CDIP EXAM PREP Revised Version.

CDIP EXAM PREP Revised Version.OIG - answerOffice 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 - answerMedicare Administrative Contractor - used by the OIG to process claims for services rendered Criteria for high quality documemtation - answer1. Legible 2. Reliable 3. Precise 4. Complete 5. Consistent 6. Clear 7. Timely EBM - answerEvidence Based Medicine - the best scientific data a available for clinical documentation Two part theory for high quality clinical documentation is derived from what - answerLegal/regulatory sources and peer reviewed research Four standards used in EBM - answer1. Design 2. Terminology 3. Performance 4. Procedural DHHS - answerDepartment of Health and Human services ARRA - answerAmerican Recovery and Reinvestment Act of 2009 provides specific guidance established as part of the meaningful use incentive program Meaningful use requirements - answerProvider 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 - answerHospital Inpatient Prospective Payment System. Reimbursement now being driven by codes assigned to the patient stay with the inception of IPPS in 1982 House Staff - answerInterns, residents and fellows - physicians in training CMS - answerCenters for Medicare and Medicaid Services NCHS - answerNational Center for Health Statistics CMS and NCHS created what? - answerBoth 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 - answerAHA -American Hospital Association AHIMA CMS NCHS ACA - answerAffordable Care Act POA Indicators - answerPresent on admission indicators. These are required by CMS beginning in 2007. Must be done on all secondary diagnoses for Medicare inpatient cases HAC - answerHospital Acquired Condition - beginning in 2008, certain HACs that are not POA may not be included in the DRG payment Deficit Reduction Act of 2005 - answerRequires POA inclusion in the payment guidelines for conditions that: 1. Are high cost, high volume or both 2. Result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis 3. Could reasonably have been prevented through the application of evidence based guidelines WHO - answerWorld Health Organization ICD-10-CM - answerReleased by WHO IN 1994. Developed by WHO in 42 languages in October 2002. Implementation of ICD-10 - answerOriginally proposed October 1 2014, then CMS delayed implementation until October 1, 2015