Certified Inpatient Coder (CIC) 

7 multiple choice questions

Recognize the limitations of EHR and how downtime is handled

Identify documentation deficiencies caused by copy/paste and use of templates

Explain HIPAA security and privacy

Define the reporting requirements under MDS

Demonstrate the proper procedure for addendums and alterations to the medial record

Identify components of the medical record

Identify the requirement for timely documentation

Recognize and properly code for procedures performed at the bedside

List the reporting requirements under UHDDS

Identify Joint Commission (JC) requirements for documentation

3 multiple choice questions

Define and apply medical terminology and anatomy

Identify pathophysiology to capture correct codes and identify documentation deficiencies

Recognize medications and conditions/diagnoses they are used to treat

7 multiple choice questions

Identify benefits of Computer Assisted Coding (CAC)

Explain what natural language processing is and which departments in the hospital use it

Apply Coding Clinic guidance to inpatient coding

Identify correct ICD-10-CM and ICD-10-PCS codes for cases done

Identify proper procedure to look up DRG (eg, book, grouper)

Explain emerging roles for inpatient coders (DRG validator, auditor)

Identify conditions POA and use of indicators

9 multiple choice questions

Recognize proper procedure for compliance with the 2 Midnight Rule and certification requirements

Define different bill types

Identify information found in a charge master

List examples of auto population of services using a charge master

Explain requirements to maintain and monitor the chargemaster

Define the role each department plays in chargemaster maintenance

Explain the 72-hour rule (24-hour for other types of inpatient services) and how services occurring prior to admit are reported

Identify different types of disposition and the impact on coding

Calculate base payments for DRGs

Identify elements needed to determine DRG assignment

Define what is supported in the DRG (eg, services performed at another facility)

List and explain different types of DRGs (eg, APR-DRG)

Identify Medicare Code Edits

Define different inpatient types

Explain and apply guidelines for selecting the principal diagnosis for different inpatient facilities

Explain impact of readmissions in a 30-day period

Explain when to rebill inpatient claim as an outpatient claim

Identify data submitted on a UB-04

3 multiple choice questions

Identify differences between outpatient and inpatient payment methodologies

Explain coding requirements under OPPS: Pass through payments

Explain coding requirements under OPPS: APCs and Status Indicators

6 multiple choice questions

Review LCD/NCD and apply the policy to inpatient coding

Identify services covered by Medicare Parts A, B, C, D

Explain proper execution of the ABN and HINN

Review private payer policy and apply to inpatient payment

Identify precertification requirements

5 multiple choice questions

Explain external payer audits process and responsibilities of hospital staff

Explain internal audits and how they relate to compliance plans

Know how to interact with auditors during an onsite audit

Identify audit targets on the OIG work plan

Explain the CERT audit process and requirements for response to a request for records

Explain the PEPPER report and how it is utilized.

Identify examples of fraud and abuse

Explain the MAC audit process

Identify services approved for audit by the RAC auditors

Explain the Medicare appeal process and discuss requirements at each level

Explain the RAC audit process and requirements for response to a request for records

7 inpatient cases fill-in-the-blank

Code the ICD-10-CM and ICD-10-PCS codes for 7 inpatient cases

Each case will have anywhere from 5-15 possible answers. Each answer is weighted the same