CRC certification Word Scramble

Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

Normal Size Small Size show me how

Question	Answer
what two medications are prescribed to cancer patients to eradicate the cancer or for prophylaxis	tamoxifen, anastrozole
the definitions of a best medical record for a RADV audit is	documentation validates the CMS requested HCC's and contains all the necessary documentation elements and has additional HCC's not requested by CMS
what is reported by a provider for beneficiaries in medicare advantage plan	nature of presenting problem, all chronic conditions
retrospective audits should include	provider signatures, supporting documentation of pts dx, DOS
what type of audit evaluates appropriate risk score of pts	RADV
what info is required when submitting documentation to support a dx for a RADV/IVA	single DOS for outpatient records and the full inpatient set for hospital records
how often should a provider see and assess a pt in a calendar year to validate amputation status	once a year
a peg tube is	percutaneous endoscopic gastrostromy, g tube, gastrostomy
Conditions listed on the problem list for dm pt are coded as complications of the dm: True or false	false
what info is usually documented by provider during pt hx	pts response to current treatment, reason for encounter, providers observation of pts mood
which organs are in thoracic cavity	heart, lungs
what is true regarding hierarchies	utilized by some private payers
the star ratings program monitors	performance of medicare advantage plans
what risk adjustment model is used by medicaid	CDPS
quality measures like Star ratings and HEDIS have no correlation with the medical record information that is collected in support of risk adjustment. True or False	False
which medical records can be submitted for HCC validation	physicians office progress note, outpatient hospital, critical access hospital
what elements would not be taken into consideration for risk adjustment	the number of years pt has been covered under medicare advantage
what is purpose of RADV audit	verify accuracy of dx submitted for payment
when in outpatient setting would you code an uncertain dx	code as sign or symptom
when do you code for coexisting conditions	at the time of the encounter
medicare funding is allocated	previous years known dxs
what data elements are used in predictive modeling	DME claims, rx events, physicians claims data, facility claims data
what are domains in PQRS	community population health, effective clinical care, efficiency and cost reduction, patient safety
what info is verified during RADV audit	all dx codes reported are supported in medical record
what is reported when the provider documents arrow up HTN	query physician
what is acceptable signature	hand written
which organization is the coding clinic associated with	AHA
what is the guidelines for probable, suspected, possible, questionable, in inpatient setting	code the condition as if it was established
when can hemiparesis be coded	documentation states weakness on one side of body, weakness on one side of body due to stroke
and addendum is used to include info about what was done to pt and should be added in a reasonable time frame, which is usually capped at a mx of X days	60 days
when does medicare require the provider to sign the medical record	timely basis
when are cancer dx's coded as current	when receiving treatment
what is the goal when coding for risk adjustment purposes	code all current dx a pt has
funding is allocated base on what for commercial plans	current years known dx's
how many records are submitted per pt in a RADV audit	five
what is true regarding the star quality rating system	quality bonus payments are made to medicare advantages plans who score at least four stars
what is the goal of HEDIS	allow pts to compare health plans
which of the following payment models are used for payment year 2014	blended 25% of 2013 and 75% of 2014
what element of the medical record is NOT used to capture current dx	radiology report
what is the purpose of collecting dx's in risk adjustment coding	risk adjustment factor
what element of the documentation includes the providers objective findings	exam
what is acronym for risk adjustment coding	HCC
what is the purpose of risk adjustment values	budget care of pt for the following year
medicare defaults much of its risk adjustment dx coding guidance to	official coding guidelines and coding clinic
what is reporting period for risk adjustment coding	jan to dec
what is the impact on reimbursement under the risk adjustment model if chronic conditions are not coded	failure to code for chronic conditions the pt has may result in inaccurate RAF
in Star program which measure is given the highest weight	outcomes
what is the purpose for capturing codes in an HCC model	determine the combined risk adjustment factor
when is added value factored into the RAF for the HC model for disease interaction	when two chronic illnesses paired together are complex to treat
what would lead to an underpayment	failing to report all the dx's supported in the medical record
what is true regarding the star program	states can either use the federal methodology or propose an alternative for certification by HHS
what is the lowest rating a plan must achieve to avoid penalties	three
what is the next step after predictive modeling identifies a dx gap	perform a retrospective audit to confirm proper dx code selection
which of the following is a quality review measure	PQRS
how is predictive modeling used in risk adjustment	determine suspected dx based on data elements
how are PQRS measure reported to CMS	claims data, GPRO
under the health and human services hierarchial condition category model which plan has the hightest out of pocket expense once premium is paid	bronze
what is true regarding HCC's	not all dx codes are assigned an HCC
which is not to be taken into consideration for risk adjustment	frequency of office visits
which provider is not an approved provider for dx code capture under the medicare HCC model	anesthesiology assistant
