CCS (Customs & Trade Compliance Certifications) flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Excludes1 note

An ICD-10-CM instruction meaning the two conditions cannot be reported together because they are mutually exclusive; the coder must choose the more specific code supported by documentation.

ICD-10-PCS root operation

The third character of an ICD-10-PCS code that identifies the objective of the procedure, such as excision, resection, drainage, or insertion; it determines the code family.

Modifier 25

A CPT modifier appended to an evaluation and management service to indicate a significant, separately identifiable E/M service was performed on the same day as a procedure or other service.

Global surgical package

The bundle of services included with a surgical procedure, spanning 0, 10, or 90 days depending on the procedure, covering preoperative, intraoperative, and routine postoperative care.

Medical decision making

The E/M level component that considers number and complexity of problems, amount and complexity of data reviewed, and risk of complications, morbidity, or mortality.

Data element attributes

The five characteristics that fully define a data element: definition, allowable values, data type, field length, and format, all documented in the data dictionary.

HL7 FHIR

A modern interoperability standard using RESTful web services and discrete resources such as Patient, Encounter, and Observation to exchange health information between systems.

LOINC

A standardized terminology for identifying laboratory tests and clinical observations, enabling consistent exchange and aggregation of result data across systems.

SNOMED CT

A comprehensive, concept-based clinical terminology used in electronic health records for documenting findings, procedures, and diagnoses at the point of care.

Data quality dimensions

The characteristics used to assess data fitness, including accuracy, completeness, consistency, timeliness, precision, and definition, each measured against a stated standard.

Designated record set

The group of records HIPAA identifies as the source for patient access, amendment, and accounting of disclosures, including medical and billing records used to make decisions.

Legal health record

The portion of the total health record the organization designates as its official business record, defined in policy and subject to retention and release rules.

Retention schedule

A policy specifying how long each record type must be kept, based on federal and state law, statutes of limitation, and organizational need, with destruction after expiration.

Litigation hold

A directive suspending routine destruction of records relevant to pending or reasonably anticipated litigation, investigation, or audit until the matter is resolved.

Minimum necessary

The HIPAA principle limiting uses and disclosures of protected health information to the least amount needed for the purpose, with exceptions for treatment and patient access.

Clean claim rate

The percentage of claims accepted on first submission without rejection or denial, calculated as accepted first-pass claims divided by total claims submitted.

Days in accounts receivable

A revenue cycle metric calculated as total accounts receivable divided by average daily charges, indicating how many days of revenue remain uncollected.

Chargemaster

The organization's master list linking procedure codes, revenue codes, and charges; it must be reviewed and updated to reflect current services and payer rules.

Coordination of benefits

The process determining which of multiple payers is primary and which is secondary, often using the birthday rule for dependent children of parents with separate plans.

Compliance program elements

The seven components of an effective compliance program: written policies, compliance officer and committee, training, communication lines, auditing and monitoring, discipline, and corrective action.

False Claims Act

A federal statute imposing liability for knowingly submitting false claims to government programs, including qui tam provisions allowing whistleblowers to sue and share recoveries.

Anti-Kickback Statute

A criminal statute prohibiting offering or receiving remuneration to induce referrals of items or services payable by federal health care programs, with defined safe harbors.

Stark Law

A civil statute prohibiting physician self-referral for designated health services to entities with which the physician has a financial relationship, unless an exception applies.

Breach notification

The HIPAA requirement to notify affected individuals, HHS, and in some cases the media after discovery of an impermissible acquisition, access, use, or disclosure of unsecured PHI.

Sensitivity and specificity

Test performance measures: sensitivity is true positives divided by all with disease, and specificity is true negatives divided by all without disease.

Positive predictive value

The probability that a patient with a positive test truly has the disease, calculated as true positives divided by true positives plus false positives; it depends on prevalence.

Standardized mortality ratio

The ratio of observed deaths to expected deaths for a population, with a value greater than one indicating more deaths than predicted by risk adjustment.

Control chart

A run chart with statistically derived control limits that distinguishes common-cause variation from special-cause variation; a run of seven points on one side signals special cause.

ADKAR model

A change management framework describing five building blocks for individual change: awareness, desire, knowledge, ability, and reinforcement.

RACI matrix

A responsibility assignment tool labeling each task as responsible, accountable, consulted, or informed, clarifying who does the work and who owns the outcome.

Budget variance

The difference between actual and budgeted amounts, stated as favorable or unfavorable according to whether it increases or decreases net margin relative to plan.

Informed consent

A process requiring patient capacity, disclosure of risks, benefits, and alternatives, voluntariness, and the patient's decision; a signature alone does not establish consent.