CHC Study Guide| 348 QUESTIONS| WITH COMPLETE SOLUTIONS

Federal Sentencing Guidelines - Culpability Score Aggravating Factors correct answer: 1. upper-level employee participates, condones, or ignores offense 2. repeat offense 3. hinder investigation 4. awareness and tolerance of violation is pervasive Federal Sentencing Guidelines - Culpability Score Mitigating Factors correct answer: 1. effective compliance program 2. reported promptly 3. cooperation with investigation 4. accept responsibility Federal Sentencing Guidelines - Seven Elements of an Effective Compliance Program correct answer: 1. written standards of conduct 2. Chief Compliance Officer 3. effective education and training 4. audits and evaluations to monitor compliance 5. reporting processes and procedures for complaints 6. appropriate disciplinary mechanisms 7. investigation and remediation of systematic problems The only thing worse than not having a policy is... correct answer: ...having a policy and not following it. Medicare reimbursement - hospital inpatient codes correct answer: International Classification of Diseases (ICD) Medicare reimbursement - physician codes correct answer: Current Procedural Technology (CPT) Questions to guide the scope of an internal investigation. correct answer: 1. What is the origin of the issue? 2. When did the issue originate? 3. How far back should the investigation go? 4. Can extrapolation of a statistical sample be used? It is in the best interest of the organization to have the board _______. correct answer: ...take an active rather than a passive role in compliance. Six tips for saving on future costs of compliance. correct answer: 1. embed quality into existing processes 2. centralize common processes and controls 3. improve human resources infrastructures 4. improve information systems processes 5. emphasize training 6. monitor marketing and compensation Baseline Audit Process correct answer: 1. outline the current operational standards 2. identify real and potential weaknesses 3. offer recommendations Compliance Program - Measures of Effectiveness correct answer: 1. staff knowledge 2. all 7 elements included 3. comparing issues year to year 4. tracking and trending complaints 5. tracking corrective actions 6. reviewing current audits 7. educational session pre and post tests 8. tracking bill denials 9. organizational survey results 10. audit results 11. compliance topics on department/organization agendas Modifier correct answer: a two digit alpha/numeric code used in conjunction with CPT or HCPCS codes that may increase or decrease reimbursement gives new meaning to the code International Classification of Diseases (ICD) correct answer: a statistical classification system that arranges diseases and injuries into groups according to established criteria (signs and symptoms) Current Procedural Terminology (CPT) correct answer: American Medical Association publishes and maintains this coding system Organized Health Care Arrangements (OHCA) correct answer: HIPAA arrangement between clinically integrated setting (ex: hospitals and medical staff) Diagnosis Related Group (DRG) correct answer: an inpatient classification system based on: principal diagnosis, secondary diagnosis, surgical factors, age, sex, and discharge status Healthcare Common Procedure Coding System (HCPCS) correct answer: for medication, maintained by CMS