CCA- EXAM PREP CORRECT QUESTIONS &
ANSWERS(RATED A)
A patient was admitted for abdominal pain with diarrhea and was diagnosed with infectious
gastroenteritis. The patient also has angina and chronic obstructive pulmonary disease. Which of the
following would be the correct coding and sequencing for this case? - ANSWER Infectious gastroenteritis;
chronic obstructive pulmonary disease; angina
What is TEFRA? - ANSWER Tax Equity and Fiscal Responsibility Act of 1982.
Tax Equity and Fiscal Responsibility Act (TEFRA). What was it for? - ANSWER To control the rising cost of
healthcare services to Medicare patients.
What is the difference between retrospective and prospective payment system? - ANSWER Retro was
fee-based AFTER services. Prospect is predetermined payment BEFORE services.
The (DHHS), (OIG), (CMS), and Administration on Aging (AOA), released the program called _______ in
1995 to target fraud and abuse among healthcare providers? - ANSWER Operation Restore Trust
Medicare Integrity Program (MIP) authorizes: - ANSWER CMS to contract with entities to perform cost
audits, medical reviews, and anti-fraud tasks
The Deficit Reduction Act of 2005 created - ANSWER Medicaid Integrity Program (MIP) to combat fraud,
abuse and waste
What is the difference between Balanced Budget Act and False Claims Act? - ANSWER False Claims
started during Civil War; BBA started in 1997 gave the OIG the power to EXCLUDE those who commit
fraud from getting paid
Using uniform terminology is a way to improve: - ANSWER Data reliability
, These codes are used to assign a diagnosis to a patient who is seeking health services but is not
necessarily sick.
a. C codes
b. E codes
c. M codes
d. Z codes - ANSWER Z codes
The goal of coding compliance programs is to reduce: - ANSWER Liability in regards to fraud and abuse
For the body mass index (BMI), depth of non-pressure chronic ulcers, pressure ulcer stage, coma scale,
and NIH stroke scale (NIHSS) codes, code assignment may be based on _____. - ANSWER clinician
documentation instead of the patient's provider
Explain Anti-kickback statute - ANSWER physicians can't get money for referring patients
Explain Balanced Budget Act of 1997 - ANSWER gave the OIG the power to EXCLUDE those who commit
fraud from getting paid
HIPAA (Health Insurance Portability and Accountability Act) has to do with - ANSWER privacy and
security of health information
Explain the difference between privacy and security. - ANSWER P: patient's right to control disclosure
S: how info is protected from breach
The ________ permits penalties to be awarded to those who intentionally submit fraudulent claims to
the US government:
a. Anti-kickback statute
b. Balanced budget act of 1997
c. False Claims Act of 1863
d. HIPAA - ANSWER False Claims Act of 1863
, What does MS-DRG stand for? - ANSWER Medicare Severity Diagnosis-Related Groups
Macroscopic and microscopic information about tissue removed during an operative procedure can be
found in the ____ report. - ANSWER pathology
A special webpage that offers secure access to data is called a(n) ________. - ANSWER Portal
Access control is a technical safeguard that limits access to EHR only to _______. - ANSWER authorized
entities.
"PA and Lateral Chest: The lungs are clear. The heart and mediastinum are normal in size and
configuration. ." This will be found in the _____ report. - ANSWER radiography
What departments would need to work together if an audit found that the claim did not contain the
procedure code or charge for a pacemaker insertion? - ANSWER Health Info department, Business Office,
and Cardiac Department
"Continue with Diuril, 500 mgs once daily. Return visit in 2 weeks." Which part of a POMR progress note
would this notation be written? - ANSWER in the Plan section
When clean claims are submitted, they can be adjudicated in many ways through computer software
automatically. Which statement is not one of the outcomes that can occur as part of auto-adjudication?
a. Auto-pay
b. Auto-suspend
c. Auto-calculate
d. Auto-deny - ANSWER auto-calculate
The guarantor is the person ____ for the bill, such as a parent. - ANSWER responsible
Common forms of fraud and abuse include all of the following except:
a. Upcoding
ANSWERS(RATED A)
A patient was admitted for abdominal pain with diarrhea and was diagnosed with infectious
gastroenteritis. The patient also has angina and chronic obstructive pulmonary disease. Which of the
following would be the correct coding and sequencing for this case? - ANSWER Infectious gastroenteritis;
chronic obstructive pulmonary disease; angina
What is TEFRA? - ANSWER Tax Equity and Fiscal Responsibility Act of 1982.