when are retrospective reviews usually performed	after the dx and risk factor data has been reported to CMS
under the HHS and HCC model which plan has the lowest out of pocket expense once the premium is paid	platinum
how is FFS data used for the purposes of risk adjustment	used to determine the FFS normalization adjustment
what does the abbreviation CDPS indicate	Chronic Disability Payment System
what is risk adjustment models used for	to determine projected costs of healthcare based on the conditions of patients
in CDPS risk adjustment models where do heart attacks fall	medium
what are extra risk adjustment values or factors added when a patient has more then one major significant dx identified in the model	interactions
when are prospective reviews performed	prior to the dx and risk factor data being reported to CMS
what fx is considered traumatic	compound
in which circumstances would an external cause be reported	causes of injury or health condition
when provider documents urosepsis what do you do	query
which structure in the urinary system differs in position/length between male and femal	urethra
where is bile produced	liver
what belongs to the appendicular skeleton	pelvic girdle
which membrane is found lining the interior walls of digestive system	mucous
layer in the middle of the eyeball	choroid
term for first portion of the small intestine	duodenum
term for draining pus out of ear	otopyorrhea
long bone	metacarpals
gland that secretes thyroid hormone and calitonin	thyroid gland
another term for great toe	hallux
glaucoma means	abnormally high intraocular pressure
not considered part of the skin	hypodermis
bowmans capsule	c shaped structure partically surrounding the glomerulus
in order starting with innermost layer for walls of digestive tract	mucosa, submucosa, muscle, serosa
auditory ossicles	stapes and incus
carries sperm out of the epididymis	vas deferens
bone that have trochanters	femur
does not contribute to refraction of the eye	aqueous
pneumomediastinum	presence of air in mediastinum
does not circulate fluids thru body	endocrine
tympanic membrane does what	separate external ear from middle ear
leaving stomach nutrients move thru what order	duodenum, jejunum, ileum
urine transported from kidneys to bladder by what	ureter
respiratory structure comprised of cartilage and ligaments	trachea
lies on top of the dermis and has access to rich supply of blood	stratum germinativum
what is MI	lack of O2 to heart tissue, resulting in tissue death
sentinel vs lymp nodes	sential first lymph node to be reached by mets CA cells
ABN cost estimate should be within which range	$100 or 25%
what document assists provider offices with development of compliance manuals	OIG compliance Plan guidance
what is not considered a covered entity under HIPAA	patients
which document is reference when looking for potential programs areas identified by the government indicating scrutiny of the serves with the coming year	OIG work plan
which act was enacted a part of the american recovery and reninvestment acot of 2009	HITECH
what information is not maintained in medical record	financial record
what will the scope of a compliance program depend on	the size and resources of the providers practice
what year was AAPC founded	1988
when did HIPAA become law	1996
when did HITECH enacted	2009
according to OIG internal monitoring and auditing should be performed by waht	periodic audits
which medicare program part is affected by centers for medicare and Medicaid services	part C
what is not covered under HIPAA	workers comp
a covered entity may obtain consent from an individual to use or disclose protected health info except for	reasearch
what medicare part covers provider fees without the use of private insurance	part B
what is the value of remittance advice	states what will be paid and why any changes to charges were made
who is responsible for enforcing HIPAA	OCR
what can result from improper use of cut and past in EHR	dx's that are not relevant for DOS
which payer uses HEDIS measures	a variety
RADV means	risk adjustment data validation
how are HCC's categorized	disease groups
Do HCC category hierarchies play a role in which medical record is submitted for RADV	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
Retrospective audits provide companies ability to scrub/correct data what does this accomplish	opportunity to increase revenue, compare claims to documentation submit deletions if not supported
example of fraud	setting a policy to report all pts w/DM and CKD as a dm manifestation in order to elevate risk scores
Risk adjustment is	prospective payment system
The purpose of RADV audit is to validate submitted HCC data. True or false	True
how can MA plan improve their revenue	develop prospective and restrospective reviews to make sure all accurate dx's are captured
An AV Fistula connects	artery to vein
Chronic and acute conditions from the prev year that risk adjust are used to establish reimbursement for pt care provided by the MA plan.	health reisk is redetermined every year/document all clinical findings in the medical record/HCCs must be captured every 12 months
what do you need to code for vascular ulcer	location and type
what is the function of thyroid gland	secrete hormones regulating body metabolism and blood calcium
which cells produce hormones to regulate blood sugar	pancreatic islets
excessive potassium	hyperkalemia
what is predictive modeling	analysis of data to determine hypothesis related to the future health care needs of patients
in risk adjustment models, risk scores are used to adjust payments for each beneficiary's expected expenditures. True or false	true
what can affect RAF score	disease interactions, age, manifestations of chronic illness
Is HEDIS a division of the centers of medicare and Medicaid services	no
RAPS is	Risk adjustment processing system
what risk adjustment model incorporates high, medium and low risk in the numeric value	CDPS

Created by: Thollie