Certified Inpatient Coder (CIC)
The new inpatient medical coding certification standard, CIC (Certified Inpatient Coder), is the only certification dedicated exclusively to inpatient hospital/facility coding. The CIC validates expert level knowledge and experience in abstracting information from the medical record for ICD-10-CM and ICD-10-PCS coding, and specialized payment knowledge in MS-DRGs and Inpatient Prospective Payment Systems (IPPS). Invest in your future with the CIC™ certification—certified coders earn 40% more than non-credentialed coders.
CICs have demonstrated:
- Expertise in medical record review to abstract information required to support accurate inpatient coding
- Expertise in assigning accurate ICD-10 medical codes for diagnoses and procedures performed in the inpatient setting
- Superior knowledge of current rules, regulations, and issues regarding medical coding, compliance, and reimbursement under MS-DRG and IPPS systems
- Strong ability to integrate coding and reimbursement rule changes in a timely manner to include updating the Charge Description Master (CDM), fee updates, and the Field Locators (FL) on the UB04
- Solid understanding of anatomy, physiology, and medical terminology required to correctly code facility services and diagnoses
- Understanding of outpatient reimbursement methodologies (OPPS)
CIC Exam
The CIC Exam
- 60 multiple choice questions and 10 inpatient cases fill in the blank (proctored)
- 5 hours and 40 minutes to finish the exam
- $650 which includes one year membership
- One free retake
- Open code book (manuals)
The CIC examination consists of questions regarding the correct application of ICD-10-PCS procedure codes and ICD-10-CM diagnosis codes used for coding and billing inpatient facility/hospital services to insurance companies.
The CIC exam thoroughly covers:
Medical Record and Healthcare Documentation Guidelines
- 10 multiple choice questions
- Recognize the limitations of EHR and how downtime is handled
- Identify documentation deficiencies caused by copy/paste and use of templates
- Understand HIPAA security and privacy
- Understand the reporting requirements under MDS
- Demonstrate proper procedure for addendums and alterations to the medial record
- Identify components of the medical record
- Identify the length of time the provider has to document services
- Understand the requirement for timely documentation
- Recognize and properly code for procedures performed at the bedside
- Understand the reporting requirements under UHDDS
- Understand Joint Commission (JC) requirements for documentation
Medical Terminology, Anatomy and Pathophysiology
- 5 multiple choice questions
- Understand medical terminology and anatomy
- Understand pathophysiology to capture correct codes and identify documentation deficiencies
- Recognize medications and conditions/diagnoses they are used to treat
Inpatient Coding
- 10 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)
- Understand emerging roles for inpatient coders (DRG validator, auditor)
- Identify conditions POA and use of indicators
Inpatient Payment Methodologies
- 13 multiple choice questions
- Recognize proper procedure for compliance with the 2 Midnight Rule and certification requirements
- Understand 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
- Understand the role each department plays in chargemaster maintenance
- Understand 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
- Understand what is supported in the DRG (eg, services performed at another facility)
- Understand different types of DRGs (eg, APR-DRG)
- Understand Medicare Code Edits
- Understand different inpatient types
- Understand guidelines for selecting the principle 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
Outpatient Payment Methodology
- 5 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
Regulatory and Payer Requirements
- 9 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
Compliance
- 8 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
- Understand 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
Coding Cases
- 10 inpatient cases fill in the blank
- Code the ICD-10-CM and ICD-10-PCS codes for 10 inpatient cases
Certification Requirements