Tax Equity and Fiscal Responsibility Act (TEFRA). What was it for? - ANSWER To control the rising cost of
healthcare services to Medicare patients.
What is the difference between retrospective and prospective payment system? - ANSWER Retro was
fee-based AFTER services. Prospect is predetermined payment BEFORE services.
The (DHHS), (OIG), (CMS), and Administration on Aging (AOA), released the program called _______ in
1995 to target fraud and abuse among healthcare providers? - ANSWER Operation Restore Trust
Medicare Integrity Program (MIP) authorizes: - ANSWER CMS to contract with entities to perform cost
audits, medical reviews, and anti-fraud tasks
The Deficit Reduction Act of 2005 created - ANSWER Medicaid Integrity Program (MIP) to combat fraud,
abuse and waste
What is the difference between Balanced Budget Act and False Claims Act? - ANSWER False Claims
started during Civil War; BBA started in 1997 gave the OIG the power to EXCLUDE those who commit
fraud from getting paid
Using uniform terminology is a way to improve: - ANSWER Data reliability
, These codes are used to assign a diagnosis to a patient who is seeking health services but is not
necessarily sick.
a. C codes
b. E codes
c. M codes
d. Z codes - ANSWER Z codes
The goal of coding compliance programs is to reduce: - ANSWER Liability in regards to fraud and abuse
For the body mass index (BMI), depth of non-pressure chronic ulcers, pressure ulcer stage, coma scale,
and NIH stroke scale (NIHSS) codes, code assignment may be based on _____. - ANSWER clinician
documentation instead of the patient's provider
Explain Anti-kickback statute - ANSWER physicians can't get money for referring patients
Explain Balanced Budget Act of 1997 - ANSWER gave the OIG the power to EXCLUDE those who commit
fraud from getting paid
HIPAA (Health Insurance Portability and Accountability Act) has to do with - ANSWER privacy and
security of health information
Explain the difference between privacy and security. - ANSWER P: patient's right to control disclosure
S: how info is protected from breach
The ________ permits penalties to be awarded to those who intentionally submit fraudulent claims to
the US government:
a. Anti-kickback statute
b. Balanced budget act of 1997
c. False Claims Act of 1863
d. HIPAA - ANSWER False Claims Act of 1863
, What does MS-DRG stand for? - ANSWER Medicare Severity Diagnosis-Related Groups
Macroscopic and microscopic information about tissue removed during an operative procedure can be
found in the ____ report. - ANSWER pathology
A special webpage that offers secure access to data is called a(n) ________. - ANSWER Portal
Access control is a technical safeguard that limits access to EHR only to _______. - ANSWER authorized
entities.
"PA and Lateral Chest: The lungs are clear. The heart and mediastinum are normal in size and
configuration. ." This will be found in the _____ report. - ANSWER radiography
What departments would need to work together if an audit found that the claim did not contain the
procedure code or charge for a pacemaker insertion? - ANSWER Health Info department, Business Office,
and Cardiac Department
"Continue with Diuril, 500 mgs once daily. Return visit in 2 weeks." Which part of a POMR progress note
would this notation be written? - ANSWER in the Plan section
When clean claims are submitted, they can be adjudicated in many ways through computer software
automatically. Which statement is not one of the outcomes that can occur as part of auto-adjudication?
a. Auto-pay
b. Auto-suspend
c. Auto-calculate
d. Auto-deny - ANSWER auto-calculate
The guarantor is the person ____ for the bill, such as a parent. - ANSWER responsible
Common forms of fraud and abuse include all of the following except:
a. Upcoding
