Coding
A coding system used by healthcare providers to classify and code diagnoses, symptoms, and procedures for claims processing, health statistics, and research, ensuring consistent data collection and analysis globally
What is ICD-10 (International Classification of Diseases)?
The chief corporate compliance officer at MCW holding the VP title for Corporate Compliance and Risk Management
Who is Tennille Sifuentes?
The electronic health record the Medical College of WI and FTCH utilize
What is EPIC?
Manager of Clinical Compliance at MCW
Who is Karen Rhyner?
A person who is a healthcare professional trained in the use and administration of medications
What is a pharmacist?
Is divided into broad categories such as office visits, hospital inpatient or observation care visits, and consultations
What are Evaluation and Management (E/M) Services?
A way to anonymously report a concern
What is the Compliance Hotline?
A system used to monitor access to electronic health records
What is Protenus?
Is the newest member of the Clinical Compliance team at MCW
Who is Hannah Moreno, Compliance Education Coordinator?
A person who operates on patients to treat injuries
What is a surgeon?
A coding system used by the American Medical Association (AMA) to assign codes for medical procedures and services, ensuring accurate and standardized reporting for billing and administrative purposes
What is CPT (Current Procedural Terminology)?
There are seven elements to an effective compliance program according to this group
What is the OIG (Office of Inspector General)?
The number of days a clinician has to close an encounter
What is 10 days?
Has worked at the Medical College of Wisconsin the longest
Who is Georgia Dollhopf, Compliance Coordinator lll?
A person typically referred to as "house staff" in a hospital setting supervised by an attending physician
What is a resident?
Two-digit codes appended to CPT codes to provide additional information about a procedure or service, without changing the code’s meaning, and are used to communicate specific circumstances to payers
What are modifiers?
A form used to inform a patient that Medicare may or may not pay for service
What is an ABN (Advanced Beneficiary Notice of Non-coverage)?
The regulation guiding encounters to be closed
What is information blocking?
Does investigations for Clinical Compliance
Who is Leslie Lauren, Compliance Coordinator lll & Special Investigations of HIPAA breaches and OTH?
A federal law that requires hospitals participating in Medicare to provide a medical screening examination and stabilizing treatment to anyone who comes to the emergency department regardless of insurance status or ability to pay
What is EMTALA (Emergency Medical Treatment and Labor Act)?
A standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes
What is HCPCS (Healthcare Common Procedure Coding System)?
Medicare document that can be used to determine the RVU value of a CPT code
What is the physician fee schedule?
When an employee accesses protected health information for non-business purposes
What is a HIPAA privacy violation?
The radiology expert for the team
Who is Breanna Suskey-Payton, Compliance Coordinator lll?
A physician who self-refers violates this law
What is the Stark Law?