CCA (CNCF) flashcards

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

Root operation objective

In ICD-10-PCS the root operation describes the objective of the procedure, such as excision, resection, or destruction, rather than the surgical approach or the device used to perform it.

Seventh character encounter

The seventh character on injury codes identifies the encounter: A for initial encounter with active treatment, D for subsequent encounter with routine healing care, and S for sequela of a prior condition.

Combination code

A single ICD-10-CM code that reports both an underlying etiology and its manifestation, such as a disease with a related complication, so no separate manifestation code is assigned.

Modifier 25

Appended to an evaluation and management service when the provider documents a significant, separately identifiable service on the same date as a procedure or other service with a global period.

Surgical global package

The bundle of services included with a surgical procedure: the operation, local anesthesia, and typical postoperative care during the global period, which cannot be billed separately.

Physician query

A written request to the treating provider for clarification of ambiguous or conflicting documentation; it must be non-leading and the response added to the record to support code assignment.

Data dictionary

A document that defines each data element in a data set, specifying its name, definition, data type, format, allowed values, and source, supporting consistent collection and interpretation.

Data completeness

A data quality dimension measuring the proportion of required fields that are populated, calculated as completed fields divided by the total expected fields for the record set.

LOINC

Logical Observation Identifiers Names and Codes, a terminology standard that provides universal identifiers for laboratory tests and clinical observations, enabling exchange of result data across systems.

SNOMED CT

A comprehensive clinical terminology of concepts with defined relationships, used to represent clinical findings, procedures, and diagnoses in electronic health records and for semantic interoperability.

Semantic interoperability

The level of interoperability in which exchanged data retains shared meaning because both systems use common coded vocabularies and value sets, beyond mere format compatibility.

HL7 FHIR

Fast Healthcare Interoperability Resources, a standard using RESTful application programming interfaces and discrete resources such as Patient and Observation, exchanged as JSON or XML.

Data abstraction

The process of reviewing a patient record and extracting specified data elements into a registry, database, or report, with each abstracted value traceable to source documentation.

Designated record set

The HIPAA-defined group of records used to make decisions about individuals, including medical and billing records, which patients have the right to access and request amendment.

Legal health record

The portion of the health record designated by organizational policy as the official business record released for legal and disclosure purposes, defined separately from the designated record set.

Retention schedule

A policy specifying how long each record type is kept before destruction, based on federal and state law, statutes of limitation, and organizational needs, applying the longer requirement when laws conflict.

Data stewardship

The assignment of accountability for a defined data domain, including quality, definitions, and appropriate use, to a responsible role that coordinates with data owners and custodians.

Legal hold

A directive suspending routine record destruction when litigation, an audit, or an investigation is reasonably anticipated, preserving potentially relevant records until the hold is released.

Information governance framework

The enterprise structure of decision rights, policies, and standards governing data quality, access, privacy, security, retention, and use, with assigned accountability across the organization.

Days in accounts receivable

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

Net collection rate

Payments received divided by gross charges minus contractual adjustments, measuring how effectively the organization collects the revenue it is actually owed after allowances.

Clean claim rate

The number of claims accepted on first submission divided by total claims submitted, measuring front-end accuracy of registration, coding, and charge capture before payer adjudication.

Chargemaster

The organization's master file of billable items and services, linking charge codes to CPT or HCPCS codes, revenue codes, and prices, updated as code sets and fee schedules change.

First-pass denial

A claim rejected or denied on its initial submission, tracked as a rate to identify front-end registration, eligibility, coding, or authorization failures requiring correction.

Contractual adjustment

The difference between billed charges and the payer-allowed amount under a contracted rate, written off rather than collected from the patient or payer.

Revenue cycle sequence

The ordered financial process from preregistration and registration through charge capture, coding, claim submission, adjudication, remittance posting, denial management, and patient collection.

HIPAA minimum necessary

The requirement to limit uses and disclosures of protected health information to the least amount needed for the purpose, except for treatment and disclosures to the individual.

Breach notification deadline

Affected individuals must be notified without unreasonable delay and no later than sixty days after discovery of a breach of unsecured protected health information.

Anti-Kickback Statute

A federal criminal statute prohibiting knowingly offering or receiving remuneration to induce referrals for items or services payable by federal health care programs.

Stark Law

A civil strict-liability statute prohibiting physician self-referral of designated health services to entities with which the physician or an immediate family member has a financial relationship, absent an exception.

Sixty-day overpayment rule

An identified overpayment must be reported and returned to the payer within sixty days of identification, and the retained overpayment may create reverse false claim liability.

OIG compliance elements

The seven program elements: written policies, a compliance officer and committee, training, communication lines, internal monitoring and auditing, and enforcement through corrective action.