Experience the Quality With Free CCA Exam Questions That Helps Candidates Pass

The End-Stage Renal Disease (ESRD) Prospective Payment System reimburses dialysis facilities using a bundled per-treatment payment that covers services, supplies, and certain drugs. OPPS (A) applies to outpatient hospitals, MS-DRGs (C) to inpatient, and capitation (D) to managed care. Coders must recognize ESRD PPS because diagnosis and procedure codes directly impact compliance and claims review.

The Office of Inspector General (OIG) Work Plan outlines areas where federal auditors will focus on detecting fraud, waste, and abuse in healthcare. Coders and compliance officers use the Work Plan to guide internal audits and prepare for external reviews. HIPAA standards (A) are separate. ICD-10-CM guidelines (C) are developed by NCHS/CMS. MS-DRGs (D) are managed by CMS, not OIG. Awareness of OIG priorities helps CCAs align with compliance best practices.

The query process allows coders to ask providers for clarification on incomplete, conflicting, or ambiguous documentation. Audit trails (A) monitor access to PHI. NCCI edits (C) prevent coding conflicts. Encryption (D) protects data but doesn’t improve documentation. Properly worded queries are essential for coding accuracy and compliance with AHIMA standards.

HIPAA’s Privacy Rule requires covered entities to limit uses, disclosures, and requests for PHI to the minimum necessary to accomplish the intended purpose, except for certain circumstances (e.g., treatment, patient access, or disclosures required by law). In a payer audit seeking documentation to substantiate a billed procedure, sending only the labs and operative report (and any strictly necessary ancillary pieces) meets the minimum necessary standard. Option A violates the standard by disclosing entire charts broadly. Option C exceeds the purpose of verifying sick leave; employer requests generally require careful authorization and tailored disclosure. Option D conflicts with role-based access controls, which should restrict workforce members to the least privilege necessary for their job tasks. CCA candidates must understand privacy principles, organizational policies, and documentation of decision pathways in disclosures.

Hospital outpatient facility services are reimbursed under the Medicare Outpatient Prospective Payment System (OPPS). Under OPPS, individual services and procedures are grouped into Ambulatory Payment Classifications (APCs) that determine payment rates, with status indicators guiding bundling and packaging logic. Cataract extraction with IOL is assigned to a surgical APC, and payment includes packaged services as applicable (e.g., some drugs, supplies, and ancillary services) per OPPS rules. Option A (MS-DRG) applies to inpatient acute care stays under IPPS, not outpatient. Option B “per diem” is not the Medicare acute inpatient methodology (that’s case-based MS-DRG), and in any case does not apply to outpatient. Option D (RBRVS) underlies physician/professional component reimbursement (e.g., CMS-1500 claims), not the facility UB-04. CCA candidates must distinguish billing forms (UB-04 vs CMS-1500), payment systems (OPPS/APC vs IPPS/MS-DRG vs RBRVS), and know how OPPS packaging and modifiers influence outpatient facility payment.