CCS Exam Prep 2023/ 2024 |Complete Guide with Questions and Answers (Verified Answers)

CCS Exam Prep 2023/ 2024 |Complete Guide with Questions and Answers (Verified Answers) Q: A patient is admitted to the hospital for a coronary artery bypass surgery. Postoperatively, he develops a pulmonary embolism. The present on admission (POA) indicator is Answer: N = not present at the time of inpatient admission Q: In assigning E/M codes, three key components are used. These are Answer: history, examination, and medical decision making Q: Under APCs, payment status indicator "X" means Answer: ancillary services Q: A coworker complained of sudden onset of chest pain and went to the emergency room. A myocardial infarction was ruled out. You would code Answer: only the chest pain Q: The special form that plays the central role in planning and providing care at nursing, psychiatric, and rehabilitation facilities is Answer: the interdisciplinary patient care plan Q: The _______________ are the organizations that contract with Medicare to perform reviews of medical records with the corresponding Medicare claims to detect and correct improper payments. Answer: recovery audit contractors (RACs) Q: This document is published by the Office of Inspector General (OIG) every year. It details the OIG's focus for Medicare fraud and abuse for that year. It gives health care providers an indication of general and specific areas that are targeted for review. It can be found on the Internet on CMS's website. Answer: the OIG's Work Plan Q: ____ is knowingly making false statements or representation of material facts to obtain a benefit or payment for which no entitlement would otherwise exist. Answer: Fraud Q: Before a user is allowed to access protected health information, the system confirms that the patient is who he or she says he or she is. This is known as Answer: authentication Q: ____ are errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients. Answer: Never events or sentinel events Q: Which of the following can be released without consent or authorization? Answer: de-identified health information Q: Based on CMS's DRG system, other systems have been developed for payment purposes. The one that classifies the non-Medicare population, such as HIV patients, neonates, and pediatric patients, is known as Answer: APR-DRGs Q: Under which of the following conditions can an original paper-based patient health record be physically removed from the hospital? Answer: when the director of health records is acting in response to a subpoena duces tecum and takes the health record to court Q: You want to review the one document in your facility that will spell out the documentation requirements for patient records, designate the time frame for completion by the active medical staff, and indicate the penalties for failure to comply with these record standards. Your best resource will be Answer: medical staff rules and regulations Q: The PQRS is a reporting system established by the federal government for physician practices that participate in Medicare for Answer: quality measure reporting Q: The best resource for checking out specific voluntary accreditation standards and guidelines for a rehabilitation facility is the Answer: CARF manual Q: What does CARF manual means? Answer: Commission on Accreditation of Rehabilitation Facilities Q: When health care providers are found guilty under any of the civil false claims statutes, the Office of Inspector General is responsible for negotiating these settlements and the provider is placed under a Answer: Corporate Integrity Agreement Q: What is ANSI ASC X12N 837 format? Answer: The ANSI ASC X12 837 is the claim/encounter format. It is important to note all X12 formats are messaging standards developed for the sole purpose of transmitting data between two entities referred to as trading partners in the HIPAA legislation Q: The Health Insurance Portability and Accountability Act (HIPAA) requires the retention of health insurance claims and accounting records for a minimum of ____ years, unless state law specifies a longer period. Answer: 5 Q: This initiative was instituted by the government to eliminate fraud and abuse and recover overpayments, and involves the use of ______________. Charts are audited to identify Medicare overpayments and underpayments. These entities are paid based on a percentage of money they identify and collect on behalf of the government. Answer: Recovery Audit Contractors (RAC) Q: When a provider, knowingly or unknowingly, uses practices that are inconsistent with accepted medical practice and that directly or indirectly result in unnecessary costs to the Medicare program, this is called Answer: abuse Q: Your hospital is required by the Joint Commission and CMS to participate in national benchmarking on specific disease entities for quality of care measurement. This required collection and reporting of disease-specific data is considered Answer: a series of core measures