CDIP Domain 6: Compliance Exam Study #1.

Who sets the official Guidelines for coding and reporting (ICD-10)? - correct answer American Hospital Associates (AHA) American Health information management association (AHIMA) National Center for Health Statistics (NCHS) Center for Medicare and Medicaid Services (CMS) AHA - correct answer Serves as a clearing house for issues related to use of ICD-10 codes services in representation and advocacy role on national classification and data issues publisher of the AHA coding Clinic (updated quarterly AHIMA - correct answer serves as a nonprofit association of health information professionals takes a lead in advancing health data and information management provides multiple resources NCHS - correct answer serves as World Health Organization (WHO) collaboration center for family of international classification of North America coordinates all official disease classifications activities in the US CMS - correct answer part of the US department of Health and Human Services (HHS) administers medicare and medicaid programs compares websites for healthcare data HAC - correct answer Hospital Acquired Conditions PSI - correct answer patient safety indicator Fraud and abuse - correct answer The intentional and mistaken misrepresentation of reimbursement claims submitted to government-sponsored health programs Federal False Claims Act - correct answer makes it an offense to submit a false claim to the government for payment of health care services Patient Protection and Affordable Care Act - correct answer health care reform law passed in 2010 that includes incentives and penalties for employers providing health insurance as a benefit Title XI of the social security activities - correct answer exclusion from the federal payer program if convicted of misconduct Compliance - correct answer the tendency to agree to do things requested by others HIPAA - correct answer The Health Insurance Portability and Accountability Act, a federal law protecting the privacy of patient-specific health care information and providing the patient with control over how this information is used and distributed. - 1996 DOJ - correct answer Department of Justice; one of the entities, along with the Office of Inspector General (OIG), that coordinates fraud and abuse control. OIG - correct answer Office of Inspector General in DHHS. Monitors compliance with reimbursement laws & regulations Developed in 1976 focuses on high dollar fraud and abuse Annual Coding updates - correct answer CPT - on January 1st HCPCS Level 2 - on January 1st ICD-10-CM/PCS - On October First Coding Clinic - correct answer Published quarterly by the Central Office on ICD-9-CM Coding of the American Hospital Association-AHA providing office ICD-9 coding guidelines CPT Assistant - correct answer An online CPT coding journal, supported by the American Medical Association (AMA), that addresses subjects such as appealing insurance denials, validating coding to auditors, training staff members, and answering day-to-day coding questions. updated monthly Seven Characteristics of quality documentation - correct answer legible reliable precise complete