Coding Systems Assignment: Healthcare Coding Systems Unit Assessment

This assignment solution addresses a unit assessment on coding systems within the healthcare field. The document answers questions related to RAC reviews, different coding systems (ICD, CPT, HCPCS), common causes of improper payments, fraud and abuse, benchmarking, and compliance plans. It covers topics such as the RAC prepayment review demonstration project, the OIG work plan, and the CERT program. The assignment requires understanding of various coding systems used for diagnoses, procedures, and medical supplies, along with their respective applications. It also includes the importance of effective communication and training within an effective compliance plan. The document provides a comprehensive overview of the key concepts and principles of coding in healthcare.

Running head: CODING SYSTEMS 1
Coding Systems
Name of Author
Institution of Affiliation
Date of Submission

CODING SYSTEMS 2
UNIT ASSESMENT
Read the chapter on Coding systems and answer the following questions.
Read the PDF file – Coding Systems
Questions
1. Which type of RAC review combines data analysis and submission of medical records to the
RAC?
a. Automated
b. Semi-automated
c. Complex
d. Onsite
2. Which of the following systems was created for reporting procedures and services performed by
physicians in clinical practice?
a. ICD- 9 –CM
b. CPT
c. ICD-10-PCS
d. HCPCS Level 11
3. The International Classification of Diseases (ICD) is maintained by the American Medical
Association.
T/F
False
4. Describe the importance of the RAC prepayment review demonstration project. ( 50 words)
The RAC prepayment demonstration project is crucial as it allows CMS to define error claims
prior to paying such claims. It ensures there is accuracy and maximizes transparency as well as
effective implementation of recovery audit program (Casto & Forrestal, 2013).
Furthermore, RAC is important as it reviews vulnerabilities which is approved by the recovery
audit validation contractor.
5. Which of the following is not a common cause of improper payments?
a. Physician orders not present in the medical record
b. Implementation of a documentation improvement program
c. Medical necessity is not supported in the medical record
d. Incorrect coding
6. The RAC appeals process has --5--- levels
a. 2
b. 3
c. 4
d. 5
7. Common forms of fraud and abuse include all of the following except:
a. Upcoding
b. Unbundling
c. Refiling claims after denails

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d. Billing for services not furnished to patients
8. Which of the following is an example of fraud?
a. Billing for a service not furnished as represented on the claim
b. Misinterpreting coding clinic advice
c. Transposition of digits that results in an inaccurate code to be reported
d. Duplicate bills submitted due to a systems issue
9. What two forms of benchmarking can be used to determine a staff’s level of compliance?( 50
words)
Internal benchmarking and external benchmarking. Bench-making involves the approach of
comparing performance with pre-established performance of another group of individuals.
Internal benchmarking is utilized by the manager to help in examining reporting rates over a given
time. On the other hand, external benchmarking helps the manager in understanding how his or
her are performing by comparing with peers. (Casto & Forrestal, 2013).
10. Which of the following entities does not perform improper payment reviews for CMS?
a. QIO
b. CERT
c. RACs
d. MACs
e. None of the above
11. The coding system that is used primarily for reporting diagnoses for hospital inpatients is known
a. ICD-10-CM
b. CPT
c. ICD-10-PCS
d. HCPCS Level II
12. Match each coding system on the left with its description of uses.
ICD a. Physician inpatient and outpatient
procedures
HCPCS Level II b. Diagnoses and inpatient procedures
CPT c. Medical and surgical supplies
ICD ----------------------b) Diagnoses and inpatient procedures
HCPCS Level II----------c) Medical and surgical supplies
CPT------------------------a) Physician inpatient and outpatient procedures
13. The policies and procedures section of a coding compliance plan should include:
a. Upcoding
b. Coding medical records without complete documentation
c. Correct use of encoding software
d. All of the above
14. Recovery audit contractors are different from other payment review contractors because:
a. RACs are reimbursed on a contingency based system
b. RACs are charged with finding overpayment and underpayments

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c. RACs audit inpatient and outpatient claims
d. All of the above
15. Name and describe two of the seven OIG of an effective compliance plan. (60 words account)
Some fundamental elements of an effective compliance plan include effective
communication, effective education and training. Effective communication within the
organization is crucial element of an effective compliance plan as it encourages workers to
feel comfortable when reporting internal issues affecting the organization (Casto &
Forrestal, 2013). Effective training and education allows all workers including both doctors
and board member to receive training on fraud and compliance programs.
16. Which of the following is the correct format for HCPCS Level 11 codes?
a. 1234A
b. 123A4
c. 12A34
d. 1A234
e. A1234
17. The CERT program was established to correct improper payments.
T/F
True
18. What resource can managers use to discover current hot areas of compliance? (50 words
account)
OIG work plan is utilized by managers in healthcare organizations to discover the current hot
areas of compliance. It sets forth different projects and evaluates as well as audits the underway
or planned projects (Casto & Forrestal, 2013). It audits and evaluates these projects in order
to prevent or detect fraud or mismanagement of operations in hospitals.

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References
Casto, A. B., & Forrestal, E. (2013). Principles of healthcare reimbursement. American Health
Information Management Association.