix index for that year?

1.4509

All of the following statements are true of MS-DRGs, except for the one that states:

a patient claim may have more than one MS-DRG.

Which of the following procedures will group an inpatient encounter into one of the Pre-MDC DRGs?

bone marrow transplant

Select the sequence of steps needed to manually assign an MS-DRG.

Principal diagnosis, major diagnostic category, medical/surgical partition, Medicare Severity-DRG

What term is used to describe inpatient cases that require considerably more hospital resource usage than average?

outliers

Which of the following refers to the type of patients treated by a hospital, reflecting the resource intensity or clinical severity of the hospital's patient population?

case mix

Ken Correll stayed at Okefanokee Hospital for two (2) days and was subsequently transferred to Chattanooga General for eight (8) days. Both hospitals are short term, acute care PPS hospitals. The MS-DRG that is assigned is the same for both hospitals. The PPS amount for the MS-DRG is $12,000 at Okefanokee and $9,000 at Chattanooga. The GM/LOS for the MS-DRG is 8, while the ALOS is 6.

Okefanokee Hospital will receive a reimbursement of

$4,500

Ken Correll stayed at Okefanokee Hospital for two (2) days and was subsequently transferred to Chattanooga General for eight (8) days. Both hospitals are short term, acute care PPS hospitals. The MS-DRG that is assigned is the same for both hospitals. The PPS amount for the MS-DRG is $12,000 at Okefanokee and $9,000 at Chattanooga. The GM/LOS for the MS-DRG is 8, while the ALOS is 6.

Chattanooga General, which discharged Ken home on day 7, will receive a reimbursement of:

$9,000

Use the following table to answer the last two (2) questions. (The table will repeat)

Plantation Hospital's Top 10 MS-DRGs MS-DRG Description Number of Patients CMS Relative Weight
470 Major joint replacement or reattachment of lower extremity w/o MCC 2,750 1.9871
392 Esophagitis, gastroent & misc digest disorders w/o MCC 2,200 0.7121
194 Simple pneumonia & pleurisy w CC 1,150 1.0235
247 Perc cardiovasc proc w drug-eluting stent w/o MCC 900 2.1255
293 Heart failure & shock w/o CC/MCC 850 0.8765
313 Chest pain 650 0.5489
292 Heart failure & shock w CC 550 1.0134
690 Kidney and urinary tract infects w/o MCC 400 0.8000
192 Chronic obstructive pulmonary disease w/o CC/MCC 300 0.8145
871 Septicemia or severe sepsis w/o MV 96+ Hours 250 1.7484

The case-mix index (CMI) for the top 10 MS-DRGs above is:

1.278

Use the following table to answer the question.

Plantation Hospital's Top 10 MS-DRGs MS-DRG Description Number of Patients CMS Relative Weight
470 Major joint replacement or reattachment of lower extremity w/o MCC 2,750 1.9871
392 Esophagitis, gastroent & misc digest disorders w/o MCC 2,200 0.7121
194 Simple pneumonia & pleurisy w CC 1,150 1.0235
247 Perc cardiovasc proc w drug-eluting stent w/o MCC 900 2.1255
293 Heart failure & shock w/o CC/MCC 850 0.8765
313 Chest pain 650 0.5489
292 Heart failure & shock w CC 550 1.0134
690 Kidney and urinary tract infects w/o MCC 400 0.8000
192 Chronic obstructive pulmonary disease w/o CC/MCC 300 0.8145
871 Septicemia or severe sepsis w/o MV 96+ Hours 250 1.7484

Which of the listed MS-DRGs has the highest CMS relative weight?

247

The coding supervisor notices that the coders are routinely failing to code all possible diagnoses and procedures for a patient encounter. This indicates to the supervisor that there is a problem with:

completeness

"An intentional representation that an individual knows to be false or does not believe to be true and makes, knowing that the representation could result in some unauthorized benefit to himself/herself or some other person" is Medicare's definition of:

healthcare fraud

Groups of doctors and other health care experts compose private medical review organizations that contract with CMS to ensure that the government pays only for medically necessary, appropriate, and high-quality healthcare services. What acronym is used to identify these organizations?

QIOs

After a coding quality record review, individual audit results should become part of the:

individual employee's performance evaluation.

Healthcare violations of the False Claims Act can result in:

all of the above

Which office within the Department of Health and Human Services (DHHS) carries the mission of protecting the integrity of DHHS programs, as well as protecting the health and welfare of the DHHS programs beneficiaries?

Office of Inspector General (OIG)

One staff member of the hospital is responsible for evaluating and monitoring educational plans for coders within a coding department. Which staff member has these responsibilities?

Coding manager

Which of the following is an electronic data report that contains a single hospital's claims data statistics for Medicare-severity diagnosis related groups (MS-DRGs) and discharges at high risk for improper payment due to billing and/or coding issues? Data in the report are presented in tabular form, as well as in graphs that identify both potential overpayments as well as underpayments.

Program for Evaluating Payment Patterns Electronic Report (PEPPER)

Quality Improvement Organizations (QIOs) work with Medicare to improve the quality of care to beneficiaries of the Medicare Program by contracting to monitor hospital performance in a state or on a regional basis. The contract is called a SOW. What does "SOW" mean?

Statement of Work

Which of the following federal laws provided the framework for all federal fraud and abuse penalties and investigations that followed?

False Claims Act

Regarding quality of coding, the degree to which the codes selected accurately reflect the documented diagnoses and procedures refers to:

validity

Recovery Audit Contractors (RACs) are paid by retaining a portion of the monies recovered for all accurately identified CMS overpayments as well as a percentage amount for all accurately identified underpayments. This is referred to as being paid on what basis?

contingency basis

The method of calculating errors in a coding audit that allows for benchmarking with other hospitals, and permits the reviewer to track errors by case type. is the:

record method.

The first step in any inpatient record review will be to verify correct assignment of the:

principal diagnosis code.

What is the goal of the Recovery Audit Contractor (RAC) program?

Identify and correct improper payments made on claims of services provided to Medicare beneficiaries

The method of calculating errors in a coding audit that allows for the reviewer to recognize a coder's ability to identify all codes, as well as permitting the identification of all coder weaknesses, including missed secondary codes and sequencing errors, is the

code method

Regarding quality of coding, the degree to which the same results (same codes) are obtained by different coders or on multiple attempts by the same coder refers to:

reliability

The practice of reporting a code that results in a higher payment to the provider rather than reporting the code that accurately reflects the item or service provided is known as:

upcoding

What is the length of time QIOs contract with Medicare for each Statement of Work?

Three (3) years

When the same coder who originally codes a chart can obtain the same codes when recoding the chart, this is a data quality study known as:

intrarater reliability

When a Medicare provider or supplier unknowingly or unintentionally submits an inaccurate claim for payment, they are generally referred as having committed an act of:

abuse

Which of the following was published in 1998 by the Office of Inspector General (OIG) of the Department of Health and Human Services (DHHS) to develop controls to prevent fraud and abuse of health care plans?

Compliance Program Guidance for Hospitals

When a coder fragments a service or procedure by reporting separate codes for services or procedures that are included in one (1) code, they are:

unbundling

The purpose of QIOs does not include determining:

Whether the health care facility had met accreditation and licensing standards.

If you were to accept a position at a healthcare facility as a coder, and with experience you became able to perform the duties of your role at an acceptable skill level with ethical standards, you will have become:

compliant

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