Exam (elaborations)
CCA EXAM QUESTIONS PDOAN
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CCA EXAM QUESTIONS PDOAN
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CCA EXAM QUESTIONS PDOANWhich organization updates the procedure classification of ICD-10-PCS - Answers -
CMS
What does the 4th character of an ICD-10-CM diagnosis code capture? - Answers -
Etiology
True or false: Critical access hospitals are reimbursed under Medicare's outpatient
prospective payment system. - Answers -False. They are paid based on a cost-based
payment system.
If the placement of a catheter is billed along with an infusion on the same day of service
for an outpatient beneficiary, what will Medicare pay for? - Answers -The infusion
procedure. The insertion of the catheter is integral to the procedure and not coded
separately.
What is the goal of a coding compliance program? - Answers -To prevent accusations
of fraud and abuse
What would be the best way for a hospital to determine whether POA indicators for the
conditions selected by CMS are having a negative impact on reimbursement? -
Answers -Identify all records for a period having these indicators for these conditions
and determine if these conditions are the only secondary diagnoses present that will
lead to higher payment.
In a fee-for-service arrangement, what would be a cost control process for inpatient
surgery? - Answers -Prospectively precertify the necessity of the surgery
True or false: The outpatient claims editor generates denials of outpatient claims. -
Answers -False. An outpatient claims editor does not exist.
What is the electronic format for hospital technical fees? - Answers -8371
How many days does of a covered entity have to respond to a patient's request to
review or copy his/her health information? - Answers -30
True or False: Consent for use and disclosure must be obtained from every patient. -
Answers -False. Providers are not required to obtain patient consent to use of disclose
PHI for treatment, payment, or healthcare operations
True or False: A business associate agreement allows the business associate to
maintain PHI indefinitely. - Answers -False. At termination of the contract, the associate
should return or destroy all PHI to the covered entity.
, What is the coronary arteriography that uses two catheters inserted percutaneously
through the femoral artery? - Answers -Judkins
What is clustering? - Answers -Coding or charging one or two middle levels of service
codes exclusively.
How is a hospital reimbursed if two patients in the same DRG category have differnent
lengths of stay? - Answers -The hospital will receive the same reimbursement for the
same DRG regardless of LOS.
True or False: Stage I pressure ulcers are a hospital-acquired condition. - Answers -
False, but stage II and III are.
The electronic claim format (8371) replaces which paper billing form? - Answers -CMS-
1450 (UB-04)
Which document must be present before surgery may be performed? - Answers -
History and physical
If the number of incomplete charts exceeds the standard set by the Joint Commission,
what would be a good method for overcoming noncompliance? - Answers -Contact
other hospitals to see what methods they use to ensure compliance.
What standards must a skilled nursing facility meet in order to become certified to take
part in federal government reimbursement programs? - Answers -Conditions of
participation
What is the best source to determine the size of a removed malignant lesion? - Answers
-Operative report
The annual OIG work plan addresses areas of compliance it will be investigating for the
year. What is the expectation of the hospital in relation to the work plan? - Answers -
Hospitals should plan their compliance and auditing programs around the work plan.
Under what security mechanism is a coder allowed to access an electronic medical
record? - Answers -Role-based
In what form of health information exchange are data centrally located but physically
separated? - Answers -Consolidated federated. Records are centrally managed but
logically and physically separated.
If a patient requests copies of personal health information on CD, but is unable to read
the CD on his/her computer, how should the hospital respond when the patient requests
paper forms? - Answers -Provide the records in paper format
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