AHIMA CCA Exam 1: Questions With Step-By-Step
Solutions
A system that provides alerts and reminders to clinicians is a(n):
a. Clinical decision support system
b. Electronic data interchange
c. Point of care charting system
d. Knowledge database Accurate Answer:- A Clinical decision support
includes providing documentation of clinical findings and procedures, active
reminders about medication administration, suggestions for prescribing less
expensive but equally effective drugs, protocols for certain health
maintenance procedures, alerts that a duplicate lab test is being ordered, and
countless other decision-making aids for all stakeholders in the care process
(Johns 2011, 138).
What does an audit trail check for?
a. Unauthorized access to a system
b. Loss of data
c. Presence of a virus
d. Successful completion of a backup Accurate Answer:- A
Audit trails can provide tracking information such as who accessed which
records and for what purpose (Johns 2011, 403).
A hospital HIM department wants to purchase an electronic system that
records the location of health records removed from the filing system and
documents the date of their return to the HIM department. Which of the
following electronic systems would fulfill this purpose?
a. Chart deficiency system
,b. Chart tracking system
c. Chart abstracting system
d. Chart encoder Accurate Answer:- B
With an automated tracking system, it is easy to track how many records are
charged out of the system, their location, and whether they have been
returned on the due dates indicated (Johns 2011, 402).
Ensuring the continuity of future care by providing information to the
patient's attending physician, referring physician, and any consulting
physicians is a function of the:
a. Discharge summary
b. Autopsy report
c. Incident report
d. Consent to treatment Accurate Answer:- A
The discharge summary is a concise account of the patient's illness, course of
treatment, response to treatment, and condition at the time the patient is
discharged (Johns 2011, 78).
CMS developed medically unlikely edits (MUEs) to prevent providers from
billing units of services greater than the norm would indicate. These MUEs
were implemented on January 1, 2007, and are applied to which code set?
a. Diagnosis-related groups
b. HCPCS/CPT codes
c. ICD-9-CM diagnosis and procedure codes
d. Resource utilization groups Accurate Answer:- B
, CMS developed MUEs to prevent providers from billing units in excess and
receiving inappropriate payments. This new editing was the result of the
outpatient prospective payment system which pays providers passed on the
HCPCS/CPT code and units. Payment is directly related to units for specified
HCPCS/CPT codes assigned to an ambulatory payment classification (CMS
2012b).
What is the best reference tool to determine how CPT codes should be
assigned?
a. Local coverage determination from Medicare
b. American Medical Association's CPT Assistant newsletter
c. American Hospital Association's Coding Clinic
d. CMS website Accurate Answer:- B
CPT Assistant provides additional CPT coding guidance on how to assign a
CPT code by providing intent on the use of the code and explanation of
parenthetical instructions. The American Medical Association publishes the
guidance monthly (AMA 2012b).
A software interface is a:
a. Device to enter data
b. Protocol for describing data
c. Program to exchange data
d. Standard vocabulary Accurate Answer:- C
A software interface is a computer program that allows different applications
to communicate and exchange data (Johns 2011, 137).
What did the Centers of Medicare and Medicaid Services develop to promote
national correct coding methodologies and to control improper coding leading
to inappropriate payment in Part B claims?
Solutions
A system that provides alerts and reminders to clinicians is a(n):
a. Clinical decision support system
b. Electronic data interchange
c. Point of care charting system
d. Knowledge database Accurate Answer:- A Clinical decision support
includes providing documentation of clinical findings and procedures, active
reminders about medication administration, suggestions for prescribing less
expensive but equally effective drugs, protocols for certain health
maintenance procedures, alerts that a duplicate lab test is being ordered, and
countless other decision-making aids for all stakeholders in the care process
(Johns 2011, 138).
What does an audit trail check for?
a. Unauthorized access to a system
b. Loss of data
c. Presence of a virus
d. Successful completion of a backup Accurate Answer:- A
Audit trails can provide tracking information such as who accessed which
records and for what purpose (Johns 2011, 403).
A hospital HIM department wants to purchase an electronic system that
records the location of health records removed from the filing system and
documents the date of their return to the HIM department. Which of the
following electronic systems would fulfill this purpose?
a. Chart deficiency system
,b. Chart tracking system
c. Chart abstracting system
d. Chart encoder Accurate Answer:- B
With an automated tracking system, it is easy to track how many records are
charged out of the system, their location, and whether they have been
returned on the due dates indicated (Johns 2011, 402).
Ensuring the continuity of future care by providing information to the
patient's attending physician, referring physician, and any consulting
physicians is a function of the:
a. Discharge summary
b. Autopsy report
c. Incident report
d. Consent to treatment Accurate Answer:- A
The discharge summary is a concise account of the patient's illness, course of
treatment, response to treatment, and condition at the time the patient is
discharged (Johns 2011, 78).
CMS developed medically unlikely edits (MUEs) to prevent providers from
billing units of services greater than the norm would indicate. These MUEs
were implemented on January 1, 2007, and are applied to which code set?
a. Diagnosis-related groups
b. HCPCS/CPT codes
c. ICD-9-CM diagnosis and procedure codes
d. Resource utilization groups Accurate Answer:- B
, CMS developed MUEs to prevent providers from billing units in excess and
receiving inappropriate payments. This new editing was the result of the
outpatient prospective payment system which pays providers passed on the
HCPCS/CPT code and units. Payment is directly related to units for specified
HCPCS/CPT codes assigned to an ambulatory payment classification (CMS
2012b).
What is the best reference tool to determine how CPT codes should be
assigned?
a. Local coverage determination from Medicare
b. American Medical Association's CPT Assistant newsletter
c. American Hospital Association's Coding Clinic
d. CMS website Accurate Answer:- B
CPT Assistant provides additional CPT coding guidance on how to assign a
CPT code by providing intent on the use of the code and explanation of
parenthetical instructions. The American Medical Association publishes the
guidance monthly (AMA 2012b).
A software interface is a:
a. Device to enter data
b. Protocol for describing data
c. Program to exchange data
d. Standard vocabulary Accurate Answer:- C
A software interface is a computer program that allows different applications
to communicate and exchange data (Johns 2011, 137).
What did the Centers of Medicare and Medicaid Services develop to promote
national correct coding methodologies and to control improper coding leading
to inappropriate payment in Part B claims?
