CDIP EXAM PREP 2023 WITH COMPLETE ANSWERS

OIG Office of Inspector General- established by the Dept. of Labor by the Inspector General Act of 1978 to identify fraud and abuse of Medicare part A and part B programs MAC Medicare Administrative Contractor - used by the OIG to process claims for services rendered Criteria for high quality documemtation 1. Legible 2. Reliable 3. Precise 4. Complete 5. Consistent 6. Clear 7. Timely EBM Evidence Based Medicine - the best scientific data a available for clinical documentation Two part theory for high quality clinical documentation is derived from what Legal/regulatory sources and peer reviewed research Four standards used in EBM 1. Design 2. Terminology 3. Performance 4. Procedural DHHS Department of Health and Human services ARRA American Recovery and Reinvestment Act of 2009 provides specific guidance established as part of the meaningful use incentive program Meaningful use requirements Provider must maintain an up to date problem list of current and active diagnoses for 80% of patients and 80% of all patients have to have at least one coded problem as opposed to their entire problem list coded IPPS Hospital Inpatient Prospective Payment System. Reimbursement now being driven by codes assigned to the patient stay with the inception of IPPS in 1982 House Staff Interns, residents and fellows - physicians in training CMS Centers for Medicare and Medicaid Services NCHS National Center for Health Statistics CMS and NCHS created what? Both departments within DHHS, CMS AND DCHS created the Official guidelines for Coding and Reporting Cooperating parties that developed and approved ICD-9-CM AND ICD-10-CM AHA -American Hospital Association AHIMA CMS NCHS ACA Affordable Care Act POA Indicators Present on admission indicators. These are required by CMS beginning in 2007. Must be done on all secondary diagnoses for Medicare inpatient cases HAC Hospital Acquired Condition - beginning in 2008, certain HACs that are not POA may not be included in the DRG payment Deficit Reduction Act of 2005 Requires POA inclusion in the payment guidelines for conditions that: 1. Are high cost, high volume or both 2. Result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis 3. Could reasonably have been prevented through the application of evidence based guidelines WHO World Health Organization