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CDIP EXAM PREP Study Guide
OIG -
✔️ Office of Inspector General- established by the Dept. of Labor by the Inspector General Act of 1978 to identify fraud and abuse of Medicare part A and part B programs
MAC - ✔️ Medicare Administrative Contractor - used by the OIG to process claims for services rendered
Criteria for high quality documemtation - ✔️ 1. Legible
- Reliable
- Precise
- Complete
- Consistent
- Clear
- Timely
EBM - ✔️ Evidence Based Medicine - the best scientific data a available for clinical documentation
Two part theory for high quality clinical documentation is derived from what - ✔️ Legal/regulatory sources and peer reviewed research
Four standards used in EBM - ✔️ 1. Design
- Terminology
- Performance
- Procedural
DHHS - ✔️ Department of Health and Human services
ARRA - ✔️ American Recovery and Reinvestment Act of 2009 provides specific guidance established as part of the meaningful use incentive program
Meaningful use requirements - ✔️ Provider must maintain an up to date problem list of current and active diagnoses for 80% of patients and 80% of all patients have to have at least one coded problem as opposed to their entire problem list coded
IPPS -
✔️ Hospital Inpatient Prospective Payment System. Reimbursement now being driven by codes assigned to the patient stay with the inception of IPPS in 1982
House Staff - ✔️ Interns, residents and fellows - physicians in training
CMS - ✔️ Centers for Medicare and Medicaid Services
NCHS - ✔️ National Center for Health Statistics
CMS and NCHS created what? - ✔️ Both departments within DHHS, CMS AND DCHS created the Official guidelines for Coding and Reporting
Cooperating parties that developed and approved ICD- 9 - CM AND ICD- 10 - CM - ✔️ AHA - American Hospital Association AHIMA CMS NCHS
ACA - ✔️ Affordable Care Act
POA Indicators - ✔️ Present on admission indicators. These are required by CMS beginning in 2007. Must be done on all secondary diagnoses for Medicare inpatient cases
HAC - ✔️ Hospital Acquired Condition - beginning in 2008, certain HACs that are not POA may not be included in the DRG payment
Deficit Reduction Act of 2005 - ✔️ Requires POA inclusion in the payment guidelines for conditions that:
- Are high cost, high volume or both
- Result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis
- Could reasonably have been prevented through the application of evidence based guidelines
WHO - ✔️ World Health Organization
ICD- 10 - CM - ✔️ Released by WHO IN 1994. Developed by WHO in 42 languages in October
