AHIMA CCA Compliance questions with complete solutions

1. In a joint effort of the Department of Health and Human Services [DHHS], Office of Inspector General [OIG], Centers for Medicare and Medicaid Services [CMS], and Administration on Aging [AOA], which program was released in 1995 to target fraud and abuse among healthcare providers? a. operation restore trust b. medicare integrity program c. tax equity and fiscal responsibility act [TEFRA] d. medicare and medicaid patient and program protection act Correct Answer: a. operation restore trust operation restore trust was released in 1995 to target fraud and abuse among healthcare providers. 2. All of the following should be part of the core areas of a coding compliance plan except: a. physician query process b. correct use of encoder software c. coding diagnoses supported by medical record documentation d. tracking length of stay Correct Answer: d. tracking length of stay tracking length of stay is part of the hospital utilization review committee function 3. Common forms of fraud and abuse include all of the following except: a. upcoding b. unbundling or "exploding" charges c. refilling claims after denials d. billing for services not furnished to patients Correct Answer: c. refilling claims after denials refilling claims after denial is not possible because denied claims must be appealed and is not a factor in controlling fraud and abuse. 4. What is the primary use of the case-mix index? a. benchmark of emergency room levels b. defines how a hospital compares to peers and whether the facility is at risk c. audit of APCS and the comparison to same-size hospitals d. a tool for the coding manager to compare coder productivity Correct Answer: b. defines how a hospital compares to peers and whether the facility is at risk BENCHMARKING or PEER COMPARISON helps a manager to know how his or her team has performed compared to peers. This include w