1 2. Two Medicare patients were hospitalized with bacterial pneumonia. One patient was hospitalized for three days, and the other patient was hospitalized for 30 days. Both cases result in the same MS-DRG with different lengths of stay. Which answer most closely describes how the hospital will be reimbursed? a. The hospital will receive the same MS-DRG for both patients but additional reimbursement will be allowed for the patient who stayed 30 days because the length of stay was greater than the geometric length of stay for this MS-DRG. CCA P ractice Exam Questions and Answers 20 24 Rationale: Seven elements are required as part of the basic elements of a corporate compliance program. A medical staff appointee is not one of these required elements b. The hospital will receive the same reimbursement for the same MS- DRG regardless of the length of stay. c. The hospital can appeal the payment for the patient who was in the hospital for 30 days because the cost of care was significantly higher than the average length of stay for the MS-DRG payment. d. The hospital will receive a day outlier for the patient who was hospitalized for 30 days. a. Designation of a chief compliance officer b. Implementation of regular and effective education and training programs for all employees c. Medical staf f appointee for documentation compliance d. The use of audits or other evaluation techniques to monitor compliance 1.Corporate compliance programs were released by the OIG for hospitals to develop and implement their own compliance programs. All of the following except are basic elements of a corporate compliance program. 2 a. Omit codes that reflect negatively on quality and patient safety measurement. b. Follow -up on and monitor identified problems. c. Evaluate and trend diagnoses and procedure code selections. d. Report data quality review results to organizational leadership, compliance staff, and the medical staff. 4.HIM coding professionals and the organizations that employ them have the responsibility to not tolerate behavior that adversely affects data quality. Which of the following is an example of behavior that should not be tolerated? 5.CMS identified conditions that are not present on admission and could be “reasonably preventable.” Hospitals are not allowed to receive additional payment for these conditions when the condition is present on admission. What are these conditions called? Rationale: The hospital will receive the same reimbursement regardless of the length of stay Rationale: The nature and duration of the symptoms that caused the patient to seek medical attention as stated in the patient’s own words Rationale: The coder is not following Standard 6 of AHIMA Standards of Ethical Coding, which states that all healthcare data elements required for external reporting purposes, including quality and patient safety measurements, are to be reported a. Ruptured appendix b. Exploratory laparoscopy c. Abdominal pain d. Cholelithiasis 3.A 65-year-old white male was admitted to the hospital on 1/15 complaining of abdominal pain. The attending physician requested an upper GI series and laboratory evaluation of CBC and UA. The x-ray revealed possible cholelithiasis, and the UA showed an increased white blood cell count. The patient was taken to surgery for an exploratory laparoscopy, and a ruptured appendix was discovered. The chief complaint was . 3 a. According to the discharge condition b. According to the nursing progress notes c. According to the condition at time of admission d. As documented in the Discharge Summary 6.For ulcers that were present on admission but healed at the time of discharge, assign the code for the site and stage of the pressure ulcer . a. Brachial b. Stones c. Judkins d. Femoral Rationale: CMS identified hospital -acquired conditions (not present on admission) as “reasonably preventable,” and hospitals do not receive additional payment for cases in which these conditions are not present on admission Rationale: Coding Guideline I.C.12.a.5 notes that pressure ulcers present on admission but healed at the time of discharge are assigned the code for site and stage at time of admission. a. Conditions of Participation b. Present on admission c. Hospital -acquired conditions d. Hospital -acquired infection 7.Coronary arteriography serves as a diagnostic tool in detecting obstruction within the coronary arteries. Identify the technique using two catheters inserted percutaneously through the femoral artery. 4 a. Recovery room record b. Pathology report c. Operative report d. Discharge summary 9.This document includes a microscopic description of tissue excised during surgery: Rationale: The Judkins technique provides x-ray imaging of the coronary arteries by introducing one catheter into the femoral artery with maneuvering up into the left coronary artery orifice, followed by a second catheter guided up into the right coronary artery, and subsequent injection of a contrast material 8.Which of the following is not a function of the discharge summary? Rationale: The discharge summary provides an overview of the entire medical encounter to ensure the continuity of future care by providing information to the patient’s attending physician, referring physician, and any consulting physicians, to provide information to support the activities of the medical staf f review committee and to provide concise information that can be used to answer information requests from authorized individuals or entities Rationale: The pathology report describes specimens examined by the pathologist a. Providing information about the patient’s insurance coverage b. Ensuring the continuity of future care c. Providing information to support the activities of the medical staff review committee d. Providing concise information that can be used to answer information requests
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