According to the U.S. Sentencing Guidelines, the formality and scope of the compliance program will depend on
the size of the organization
. … Small practices are expected to demonstrate the same level of commitment to compliance as large organizations, but with less formality and fewer resources.
What will the scope of a compliance program depend on quizlet?
What will the scope of a compliance program depend on?
The size and resources of the provider’s practice
. The minimum necessary rule is based on sound current practice that protected health information should NOT be used or disclosed when it is not necessary to satisfy a particular purpose or carry out a function.
What is a benefit of an active compliance plan?
An effective compliance plan
keeps pace with changing government regulations, payer requirements, office operations, and technology
. Compliance plan updates should acknowledge government regulation and payer requirement changes, but should also incorporate lessons from within your own office or facility.
What are five tips for coding operative op reports?
| Question Answer | What are five tips for coding operative (op) reports? Diagnosis code reporting, Start with the procedures listed, look for key words, highlight unfamiliar words, read the body. |
|---|
Which Medicare program is affected by CMS HCC?
The CMS-HCC risk adjustment model is used to adjust payments for
Part C benefits
offered by MA plans and PACE organizations to aged/disabled beneficiaries. The CMS- HCC model includes both diseases and demographic factors.
How many components are included in an effective compliance plan?
The
7 Elements
of a Compliance Program Are as Follows: Implementing written policies, procedures, and standards of conduct. Designating a compliance officer and compliance committee. Conducting effective training and education.
How often should healthcare organizations assess compliance programs?
The Supplemental Guidance again sets out these seven elements, but strongly recommends that hospitals also assess the overall program
at least annually
, including the underlying structure and process related to each compliance program element, rather than simply focusing on numerical audit results of individual issues.
Which of the following is a benefit of a compliance plan?
Effective lines of communication; Enforcement of standards through publicized disciplinary guidelines
; Regular internal monitoring and auditing; and. Responding to detected offenses, developing corrective action plan.
What are the benefits of an employer developing an effective compliance program?
An effective program will
sensitize employees to key issues and solidify your reputation as a diligent, ethical business
.” To the third and fourth points, having a robust ethics and compliance program can reduce adverse legal action and lessen financial penalties.
What are the benefits of a coding compliance plan?
- Prevents fines and/or jail time.
- Improves your ROI (are you leaving money on the table?)
- Improves medical record accuracy.
- Helps with training and education.
- Plays integral role in maintaining a culture of compliance.
- Keeps you up-to-date on coding rules and regulations.
What are the 10 steps to reviewing an operative report?
- Step 2: Note the pre- and post-operative diagnoses. …
- Step 3: Read the general statement of the procedure. …
- Step 4: Check for complications. …
- Step 5: Note the pathology specimen. …
- Step 6: Check the EBL. …
- Step 7: Review the findings. …
- Step 8: Note the indications. …
- Step 9: Read the description of the procedure(s) carefully.
How do you code a surgery report?
- Review the header of the report.
- Review the CPT
®
codebook (start in the Index). - Review the report/documentation.
- Make a preliminary code selection.
- Review the guidelines (for the preliminary codes).
- Review policies and eliminate the extras.
- Add any needed modifiers.
What is the difference between outpatient coding and inpatient coding?
Outpatient coding refers to a detailed diagnosis report in which the patient is generally treated in one visit, whereas an inpatient coding system is
used to report a patient’s diagnosis and services based on his duration of stay
.
What is the difference between CMS and HHS?
| CMS-HCC HHS-HCC | Developed for >65 year olds and disabled patients of all ages Developed for all age patients |
|---|
What does HCC mean after diagnosis?
Risk Adjustment and Hierarchical Condition Category
(HCC) coding is a payment model mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997.
What model is associated with Medicare plans?
Through
the Medicare Advantage Value-Based Insurance Design (VBID) Model
, CMS is testing a broad array of complementary Medicare Advantage (MA) health plan innovations designed to reduce Medicare program expenditures, enhance the quality of care for Medicare beneficiaries, including those with low incomes such as dual- …
