WGU- Classification Systems - C808 Test
Questions & Answers Verified 100% Correct
Diagnosis and procedure codes - ANSWER -* Medicare severity diagnosis-related
groups (ms-drg)
* Value-based purchasing (vbp)
* Quality of care measures including inpatient quality reporting (iqr)
* Severity of illness (soi)
* Expected risk of mortality (rom)
* Present on admission (poa) or hospital-acquired condition (hac) reporting
*Patient saftey measures
* Utilization of resource measures such as case-mix and medical necessity
* Protection from liability
* Public health monitoring
CDI Program - ANSWER -Function is to initiate concurrent and, as appropriate,
retrospective reviews of health records fro conflicting, incomplete, or nonspecific
provider documentation.
Concurrent Review - ANSWER -Concurrent Review of the record occurs while
the patient care is ongoing, often the reviewers are alongside the healthcare
providers on the patient care units to facilitate communication.
Retrospective Review - ANSWER -Occurs later after that patient has been
discharged.
Goals of a CDI program - ANSWER -* Obtain clinical documentation that
captures the patient severity of illness and risk of mortality
* Identify and clarify missing, conflicting, or nonspecific physician documentation
related to diagnoses and procedures.
* Support accurate diagnostic and procedural coding, and MS-DRG assignment,
leading to appropriate reimbursement.
* Promote health record completion during the patient's course of care, which
promotes patient safety.
,* Provide awareness and education.
* Improve documentation to reflect quality and outcome scores.
* Improve coders clinical knowledge
Utilization Management - ANSWER -A planned systematic review of patients in a
healthcare facility against care criteria for admission, continued stay and discharge.
Physician Champion - ANSWER -Also known in some organizations as the
physician advisor, is an individual who assists in communicating with and
educating medical staff in areas such as documentation procedures for accurate
billing and EHR procedures.
Physician Advisor - ANSWER -* Educating providers on the importance of
documentation
* Planning education for different medical departments
* Communicating with the medical staff regarding CDI ( via newletters, website,
presentations and such)
* Participating in investigation admission denials, DRG changes, Medicare core
measures documentation
* Assisting in formulating clinically appropriate and compliant queries for
physicians to clarify documentation
Methods to facilitate effective training sessions - ANSWER -* Utilize real,
practical examples of actual documentation from the facility or physician in CDI
review.
* Communicate the specific documentation needs of the ICD-10-CM/PCS system.
* Create templates for diagnoses, procedures, or services needing improvement in
documentation.
* Distribute handouts as communication tools
* Leverage newsletters
* Display posters or signage to increase awareness
* Utilize pocket cards for quick reference
Query - ANSWER -A routine communication and education tool used to advocate
for complete and compliant documentation.
, Computer-Assisted Coding (CAC) - ANSWER -An emerging technology being
utilized in the coding process. CAC is a tool intended for improved efficiency of
the coding and claims submission process.
Compliance - ANSWER -Complying with rules, laws, standards, or regulations.
Fraud - ANSWER -An intentional or deliberate deception or misrepresentation
that an individual makes in order to receive additional benefits.
Abuse - ANSWER -Practices or incidents that are not done deliberately even
though they may result in improper payments for Medicare.
Federal False Claims Act - ANSWER -A federal law that seeks to protect
governmental programs from fraud by individuals and companies.
Extrapolation Method - ANSWER -A method of auditing that looks at a small
sample of records and applies the correction in payment/reimbursement across a
large number of claims in a time period or service area.
Foundational OIG Guidelines - ANSWER -* The development and distribution of
written standards of conduct, as well as written policies and procedures that
promote the hospital's commitment to compliance. ( Example: by including
adherence to compliance as a element in evaluation managers and employees)
* The designation of a chief compliance officer and other appropriate bodies, for
example, a corporate compliance committee charged with the responsibility of
operating and monitoring the compliance program and who reports directly to the
CEO and the governing body.
* The development and implementation of regular, effective education and training
programs for all affected employees
* The maintenance of a process, such as a hotline, to receive complaints, and the
adoption of procedures to protect the anonymity of complainants and to protect
whistle blowers from retaliation.
