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Certified Coding Associate (CCA)
Exam with Complete Solutions
Auto-pay Auto-suspend Auto-calculate *** Auto-deny - ANS-When clean claims are submitted, they can be adjudicated in many ways through computer software automatically. Which statement is not one of the outcomes that can occur as part of auto-adjudication? EHR (electronic health record) EDMS (electronic document management system) *** ESA (electronic signature authentication) PACS (picture archiving and communication system) - ANS-*** A transition technology used by many hospitals to increase access to medical record content is: Acute bronchitis Acute bronchitis with chronic obstructive pulmonary disease Asthma with status asthmaticus *** Chronic obstructive asthma - ANS-A 7-year-old patient was admitted to the emergency department for treatment of shortness of breath. The patient is given epinephrine and nebulizer treatments. The shortness of breath and wheezing are unabated following treatment. What diagnosis should be suspected? Ad hoc Concurrent *** Retrospective
Post discharge - ANS-The HIM department is planning to scan medical record documentation. The project includes the scanning of documentation such as history and physicals, physician orders, operative reports, and nursing notes. Which of the following methods of scanning would be best to help HIM professionals monitor the completeness of health records during a patient's hospitalization? Confidentiality Data security *** Informational privacy Informational access control - ANS-*** The protection measures and tools for safeguarding information and information systems is a definition of: A fee-for-service schedule basis that varies according to the MPFS A rate-per-service basis that varies according to the ambulatory payment classification (APC) group to which the service is assigned *** A cost-to-charge ratio based on the hospital cost report A rate-per-service basis that varies according to the DRG group - ANS-Under the Medicare hospital outpatient perspective payment system (OPPS), services are paid according to: Length of the lesion as described in the pathology report Dimension of the specimen submitted as described in the pathology report Width times the length of the lesion as described in the operative report Diameter of the lesion as well as the most narrow margins required to adequately excise the lesion described in the operative report *** - ANS-If a patient has an excision of a malignant lesion of the skin, the CPT code is determined by the body area from which the excision occurs and which of the following? Anatomic site Severity Etiology *** Supplemental information - ANS-*** What does the fourth character of an ICD-10-CM diagnosis code capture?
records removes copies of the patient's records from another hospital where the patient was previously treated. According to HIPAA regulations, was this action correct? DEEDS EMEDS UACDS *** UHDDS - ANS-*** An outpatient clinic is reviewing the functionality of a computer system it is considering purchasing. Which of the following datasets should the clinic consult to ensure all the federally required data elements for Medicare and Medicaid outpatient clinical encounters are collected by the system? Anesthesia report Laboratory report *** Operative report Pathology report - ANS-Which of the following provides macroscopic and microscopic information about tissue removed during an operative procedure? Automated codebook Computer-assisted coding *** Logic-based encoder Decision support database - ANS-The ________ is a type of coding that is a natural outgrowth of the EHR. Privacy Bioethics Security Confidentiality *** - ANS-*** Which of the following is the area responsible for limiting disclosure of private matters including the responsibility to use, disclose, or release such information only with the knowledge and consent of the individual? Part A Part B
Part C ** Part E - ANS-*** A Medicare Advantage Plan (like an HMO or PPO) is a health coverage option under what part of Medicare? Recovery audit contractors (RACs) Medicare administrative contractors (MACs) *** Fiscal intermediaries (FIs) Office of Inspector General contractors (OIGCs) - ANS-Medicare's newest claims processing payment contract entities are referred to as: Out-of-pocket expense *** Coinsurance Deductible Premium - ANS-*** What is the healthcare expense the patient or insured party is responsible to pay which limited the amount the patient would be responsible for: DRGs RVUs *** CPT SVR - ANS-What system assigns each service a value representing the true resources involved in producing it, including the time and intensity of work, the expenses of practice, and the risk of malpractice? Inpatient Medicare claims submitted by acute care hospitals ** Inpatient Medicare and Medicaid claims submitted by hospitals Medicare claims submitted by all entities Inpatient skilled nursing facility Medicare claims - ANS-The present on admission (POA) indicator is a requirement for Demographic data
World Health Organization Voluntary Disclosure Program *** Compliance Disclosure Program Fraud and Abuse Program - ANS-*** This is a program unveiled in 1998 by the OIG that encourages healthcare providers to report fraudulent conduct affecting Medicare, Medicaid, and other federal healthcare programs: Audit controls Information access controls *** Facility access controls Workstation security - ANS-An employee in the physical therapy department arrives early every morning to snoop through the clinical information system for potential information about neighbors and friends. What security mechanisms should be implemented to prevent this security breach? Part A *** Part B Part C Part D - ANS-*** What part of Medicare covers Hospital Insurance that helps cover inpatient hospital, skilled nursing, home health, and hospice care? Operation Restore Trust Payment Error Prevention Program Recovery Audit Contractors *** Medicare Administrative Contractors - ANS-*** The Medicare Modernization Act (MMA) of 2003 called for CMS to launch a Medicare payment recovery demonstration project. The purpose of the act eventually resulted in the implementation of a group contracted by the government to monitor suspicious and improper activity of Medicare payments including overpayments and underpayments. What is this group? The patient receives any monies paid by the insurance companies over and above the charges.
Coordination of benefits is necessary to determine which policy is primary and which is secondary so that there is no duplication of payments. *** The decision on which company is primary is based on remittance advice. The patient should not have a Medicare supplement. - ANS-A patient has two health insurance policies: Medicare and a Medicare supplement. Which of the following statements is true? Encryption Malware *** Audit trail Data quality - ANS-A threat to data security is: Coding conventions defined in the CPT book National and local policies and coding edits Analysis of standard medical and surgical practice Clinical documentation in the discharge summary *** - ANS-Promoting correct coding and control of inappropriate payments is the basis of NCCI claims processing edits that help identify claims not meeting medical necessity. The NCCI automated prepayment edits used by payers is based on all of the following except: Out-of-pocket expense Coinsurance *** Deductible Premium - ANS-*** After a deductible has been paid, insured and insurer share covered losses according to a specified ratio, and the insured pays a(n) _________ amount. Retrospectively review each patient's medical record to make sure history and physicals are present. Review each patient's medical record concurrently to make sure history and physicals are present and meet the accreditation standards. *** Establish a process to review medical records immediately on discharge.
DRGs HHRGS OASIS OPPS *** - ANS-*** In processing a Medicare payment for outpatient radiology examinations, a hospital outpatient services department would receive payment under which of the following? APCs MS-DRGs RBRVS *** RUG-III - ANS-*** What reimbursement system uses the Medicare fee schedule?
