Certified Medical Coding Specialist Quality Control & Assurance 5

Question 1

Which of the following is an example of a 'never event' as defined by CMS that affects hospital reimbursement?

Accepted Answer

Wrong-site surgery

Answer

Wrong-site surgery is classified as a 'never event' or serious reportable event; CMS does not reimburse for the additional costs of treating conditions that result from these events.

Question 2

In a coding quality program, 'interrater reliability' refers to:

Accepted Answer

The degree of agreement between two or more coders coding the same record

Answer

Interrater reliability measures how consistently different coders assign the same codes to the same records, indicating standardization of coding practices.

Question 3

A hospital implements a computer-assisted coding (CAC) system. Quality assurance for CAC-generated codes should include:

Accepted Answer

Coder review and validation of all CAC-suggested codes before submission

Answer

CAC systems require human review and validation because they can suggest incorrect codes; coders must verify clinical accuracy before claim submission.

Question 4

The 'two-midnight rule' affects inpatient admission quality reviews by establishing that:

Accepted Answer

CMS generally expects inpatient admission to be appropriate when a physician reasonably expects a stay spanning at least two midnights

Answer

The two-midnight rule states that CMS considers inpatient admission appropriate when the physician reasonably expects the patient to need hospital care spanning two midnights.

Question 5

Which action would BEST demonstrate that a coding department's quality improvement plan is working?

Accepted Answer

A statistically significant reduction in error rate from one audit cycle to the next

Answer

A measurable, statistically significant reduction in error rate between audit cycles is the strongest evidence of effective quality improvement.

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Quality Control & Assurance 5