* The development of a system to respond to allegations of improper or illegals
activities and the enforcement of appropriate disciplinary action against employees
Questions & Answers Verified 100% Correct
Diagnosis and procedure codes - ANSWER -* Medicare severity diagnosis-related
groups (ms-drg)
* Value-based purchasing (vbp)
* Quality of care measures including inpatient quality reporting (iqr)
* Severity of illness (soi)
* Expected risk of mortality (rom)
* Present on admission (poa) or hospital-acquired condition (hac) reporting
*Patient saftey measures
* Utilization of resource measures such as case-mix and medical necessity
* Protection from liability
* Public health monitoring
CDI Program - ANSWER -Function is to initiate concurrent and, as appropriate,
retrospective reviews of health records fro conflicting, incomplete, or nonspecific
provider documentation.
Concurrent Review - ANSWER -Concurrent Review of the record occurs while
the patient care is ongoing, often the reviewers are alongside the healthcare
providers on the patient care units to facilitate communication.
Retrospective Review - ANSWER -Occurs later after that patient has been
discharged.
Goals of a CDI program - ANSWER -* Obtain clinical documentation that
captures the patient severity of illness and risk of mortality
* Identify and clarify missing, conflicting, or nonspecific physician documentation
related to diagnoses and procedures.
* Support accurate diagnostic and procedural coding, and MS-DRG assignment,
leading to appropriate reimbursement.
* Promote health record completion during the patient's course of care, which
promotes patient safety.
,* Provide awareness and education.
* Improve documentation to reflect quality and outcome scores.
* Improve coders clinical knowledge
Utilization Management - ANSWER -A planned systematic review of patients in a
healthcare facility against care criteria for admission, continued stay and discharge.
Physician Champion - ANSWER -Also known in some organizations as the
physician advisor, is an individual who assists in communicating with and
educating medical staff in areas such as documentation procedures for accurate
billing and EHR procedures.
Physician Advisor - ANSWER -* Educating providers on the importance of
documentation
* Planning education for different medical departments
* Communicating with the medical staff regarding CDI ( via newletters, website,
presentations and such)
* Participating in investigation admission denials, DRG changes, Medicare core
measures documentation
* Assisting in formulating clinically appropriate and compliant queries for
physicians to clarify documentation
Methods to facilitate effective training sessions - ANSWER -* Utilize real,
practical examples of actual documentation from the facility or physician in CDI
review.
* Communicate the specific documentation needs of the ICD-10-CM/PCS system.
* Create templates for diagnoses, procedures, or services needing improvement in
documentation.
* Distribute handouts as communication tools
* Leverage newsletters
* Display posters or signage to increase awareness
* Utilize pocket cards for quick reference
Query - ANSWER -A routine communication and education tool used to advocate
for complete and compliant documentation.
, Computer-Assisted Coding (CAC) - ANSWER -An emerging technology being
utilized in the coding process. CAC is a tool intended for improved efficiency of
the coding and claims submission process.
Compliance - ANSWER -Complying with rules, laws, standards, or regulations.
Fraud - ANSWER -An intentional or deliberate deception or misrepresentation
that an individual makes in order to receive additional benefits.
Abuse - ANSWER -Practices or incidents that are not done deliberately even
though they may result in improper payments for Medicare.
Federal False Claims Act - ANSWER -A federal law that seeks to protect
governmental programs from fraud by individuals and companies.
Extrapolation Method - ANSWER -A method of auditing that looks at a small
sample of records and applies the correction in payment/reimbursement across a
large number of claims in a time period or service area.
Foundational OIG Guidelines - ANSWER -* The development and distribution of
written standards of conduct, as well as written policies and procedures that
promote the hospital's commitment to compliance. ( Example: by including
adherence to compliance as a element in evaluation managers and employees)
* The designation of a chief compliance officer and other appropriate bodies, for
example, a corporate compliance committee charged with the responsibility of
operating and monitoring the compliance program and who reports directly to the
CEO and the governing body.
* The development and implementation of regular, effective education and training
programs for all affected employees
* The maintenance of a process, such as a hotline, to receive complaints, and the
adoption of procedures to protect the anonymity of complainants and to protect
whistle blowers from retaliation.
* The development of a system to respond to allegations of improper or illegals
activities and the enforcement of appropriate disciplinary action against employees
