Certified Inpatient Coding Auditor (CICA) Program Frequently Asked Questions

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1 Certified Inpatient Coding Auditor (CICA) Program Frequently Asked Questions What is the CICA program? The CICA is a new HFMA Certification intended to validate and acknowledge the professional expertise of an inpatient coding auditor professional. Accurate coding is a serious reimbursement issue and the need to insure coding accuracy is compelling. A key responsibility is to identify areas of under or over coding to avoid fraudulent coding and billing. There are several main drivers that highlight the need for coding auditors, including: Changes in reimbursement models Increases in regulatory audits Continuous DRG downgrading Increased regulatory reporting requirements What is the value of the CICA? The need for coding auditors to address coding oversight is critical in today s healthcare environment. Successful candidates are experienced coders with the knowledge of auditing procedures in an inpatient provider setting. Inpatient coding auditors are responsible for ensuring: documentation and coding are to the highest level of specificity correct code assignment optimal DRG assignment coding is compliant Who is the CICA intended for? The Certified Inpatient Coding Auditor (CICA) is an online certification is intended for Experienced coding professionals who have at least 3 years of acute care inpatient coding experience Coders who aspire to become certified coding auditors and who have a working knowledge of quality initiatives, DRG assignment and case mix index, MAC s, RAC s and the importance of accurate clinical documentation Coders who aspire to defend coding accuracy in addressing denials from RAC auditors Do I have to be a coder before I can take the CICA? Yes. The CICA designation is not available to non-coders. Are there study materials available to assist in preparing for the examination? Yes. If you need coursework to help you prepare for the Certified Inpatient Coding Auditor exam, Career Step, LLC (careerstep.com) has several online programs that will help you prepare for the CICA exam. For more information on the Career Step programs please use this link: Am I required to take an Inpatient Coding Auditor course in order to take the CICA certification assessment? No. The CICA is intended for experienced coders. Experienced professional coders may take the CICA certification assessment without completing course work if they choose.

2 Can I substitute the RHIT credential for a coding certification? Yes. The important prerequisite is professional coding experience. Is the CICA Certification recognized by AHIMA? HFMA is the certifying body for the CICA. This certification is intended for experienced coders, many of whom carry AHIMA certifications. While the two certifying organizations both serve professional coders, the CICA builds on the skill, knowledge and expertise required of certified inpatient coding auditors. How much does the CICA cost? HFMA s CICA assessment costs $300. If candidates need coursework to prepare for the exam, inpatient coding auditor coursework is available at CareerStep.com. How is the CICA assessment structured and administered? What is the passing score? The CICA online assessment includes 150 multiple-choice test items with three (3) hours of time allotted. 70% is the passing point for successfully completing the CICA assessment. Are there case studies on the exam? Yes, the CICA test item bank includes small case study scenario based questions. What topics are presented in the CICA certification assessment? Will the CICA cover SNF/NF inpatient stays? Skilled nursing facilities are not a primary focus of the CICA. The CICA certification assessment covers the topics in following list. CICA Topic Area Number of Test Items ICD-10-CM Skills 13 Apply ICD-10-CM coding guidelines. Apply ICD-10-CM documentation requirements. Review skills required for complete ICD-10-CM coding and accurate reimbursement. ICD-10-PCS Skills 13 Apply ICD-10-PCS coding guidelines. Apply ICD-10-PCS documentation requirements. Review skills required for complete ICD-10-PCS coding and accurate reimbursement. Audit Principles 25 Describe the fundamentals of hospital inpatient auditing. Identify various audit types including internal and external, and random versus focused. Explain how to scope an audit based on audit type. Articulate how to analyze data and look for problem areas for targeted audits. Documentation Integrity 28 Explain the impact of documentation on quality and reimbursement. Describe the difference between optimization and maximization.

