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25 terms

CCA Practice Domain 4: Compliance

STUDY
PLAY
Refilling claims after denials
Common forms of fraud and abuse include all of the following except:
Counsel the coder and stop the practice immediately
A coding audit shows that an inpatient coder is using multiple codes that describes the individual components of a procedure rather than using a single code that describes all the steps of the procedure performed. Which of the following should be done in this case?
Health Insurance Portability and Accountability Act (HIPAA) of 1996
The ____ mandated the development of standards for electronix medical records.
HIM professionals have worked with many data stewardship issues for years.
A true statement about data stewardship?
Compliance Officer
This person designs, implements, and maintains a program that assures conformity to all types of regulatory and voluntary accreditation requirements governing the provision of healthcare products or services:
HL7
Messaging standards for electronic data interchange in healthcare have been developed by:
Controlling access
Data Security refers to:
OIG Workplan
What resource can managers use to discover current hot areas of compliance?
Upcoding
The practice of assigning a diagnosis or procedure code specifically for the purpose of obtaining a higher level of payment is called:
Operation Restore Trust
In a joint effort of the Department of Health and Human Services (DHHS), Office of Inspector General (OIG), Centers for Medicare and Medicaid Services (CMS) and Adminstration on Aging (AOA), which program was released in 1995 to target fraud and abuse among healthcare providers?
Data reliability
Using uniform terminology is a way to improve:
Encryption
What is the process used to transform text into 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?
Malware
A treat to data security is:
Concurrent
The HIM department is planning to scan non-electronic medical record documentation. The project includes the scanning of health record documentation such as history and physicals, physician orders, operative reports, and nursing notes. Which of the following methods of scannning would be best to help HIM professionals monitor the completeness of health records during a patient's hospitalization?
An incidental disclosure
Calling out patient names in a physician's office is:
Establishment of a hotline to receive complaints and adoption of procedures to protect whistleblowers from retaliation
A health information technician 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?
Applies nationally to healthcare providers
The HIPAA Privacy rule:
Nursing staff
In developing a coding compliance program, which of the following would not be ordinarily included as participants in coding compliance education?
Tracking length of stay
Should be a part of the core areas of a coding compliance plan except:
HHS Office of Inspector General (OIG)
Issues compliance program guidance?
Must be posted in a prominent place where it is reasonable to expect that patients will read them
Notices of privacy practices must be available at the site where the individual is treated and:
Defines how a hospital compares to peers and whether the facility is at risk
What is the primary use of the case-mix index?
Pay for performance
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 further HIT efforts?
Health Information Portability and Accountability Act
Which of the following laws created the Healthcare Integrity and Protection Data Bank?
Privacy issues with regard to the management of health information, Laws affecting the use of disclosure of health information, AHIMA's professional ethical principles of practice regarding the use and disclosure of health information
The HIT professionals must have knowledge of: