Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| what two medications are prescribed to cancer patients to eradicate the cancer or for prophylaxis | show 🗑
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| the definitions of a best medical record for a RADV audit is | show 🗑
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| what is reported by a provider for beneficiaries in medicare advantage plan | show 🗑
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| retrospective audits should include | show 🗑
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| what type of audit evaluates appropriate risk score of pts | show 🗑
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| show | single DOS for outpatient records and the full inpatient set for hospital records
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| how often should a provider see and assess a pt in a calendar year to validate amputation status | show 🗑
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| a peg tube is | show 🗑
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| Conditions listed on the problem list for dm pt are coded as complications of the dm: True or false | show 🗑
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| show | pts response to current treatment, reason for encounter, providers observation of pts mood
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| which organs are in thoracic cavity | show 🗑
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| show | utilized by some private payers
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| show | performance of medicare advantage plans
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| what risk adjustment model is used by medicaid | show 🗑
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| show | False
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| show | physicians office progress note, outpatient hospital, critical access hospital
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| show | the number of years pt has been covered under medicare advantage
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| show | verify accuracy of dx submitted for payment
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| when in outpatient setting would you code an uncertain dx | show 🗑
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| when do you code for coexisting conditions | show 🗑
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| show | previous years known dxs
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| show | DME claims, rx events, physicians claims data, facility claims data
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| show | community population health, effective clinical care, efficiency and cost reduction, patient safety
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| show | all dx codes reported are supported in medical record
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| what is reported when the provider documents arrow up HTN | show 🗑
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| what is acceptable signature | show 🗑
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| which organization is the coding clinic associated with | show 🗑
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| show | code the condition as if it was established
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| when can hemiparesis be coded | show 🗑
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| show | 60 days
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| when does medicare require the provider to sign the medical record | show 🗑
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| show | when receiving treatment
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| show | code all current dx a pt has
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| funding is allocated base on what for commercial plans | show 🗑
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| show | five
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| what is true regarding the star quality rating system | show 🗑
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| what is the goal of HEDIS | show 🗑
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| which of the following payment models are used for payment year 2014 | show 🗑
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| show | radiology report
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| what is the purpose of collecting dx's in risk adjustment coding | show 🗑
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| what element of the documentation includes the providers objective findings | show 🗑
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| show | HCC
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| what is the purpose of risk adjustment values | show 🗑
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| medicare defaults much of its risk adjustment dx coding guidance to | show 🗑
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| show | jan to dec
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| what is the impact on reimbursement under the risk adjustment model if chronic conditions are not coded | show 🗑
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| show | outcomes
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| what is the purpose for capturing codes in an HCC model | show 🗑
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| when is added value factored into the RAF for the HC model for disease interaction | show 🗑
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| show | failing to report all the dx's supported in the medical record
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| show | states can either use the federal methodology or propose an alternative for certification by HHS
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| what is the lowest rating a plan must achieve to avoid penalties | show 🗑
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| show | perform a retrospective audit to confirm proper dx code selection
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| which of the following is a quality review measure | show 🗑
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| how is predictive modeling used in risk adjustment | show 🗑
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| how are PQRS measure reported to CMS | show 🗑
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| under the health and human services hierarchial condition category model which plan has the hightest out of pocket expense once premium is paid | show 🗑
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| show | not all dx codes are assigned an HCC
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| which is not to be taken into consideration for risk adjustment | show 🗑
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| which provider is not an approved provider for dx code capture under the medicare HCC model | show 🗑
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| show | after the dx and risk factor data has been reported to CMS
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| under the HHS and HCC model which plan has the lowest out of pocket expense once the premium is paid | show 🗑
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| how is FFS data used for the purposes of risk adjustment | show 🗑
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| show | Chronic Disability Payment System
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| show | to determine projected costs of healthcare based on the conditions of patients
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| in CDPS risk adjustment models where do heart attacks fall | show 🗑
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| what are extra risk adjustment values or factors added when a patient has more then one major significant dx identified in the model | show 🗑
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| when are prospective reviews performed | show 🗑
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| what fx is considered traumatic | show 🗑
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| in which circumstances would an external cause be reported | show 🗑
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| show | query
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| which structure in the urinary system differs in position/length between male and femal | show 🗑
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| where is bile produced | show 🗑
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| what belongs to the appendicular skeleton | show 🗑
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| which membrane is found lining the interior walls of digestive system | show 🗑
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| layer in the middle of the eyeball | show 🗑
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| show | duodenum
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| term for draining pus out of ear | show 🗑
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| long bone | show 🗑
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| gland that secretes thyroid hormone and calitonin | show 🗑
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| another term for great toe | show 🗑
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| glaucoma means | show 🗑
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| not considered part of the skin | show 🗑
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| bowmans capsule | show 🗑
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| show | mucosa, submucosa, muscle, serosa
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| auditory ossicles | show 🗑
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| carries sperm out of the epididymis | show 🗑
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| show | femur
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| does not contribute to refraction of the eye | show 🗑
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| pneumomediastinum | show 🗑
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| does not circulate fluids thru body | show 🗑
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| show | separate external ear from middle ear
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| leaving stomach nutrients move thru what order | show 🗑
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| show | ureter
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| show | trachea
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| lies on top of the dermis and has access to rich supply of blood | show 🗑
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| what is MI | show 🗑
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| show | sential first lymph node to be reached by mets CA cells
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| show | $100 or 25%
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| what document assists provider offices with development of compliance manuals | show 🗑
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| show | patients
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| show | OIG work plan
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| show | HITECH
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| show | financial record
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| show | the size and resources of the providers practice
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| show | 1988
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| show | 1996
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| show | 2009
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| show | periodic audits
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| which medicare program part is affected by centers for medicare and Medicaid services | show 🗑
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| show | workers comp
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| show | reasearch
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| what medicare part covers provider fees without the use of private insurance | show 🗑
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| show | states what will be paid and why any changes to charges were made
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| who is responsible for enforcing HIPAA | show 🗑
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| what can result from improper use of cut and past in EHR | show 🗑
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| which payer uses HEDIS measures | show 🗑
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| show | risk adjustment data validation
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| show | disease groups
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| show | will accept lower or higher HCC to validate an HCC within the same category and can be a financial gain by submitting a higher hierarchy HCC
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| show | opportunity to increase revenue, compare claims to documentation submit deletions if not supported
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| example of fraud | show 🗑
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| Risk adjustment is | show 🗑
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| show | True
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| how can MA plan improve their revenue | show 🗑
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| show | artery to vein
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| show | health reisk is redetermined every year/document all clinical findings in the medical record/HCCs must be captured every 12 months
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| show | location and type
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| what is the function of thyroid gland | show 🗑
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| show | pancreatic islets
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| excessive potassium | show 🗑
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| what is predictive modeling | show 🗑
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| in risk adjustment models, risk scores are used to adjust payments for each beneficiary's expected expenditures. True or false | show 🗑
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| show | disease interactions, age, manifestations of chronic illness
🗑
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| show | no
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| show | Risk adjustment processing system
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| what risk adjustment model incorporates high, medium and low risk in the numeric value | show 🗑
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Created by:
Thollie