Free CCS Exam Questions That Helps Candidates Pass

The CMS Price Transparency Rule (effective January 2021) requires hospitals to provide clear, accessible pricing information online about services, items, and pharmaceuticals. This includes a machine-readable file of standard charges and a consumer-friendly display of shoppable services. HIPAA Privacy Rule governs PHI confidentiality, not pricing. Stark Law addresses physician self-referral, and the False Claims Act targets fraudulent billing. Price transparency improves consumer empowerment, promotes competition, and aligns with CMS efforts to reduce surprise billing and healthcare costs. Hospitals failing compliance face penalties (currently $300/day up to $5,500/day depending on size). Coders and HIM professionals must understand related compliance requirements to support organizational adherence.

Firewalls protect confidentiality by preventing unauthorized network access. Availability ensures data access, integrity ensures accuracy, and authentication verifies identity. Firewalls are technical safeguards under HIPAA, essential for protecting PHI in coding and billing systems.

The Affordable Care Act (ACA) requires healthcare providers to implement compliance programs as a condition of enrollment in Medicare/Medicaid. These programs include coding audits, education, and internal monitoring. HIPAA governs privacy/security, FCA targets fraudulent claims, and HITECH strengthens electronic PHI safeguards. Coders play a central role in compliance programs by ensuring accurate, guideline-based coding and documentation.

For inpatient coding, uncertain diagnoses documented at discharge (possible, probable, suspected) are coded as if confirmed. Therefore, acute renal failure (N17.9) is coded. Outpatient rules differ, requiring confirmed diagnoses only. Correct inpatient reporting captures severity and impacts DRG assignment.

HIPAA security is based on confidentiality, integrity, and availability. Backups protect availability of data, ensuring continuity in case of disaster. Confidentiality relates to encryption, integrity to preventing tampering, and audit safeguards to monitoring. Ensuring availability allows coders and HIM to resume operations quickly, minimizing compliance and revenue cycle risks.