Kedis ku xidhan hagaha · Adag Heerka

AI ee ku jira HCC Khatarta Isku hagaajinta Kediska

Wuxuu tijaabiyaa kala sareynta CMS-HCC iyo dib u dajinta sanadlaha, dib u eegis jaantus laba-jid ah, iyo sababta HILIBku u yahay heshiis halkii uu ka ahaan lahaa xeerka CMS ee hagaajinta halista HCC.

Wadooyinka haga ee la xidhiidhaAI Ku Sugnaanta Hcc Khatarta Isku-habaynta
Su'aal 1 ee 8

Maxaa dhacaya marka loo eego kala sareynta CMS-HCC marka xaaladaha la xiriira darnaanta kala duwan labadaba la calaamadeeyay?

Horudhac su'aal kasta8 su'aalo

Jawaabaha iyo sharraxaadaha waxay soo baxayaan markaad qaadanayso kediska.

  1. Maxaa dhacaya marka loo eego kala sareynta CMS-HCC marka xaaladaha la xiriira darnaanta kala duwan labadaba la calaamadeeyay?
    • Both categories are paid and added together
    • Only the most severe category in that family counts
    • The least severe category counts
    • Neither counts until the next year
  2. Waa maxay sababta ay tahay in xaalad dabadheeraad ah dib loo diiwaangeliyo sannad kasta?
    • ICD-10-CM codes expire every year
    • Plans are paid only for new conditions
    • Diagnoses reset annually in the risk model
    • HIPAA requires it
  3. Qoraaladu waxay sheegaan sifeynta, laakiin ma jiro bixiye diiwaangeliyay ESRD. Muxuu qabanayaa socodka shaqada saxda ah?
    • Sends a documentation query rather than coding ESRD
    • Codes ESRD because dialysis implies it
    • Codes ESRD if the AI's confidence is above 90 percent
    • Deletes all kidney-related codes
  4. Maxaa ka dhigaya dib u eegista jaantuska "laba-dariiq"?
    • Two coders review every chart
    • The plan and CMS each review the chart
    • The chart is read forward and backward
    • It looks for missed codes and also flags unsupported submitted codes for deletion
  5. Hadalkee ku saabsan Hilibka ayaa sax ah sida uu qabo hagaha?
    • It is a CMS regulation with fixed penalties
    • It is an industry audit convention; the requirement is documentation that supports the code
    • It applies only to inpatient claims
    • It was replaced by V28
  6. An office visit uses an acute stroke code for a stroke that happened years ago. What should a two-way review recommend?
    • Keep it, since acute codes pay more
    • Add a second acute stroke code
    • Delete it and use a code for stroke history or its lasting effects, as documented
    • Move it to the next year's submission
  7. Which source does NOT qualify for HCC submission?
    • A diagnostic radiology report
    • A face-to-face office visit with a physician
    • A qualifying outpatient visit with a nurse practitioner
    • A hospital inpatient stay
  8. What pipeline step catches most false positives in AI chart review?
    • OCR of scanned pages
    • Calculating the RAF score
    • Sorting charts by date
    • Context detection for negated, historical or family-history mentions