CCA Exam Questions with 100% Correct
Answers | Verified | Updated 2024.
Which organization updates the procedure classification of ICD-10-PCS
CMS
What does the 4th character of an ICD-10-CM diagnosis code capture?
Etiology
True or false: Critical access hospitals are reimbursed under Medicare's outpatient prospective
payment system.
False. They are paid based on a cost-based payment system.
If the placement of a catheter is billed along with an infusion on the same day of service for an
outpatient beneficiary, what will Medicare pay for?
The infusion procedure. The insertion of the catheter is integral to the procedure and not coded
separately.
What is the goal of a coding compliance program?
To prevent accusations of fraud and abuse
What would be the best way for a hospital to determine whether POA indicators for the conditions
selected by CMS are having a negative impact on reimbursement?
Identify all records for a period having these indicators for these conditions and determine if these
conditions are the only secondary diagnoses present that will lead to higher payment.
In a fee-for-service arrangement, what would be a cost control process for inpatient surgery?
Prospectively precertify the necessity of the surgery
True or false: The outpatient claims editor generates denials of outpatient claims.
False. An outpatient claims editor does not exist.
What is the electronic format for hospital technical fees?
8371
What process determines how a claim will be reimbursed based on the insurance benefit
Adjudication
What is not one of the outcomes of auto-adjudication by computer software?
Auto-calculate. The software can auto-pay, auto-suspend, or auto-deny
, Which agency develops an annual work plan that delineates the target areas for Medicare that will be
monitored in a given year?
Office of Inspector General
What is the defining characteristic of an integrated health record?
Components are arranged in chronological order
What is the purpose of physician's orders?
Document instructions to other parties involved in providing patient care
Which program was released in 1995 to target fraud and abuse among healthcare providers?
Operation Restore Trust
Which resource can managers use to discover current areas of compliance?
OIG Workplan
What is the term for a record of all transactions that is maintained and reviewed for unauthorized
access?
Audit trail
Performance counseling usually begins with what?
Counseling or verbal warning
Healthcare facilities have written standards of conduct and policies and procedures that address fraud
as well as audits to monitor compliance. What should a compliance officer also ensure are in place?
Establishment of a hotline to receive complaints and adoption of procedures to protect whistleblowers
from retaliation.
This person designs, implements, and maintains a program that ensures conformity to all types of
regulatory and voluntary accreditation requirements
Compliance officer
What is natural-language processing?
Digital text from online documents is read directly by the software
Which technology is used by hospitals to increase access to medical record content?
EDMS (electronic document management system)
True or False: The HIPAA Privacy Rule requires that individuals be able to request restrictions on
certain uses and disclosures of PHI.
True. It also allows right of access, right to request amendment of PHI, right to accounting of disclosures,
right to request restrictions of PHI, right to request confidential communications, and right to complain
about Privacy Rule violations.
Answers | Verified | Updated 2024.
Which organization updates the procedure classification of ICD-10-PCS
CMS
What does the 4th character of an ICD-10-CM diagnosis code capture?
Etiology
True or false: Critical access hospitals are reimbursed under Medicare's outpatient prospective
payment system.
False. They are paid based on a cost-based payment system.
If the placement of a catheter is billed along with an infusion on the same day of service for an
outpatient beneficiary, what will Medicare pay for?
The infusion procedure. The insertion of the catheter is integral to the procedure and not coded
separately.
What is the goal of a coding compliance program?
To prevent accusations of fraud and abuse
What would be the best way for a hospital to determine whether POA indicators for the conditions
selected by CMS are having a negative impact on reimbursement?
Identify all records for a period having these indicators for these conditions and determine if these
conditions are the only secondary diagnoses present that will lead to higher payment.
In a fee-for-service arrangement, what would be a cost control process for inpatient surgery?
Prospectively precertify the necessity of the surgery
True or false: The outpatient claims editor generates denials of outpatient claims.
False. An outpatient claims editor does not exist.
What is the electronic format for hospital technical fees?
8371
What process determines how a claim will be reimbursed based on the insurance benefit
Adjudication
What is not one of the outcomes of auto-adjudication by computer software?
Auto-calculate. The software can auto-pay, auto-suspend, or auto-deny
, Which agency develops an annual work plan that delineates the target areas for Medicare that will be
monitored in a given year?
Office of Inspector General
What is the defining characteristic of an integrated health record?
Components are arranged in chronological order
What is the purpose of physician's orders?
Document instructions to other parties involved in providing patient care
Which program was released in 1995 to target fraud and abuse among healthcare providers?
Operation Restore Trust
Which resource can managers use to discover current areas of compliance?
OIG Workplan
What is the term for a record of all transactions that is maintained and reviewed for unauthorized
access?
Audit trail
Performance counseling usually begins with what?
Counseling or verbal warning
Healthcare facilities have written standards of conduct and policies and procedures that address fraud
as well as audits to monitor compliance. What should a compliance officer also ensure are in place?
Establishment of a hotline to receive complaints and adoption of procedures to protect whistleblowers
from retaliation.
This person designs, implements, and maintains a program that ensures conformity to all types of
regulatory and voluntary accreditation requirements
Compliance officer
What is natural-language processing?
Digital text from online documents is read directly by the software
Which technology is used by hospitals to increase access to medical record content?
EDMS (electronic document management system)
True or False: The HIPAA Privacy Rule requires that individuals be able to request restrictions on
certain uses and disclosures of PHI.
True. It also allows right of access, right to request amendment of PHI, right to accounting of disclosures,
right to request restrictions of PHI, right to request confidential communications, and right to complain
about Privacy Rule violations.
