CCS Regulatory Compliance Practice Questions
Regulatory Compliance makes up 10 of every 50 questions on a Tigertest CCS practice test. Here are 10 of the 40 questions on it, each with the answer and the reason.
Updated by the Tigertest team. Weighted to the AHIMA CCS Exam Content Outline. Original questions on coding guidelines and concepts; not affiliated with AHIMA.
1. When a CMS hospital-acquired condition was not present on admission, the condition:
- A.Voids the whole claim
- B.Cannot raise the MS-DRG
- C.Is removed from the claim
- D.Becomes the principal diagnosis
Answer: B. Under the HAC-POA payment provision, a HAC that was not POA is still coded, but it is not used as a CC or MCC, so the case is paid as if it were not present.
2. For HAC payment, which POA indicators are treated as present on admission?
- A.Y, W and U
- B.N and U
- C.Y only
- D.Y and W
Answer: D. CMS pays the CC or MCC for HAC conditions reported with Y or W. Conditions reported with N or U do not raise payment.
3. Which condition is a CMS HAC category when acquired during the stay?
- A.Stage 3 or 4 pressure ulcer
- B.Planned cesarean delivery
- C.Stage 1 pressure ulcer
- D.Community-acquired pneumonia
Answer: A. Stage III and IV pressure ulcers acquired during the stay form a CMS HAC category. Stage 1 and 2 ulcers are not on the HAC list.
4. Which hospital-acquired condition is on the CMS HAC list?
- A.A ureteral kidney stone
- B.Prostate enlargement
- C.Catheter-associated UTI
- D.Chronic kidney disease
Answer: C. Catheter-associated urinary tract infection is a HAC category, as are vascular catheter-associated infections and others that reasonable prevention can avoid.
5. A hospital-acquired DVT is a CMS HAC when it follows:
- A.A screening colonoscopy
- B.A tonsillectomy
- C.Total knee replacement
- D.Cataract extraction surgery
Answer: C. Deep vein thrombosis and pulmonary embolism after total knee or hip replacement form a HAC category.
6. An iatrogenic pneumothorax is a CMS HAC when it occurs with:
- A.Venous catheterization
- B.Nasal cannula oxygen
- C.A 12-lead ECG tracing
- D.A portable chest X-ray
Answer: A. Iatrogenic pneumothorax with venous catheterization, as during central line placement, is a HAC category.
7. Under the HAC Reduction Program, hospitals in the worst-performing quartile:
- A.Must stop elective surgery
- B.Lose Medicare status
- C.Pay a fixed annual fine
- D.Have payments cut by 1%
Answer: D. The HAC Reduction Program reduces Medicare payments by 1% for hospitals that rank in the worst-performing quartile on its HAC measures.
8. Patient Safety Indicators (PSIs) were developed by:
- A.NCHS
- B.AHRQ
- C.CMS
- D.The Joint Commission
Answer: B. The Agency for Healthcare Research and Quality publishes the PSIs, which CMS uses in quality programs.
9. PSIs are calculated mainly from:
- A.Pharmacy invoices
- B.Coded discharge data
- C.Patient experience surveys
- D.Nursing time logs
Answer: B. PSIs use hospital administrative data: diagnosis and procedure codes, POA indicators and discharge data. Coding accuracy directly affects a hospital's PSI results.
10. CMS uses which PSI measure as a composite of several patient safety indicators?
- A.PSI 06
- B.PSI 13
- C.PSI 03
- D.PSI 90
Answer: D. PSI 90 is the patient safety and adverse events composite. PSI 03 is pressure ulcer, PSI 06 iatrogenic pneumothorax and PSI 13 postoperative sepsis.
Practice all 40 regulatory compliance questions, and the rest of the 200-question bank, in the free CCS training sets. Questions you miss come back until you have mastered them.
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