Pre-Test Domain 4

validity

A coding supervisor audits coded records to ensure the codes reflect the actual documentation in the health record. This coding auditing process addresses the data quality element of: A. granularity B. reliability C. timeliness D. validity

The sepsis was not coded and so an MCC was missed.

A patient was admitted to the hospital for treatment of a myocardial infarction (heart attack) and the MS-DRG assigned was 236 Coronary bypass without cardiac cath without MCC. During the patient's admission a bypass procedure was performed on day 2. On day 4, the patient was diagnosed with sepsis that was not present on admission. Sepsis is a major complication. This case was identified as coded incorrectly in a recent audit by the coding manager. What error was made by the coder? A. The sepsis was not coded and so an MCC was missed. B. The coronary bypass procedure was coded incorrectly. C. The claim was coded correctly, and no error was made. D. The cardiac catheterization procedure was not coded.

24 hours

According to the Joint Commission standard, the history and physical exam report should be documented into the patient record within ____ hours of admission. A. 12 hours B. 24 hours C. 48 hours D. 72 hours

30-day increment

Aging of accounts is the practice of counting the days, generally in increments,, from the time a bill has been sent to the payer to the current day. What is the standard increment, in days, that most healthcare entities use for the aging of accounts? A. 7-day increment B. 14-day increment C. 30-day increment D. 90-day increment

Preventing billing from bundled services

All of the following are goals for a clinical documentation improvement program EXCEPT: A. promoting record completing during the patient's stay B. identifying missing, conflicting, or nonspecific documentation C. Improving communication between the physician and the care team D. Preventing billing from bundled services

Query the physician to ask if the patient has septicemia because of the symptomatology.

An 80-year-old female is admitted with fever, lethargy, hypotension, tachycardia, oliguria, and elevated WBC. The patient has more than 100,000 organisms of Escherichia coli per cc of urine. The attending physician documents "urosepsis." How should the coder proceed to code this case? A. Code sepsis as the principal diagnosis with urinary tract infection due to E. coli as secondary diagnosis B. Code urinary tract infection with sepsis as the principal diagnosis. C. Query the physician to ask if the patient has septicemia because of the symptomatology. D. Query the physician to ask if the patient had septic shock so that this may be used as the principal diagnosis.

Office of the Inspector General (OIG)

Coding compliance programs focus on preventing accusations of fraud and abuse in healthcare. Which organization from the Department of Health and Human Services provides guidance for healthcare organizations in developing compliance programs? A. Joint Commission B. American Health Information Management Association (AHIMA) C. Office of the Inspector General (OIG) D. Centers for Medicare and Medicaid Services (CMS)

Query the physician

Carolyn works as a coder in a hospital inpatient department. She sees a lab report in a patient's health record that is positive for staph infection. However, there is no mention of staph in the physician's documentation. What should Carolyn do? A. Assign a code for the staph infection B. Put a note in the chart C. Query the physician D. Tell her supervisor

Medicare certification

Compliance with the Conditions of Participation allows a hospital to achieve: A. Commercial insurance reimbursement B. Joint Commission accreditation C. State licensure D. Medicare certification

Code skin lesion

In a recent coding audit, the coding manager discovered the following issue: A skin lesion was removed from a patient's cheek in the dermatologist's office. The dermatologist documented skin lesion, probable basal cell carcinoma. Which of the following actions should the coding professional take in order to correctly code this encounter? A. Code basal cell carcinoma B. Code benign skin lesion C. Code skin lesion D. Query the dermatologist

Claims processing

In a typical acute-care setting, which revenue cycle area uses an internal auditing system (scrubber) to ensure that error-free claims (clean claims) are submitted to third-party payers? A. Accounts receivable B. Claims processing C. Claims reconciliation or collections D. Pre-claims submission

Allowable charge

In its payment notice (remittance advice), the healthcare plan lists that the payment for an individual laboratory test is $39. The bill that the pathologist's office submitted for the laboratory test was $45. What does the amount of $39 represent? A. Allowable charge B. Capitated rate C. Cost D. Premium

Date the claim drops

Most facilities begin counting days in accounts receivable at which of the following times? A. Date the patient registers B. Date the patient is discharged C. Date the claim drops D. Date the claim is received by the payer

length of stay

Patients who are assigned the same DRG have all of the following comparable criteria EXCEPT: A. diagnosis code B. healthcare protocol C. length of stay D. utilization management

patient, procedure, and site

The universal protocol requires a "time-out" prior to the start of any surgical or invase procedure to conduct a verification of: A. patient and procedure B. patient, procedure, and site C. surgeon and site D. surgeon, patient, and site

Skilled nursing facility

Site surveyors always look for evidence of three trigger issues including very high percentages of patients suffering from dehydration, decubitus ulcers in low-risk residents, and fecal impaction within which type of healthcare setting? A. Acute-care hospital B. Ambulatory surgery center C. Behavior health facility D. Skilled nursing facility

hospital stays

Tammy has Medicare Part A only. Which of the following services is she covered for? A. hospital stays B. office visits C. dental services D. pharmaceuticals

Medical equipment management, life safety management, and emergency management

The Joint Commission requires a varying number of safety functions and plans depending on the license or services provided by an organization. The standards require the assessment of safety features for patients, staff, and visitors. Which of the following lists are required safety standard plans for the environment of care? A. Emergency management, security management, and patient management B. Medical equipment management, life safety management, and emergency management C. Employment management, hazardous materials and waste management, and life safety management D. Utilities management, employment management, and medical equipment management

Dollars in accounts receivable

The amount of money owed a healthcare facility when claims are pending is called: A. Bad debt B. Delayed revenue C. Dollars in accounts receivable D. Write-off account

the patient and the healthcare facility

The chargemaster is maintained by: A. the health insurance company B. the patient C. the healthcare facility D. the electronic clearinghouse

Focused audit

The facility's Medicare case-mix has dropped, although other statistical measures appear constant. The CFO suspects coding errors. What type of coding audit review should be performed? A. Random audit B. Focused audit C. Compliance audit D. External audit

Bill hold

The period of time between discharge and claim submission, which a facility defines by policy, is called the: A. AR days B. Bill hold C. Cash flow days D. denial period

upcoding

The practice of using a code that results in a higher payment to the provider than the code that actually reflects the service or item provided is known as: A. unbundling B. billing for services not provided C. medically unnecessary services D. upcoding

The charges are not being paid appropriately.

Use the following custom revenue production report to determine which of the following evaluations is apparent to the practice coding manager about the consultation codes (99241-99245). A. The consultation codes are being used more frequently than expected. B. The consultation codes appear clustered. C. The charges appear to be much lower than expected. D. The charges are not being paid appropriately.

The beneficial effects of a service for the patient's physical needs and quality of life

What factor is medical necessity based on? A. The beneficial effects of a service for the patient's physical needs and quality of life B. The cost of a service compared with the beneficial effects on the patient's health C. The availability of a service at the facility D. The reimbursement available for a given service

Sue, in her role as a patient registration clerk, uses a patient's insurance information to see a specialist for cosmetic surgery.

Which of the following is an example of internal medical identity theft? A. Bob introduces a virus into the facilty's health information system. B. Joan, an ICU nurse, accesses the record of the patient she is currently treating. C. Joe uses a patient's information obtained through hacking the healthcare facility system. D. Sue, in her role as a patient registration clerk, uses a patient's insurance information to see a specialist for cosmetic surgery.