3 Understand clinical indicators, common treatments, and documentation requirements for common conditions in the major diagnostic categories (MDCs) Identify HACs. Describe the high-risk, error-prone MS-DRGs. Audit and Record Review 11 Understand what it takes to complete a successful audit. Understand the common, high-risk errors identified during an audit. Fundamentals and Reimbursement Concepts 29 Understand what impacts an MS/APR DRG. Explain the difference between Comorbidities (CCs) and Major Comorbidities (MCCs) and their impact on DRG assignment, Understand Case Mix Index (CMI) and how it is affected by DRGs. Explain the importance of Severity of Illness (SOI) and Risk of Mortality (ROM) and the impact on hospital/physician profiling. Understand the documentation requirements to support ICD-10 code specificity. Understand and explain DRG hierarchy and optimization. Understand specific DRG scenarios and documentation requirements. Explain the inpatient prospective payment system Understand the Medicare Base Rate and how it is used with DRG calculations. Regulatory Compliance Concepts 11 Define HIPAA Identify components of the Code of Ethics and Standards of Ethical Coding Describe compliance risks Administrative and Soft Skills Development 13 Sharpen written communication skills in a business context. Analyze information to clearly describe problems. Identify appropriate solutions. Communicate effectively using verbal and non-verbal technique Develop key leadership skills, including techniques for coaching, motivating, and delivering feedback. Health Care Law 7 Describe healthcare law fundamentals. Explain upcoding and other high-risk billing practices. Total Number of Test Items 150 How will the CICA exam be administered? The online examination is delivered via the Internet through HFMA s website. The link to purchase access the CICA assessment can be found on the HFMA website at There is a 3-hour time limit for the exam.

4 Can I print out a certificate after successfully passing the CICA examination? All candidates will be able to print out a certificate recognizing them as a Certified Coding Inpatient Auditor after successfully passing the exam. Can I earn CEU s for successfully completing this course? No. The CICA assessment is not eligible for continuing education credit. Unfortunately, I failed the CICA exam; am I able to see how well I did in each module and where to focus my studies? Yes, you can print out an exam summary and analysis which shows how well you did in each topic area. The exam summary is available upon completion of the exam. What is the process for retaking the CICA examination should I be unsuccessful? HFMA Board of Examiners Policy stipulates that a candidate must wait at least 30 days before being allowed to retake the CICA certification assessment. This is a standard certification industry practice and allows time for candidates to further prepare for the examination. There is no fee for the CICA assessment retake. Unsuccessful individual candidates will be allowed to retest up to 11 times within the year term of CICA. If I fail the CICA exam and need study material for the next attempt, where can I find coursework to support the content covered in the CICA exam? If you need coursework to help you prepare for the Certified Inpatient Coding Auditor exam, Career Step, LLC (careerstep.com) has several online programs that will help you prepare for the CICA exam. For more information on the Career Step programs use this link: What is required to maintain the CICA designation? The CICA designation is maintained by successfully completing a CICA recertification exam every two (2) years. HFMA will notify candidates of when they need to retest. Once the designation is earned, how long before I must recertify? What is the cost to recertify? The CIC certification is good for two (2) years after which you must recertify. The recertification is by examination and costs $100. What is the process for recertification (maintenance) of my CICA certification? Anyone who has earned the Certified Internal Coding Auditor (CICA) designation must maintain their certification by taking the CICA recertification exam every 2 years. The details of the recertification exam are: The CICA recertification exam contains 75 questions 90 minutes are allowed for the CICA recertification examination The recertification exam costs $100 Will I be notified that I am due to recertify? Yes, you will receive several reminder notices leading up to your due date. Note: To ensure receipt of HFMA notifications, make sure that your contact information is current with HFMA. To update your information simply log into your HFMA account via hfma.org and select "Update My Information."

5 Where can I take the CICA recertification examination? The only way to re-certify and retain your CICA designation is to take the CICA recertification exam through the HFMA website. Access to the exam is through your elearning account. Note: If you are not eligible to recertify the HFMA system will not allow you to purchase the CICA recertification exam. CICA recertification exam access is available starting January 1 of your due date/year. Can you please clarify the CICA recertification cycle? The first time you must re-certify may be somewhat more than 2 years from the date you originally passed the CICA certification assessment. This is because the re-certification due date is always 5/31/XX of any given year as established by HFMA. The CICA recertification cycle begins with the June following the awarding of the CICA credential. After the first time you re-certify, you will be on a regular 2-year cycle (June 1, 20XX through May 31, 20XX). An example is below: You became CICA certified in October 2018, so the 1st CICA recertification date is May 31, nd CICA recertification date = May 31, 2023, and so on... How often will the CICA certification assessment content be updated? The fundamental value of HFMA certification is its relevance to contemporary practice. This is of particular importance in an industry as dynamic as healthcare reimbursement. Therefore, the CICA certification assessment content is reviewed and updated annually. Additional questions? careerservices@hfma.org.