Quality Control & Assurance Flashcards
7 cards from real Certified Medical Coding Specialist practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Quality Control & Assurance flashcards as text
Which of the following best describes 'unbundling' in the context of coding quality?
Answer: Billing component procedures separately when a comprehensive code exists
Unbundling involves billing component parts of a procedure individually rather than using the single comprehensive code, resulting in higher reimbursement.
A quality assurance program should include which of the following to be compliant with OIG guidelines?
Answer: Written standards, training, internal auditing, and a mechanism to report concerns
The OIG's seven elements of an effective compliance program include written standards, education and training, internal auditing, and a confidential reporting mechanism.
What is the primary purpose of a charge capture audit?
Answer: To ensure all services rendered are accurately billed and not missed or duplicated
A charge capture audit ensures that all services provided are documented, coded, and billed accurately, preventing revenue leakage or overbilling.
When an outpatient facility reports a diagnosis 'confirmed' during a visit that was only suspected, this violates which coding guideline?
Answer: Outpatient coding guidelines (OGCR) Section IV
OGCR Section IV states that outpatient coders should report the condition to the highest degree of certainty, coding signs/symptoms rather than unconfirmed diagnoses.
A concurrent coding audit differs from a retrospective audit in that it:
Answer: Reviews records and codes while the patient is still receiving care
A concurrent audit reviews coding while the patient is still admitted, allowing real-time corrections before the claim is submitted.
Which coding quality indicator measures the percentage of records where the principal diagnosis was coded correctly?
Answer: Principal diagnosis accuracy rate
The principal diagnosis accuracy rate measures how often coders correctly identify and code the principal diagnosis, a key quality metric in inpatient coding.
A self-disclosure to the OIG through the Provider Self-Disclosure Protocol typically results in:
Answer: A reduced multiplier (typically 1.5x) compared to the standard treble damages under FCA
Providers who self-disclose to the OIG typically receive a reduced settlement multiplier of approximately 1.5 times the overpayment rather than the FCA's treble damages.