MAB CH 10 NTQ 1. What is the purpose of

MAB CH 10 NTQ 1. What is the purpose of a voluntary compliance program? 2. What are the effects of a successful compliance program? 3. What is the purpose of benchmarks? 4. What is included in a coding compliance program? 5. What is the purpose of CERT? 6. What payments are considered to be improper payments? 7. What is the objective of the CERT program? 8. The CERT program assigns improper payments into 5 categories, what are these categories? 9. List the strategies developed by MACs to reduce improper payments. 10. What is the goal of Medicare medical review program? 11. What is progressive correct action (PCA)? 12. In a medical review program, who initiates an additional documentation request? 13. Who implements Medicare legislation? 14. Who monitors and evaluates MAC performance? 15. What is the purpose of the National Coverage Determination (NCD)? 16. If NCD is not found, exclude or mentioned, who decides coverage? 17. What are local coverage determinations? 18. What is the purpose of the National Correct Coding Initiative and who implemented it? 19. Give an example of a medically unlikely edit/unit. 20. What is the difference between ABN And NEMB? 21. Define unbundling. 22. What is the purpose of the Recovery Audit Contractor Program (RAC of 2010)? 23. What is the purpose of the clinical documentation improvement? 24. What kinds of audits are conducted by payers to confirm accuracy of hospital coding and reimbursement? 25. What steps are taken by the hospital health information management department when a third party denies claims? 26. What is the purpose of the computer assisted coding software? 27. What does coding for medically necessity mean? 28. What does it mean that a diagnosis was medically managed? 29. What four questions should be considered when coding an reporting a diagnosis or condition? 30. Which diagnosis, documented by the provider, should not appear on the claim form? 31. When should patient encounter be documented? 32. How should corrections be made in a patient’s file? 33. When is an ABN required? 34. Why are procedure codes, but not diagnosis codes, typically included on a chargemaster? 35. What is the purpose of the Medicare Coverage Database? 36. When is a provider permitted to bill a Medicare patient directly? 37. What are local coverage determinations and are they the same from one geographic are to another? 38. What is an outpatient coding editor? 39. What are the primary and secondary purposes for creating a patient record? 40. What are the two major formats that providers use to document clinical records? 41. Explain the SOAP clinical notes. 42. List the items included in an operative report.

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