RHIA Domain IV Practice Questions Flashcards
A coder notes that the patient is taking prescribed Haldol. The final diagnoses on the progress notes include diabetes mellitus, acute pharyngitis, and malnutrition. What condition might the coder suspect the patient has that the physician should be queried to confirm?
a. Insomnia
b. Hypertension
c. Mental or behavioral problems
d. Rheumatoid arthritis
c. Mental or behavioral problems
Medical identity thefts are situations in which the following occurs:
a. When health information on the wrong patient is put in the incorrect record
b. When financial information is used to purchase nonmedical items
c. When demographic and financial information is used to acquire medical services
d. When demographic information is used to purchase nonmedical items
c. When demographic and financial information is used to acquire medical services
You are the coding supervisor and you are doing an audit of outpatient coding. Robert Thompson was seen in the outpatient department with a chronic cough, and the record states “rule out lung cancer.” What should have been coded as the patient’s diagnosis?
a. Chronic cough
b. Observation and evaluation without need for further medical care
c. Diagnosis of unknown etiology
d. Lung cancer
a. Chronic cough
Jim was admitted for hip replacement surgery, and during his procedure he was administered blood products. Postoperatively, Jim developed a rash and fever. The presence of these symptoms will be investigated by the hospital as a possible:
a. Blood verification
b. Core measure
c. Comorbidity
d. Transfusion reaction
d. Transfusion reaction
Community Hospital has received a large number of claims denials for CT scans that were
provided to patients. After review of the denied claims, the hospital has determined that clinical indications for the CT scan were not present. For which of the following reasons were these claims denied for payment?
a. Patient preferences were ignored.
b. These scans did not meet medical necessity.
c. No order was present in the record for the scans.
d. Best practices for billing were not used.
b. These scans did not meet medical necessity.
The health plan reimburses Dr. Tan $15 per patient per month. In January, Dr. Tan saw
300 patients, so he received $4,500 from the health plan. What method is the health plan
using to reimburse Dr. Tan?
a. Traditional retrospective
b. Capitated rate
c. Relative value
d. Discounted fee schedule
b. Capitated rate
The technology commonly utilized for automated claims processing (sending bills directly to
third-party payers) is:
a. Optical character recognition
b. Bar coding
c. Neural networks
d. Electronic data interchange
d. Electronic data interchange
A patient saw a neurosurgeon for treatment of a nerve that was severed in an industrial accident. The patient worked for Basic Manufacturing Company where the industrial accident occurred.
Basic Manufacturing carried workers’ compensation insurance. The workers’ compensation
insurance paid the neurosurgeon fees. Which entity is the “third party”?
a. Patient
b. Neurosurgeon
c. Basic Manufacturing Company
d. Workers’ compensation insurance
d. Workers’ compensation insurance
Alfred is tracking the amount of time it takes for physicians to respond to coding queries. He has found that these delays have caused a 30% increase in turn-around time for submitting the bills for reimbursement. Thesystem would assist him and the coders to have the necessary information to make timely coding assignment.
a. CDM
b. CPT
c. CDI
d. RCM
c. CDI
A physician query may not be appropriate in which of the following instances?
a. Diagnosis of viral pneumonia noted in the progress notes and sputum cultures showing Haemophilus influenzae
b. Discharge summary indicates chronic renal failure but the progress notes document acute renal failure throughout the stay
c. Acute respiratory failure in a patient whose lab report findings appear to not support this diagnosis
d. Diagnosis of chest pain and abnormal cardiac enzymes indicative of an AMI
c. Acute respiratory failure in a patient whose lab report findings appear to not support this diagnosis
The financial manager of the physician group practice explained that the healthcare insurance
company would be reimbursing the practice for its treatment of the exacerbation of congestive heart failure that Mrs. Zale experienced. The exacerbation, treatment, and resolution covered
approximately five weeks. The payment covered all the services that Mrs. Zale incurred during the period. What method of reimbursement was the physician group practice receiving?
a. Traditional
b. Episode-of-care
c. Per diem
d. Fee-for-service
b. Episode-of-care
Allowing patterns of retrospective documentation, hiding or ignoring negative quality review
outcomes, and hiding incomplete health records from accreditation surveyors are unethical
behaviors according to which of the following Code of Ethics principles?
a. Advocate and uphold the right to privacy
b. Respect the inherent dignity and worth of every person
c. Represent the profession accurately to the public
d. Put service before self-interest
d. Put service before self-interest
Community Hospital is trying to improve its compliance with Medicare quality reporting
requirements and, in turn, its reimbursement from Medicare’s Hospital Value-Based Purchasing Program. The hospital has added a ________ to assist in educating medical staff members on
documentation needed for accurate billing.
a. Physician advisor
b. Compliance officer
c. Chargemaster coordinator
d. Data monitor
a. Physician advisor
Which of the following healthcare entities’ mission is to reduce Medicare improper payments through detection and collection of overpayments, identification of underpayments, and implementation of actions that will prevent future improper payments?
a. Accountable care entity
b. Managed care entity
c. Revenue reduction contractor
d. Recovery audit contractor
d. Recovery audit contractor
The coding manager at Community Hospital is seeing an increased number of physicians failing to document the cause and effect of diabetes and its manifestations. Which of the following will provide the most comprehensive solution to handle this documentation issue?
a. Have coders continue to query the attending physician for this documentation.
b. Present this information at the next medical staff meeting to inform physicians on documentation standards and guidelines.
c. Do nothing because coding compliance guidelines do not allow any action.
d. Place all offending physicians on suspension if the documentation issues continue.
b. Present this information at the next medical staff meeting to inform physicians on documentation standards and guidelines.
What qualifier is used with the root operation excision, extraction, or drainage that are considered diagnostic?
a. D
b. J
c. X
d. Z
c. X
In conducting a qualitative review, the clinical documentation specialist sees that the nursing
staff has documented the patient’s skin integrity on admission to support the presence of a stage
I pressure ulcer. However, the physician’s documentation is unclear as to whether this condition was present on admission. How should the clinical documentation specialist proceed?
a. Note the condition as present on admission
b. Query the physician to determine if the condition was present on admission
c. Note the condition as unknown on admission
d. Note the condition as not present on admission
b. Query the physician to determine if the condition was present on admission
Phil White had coronary artery bypass graft surgery. Unfortunately, during the surgery, Phil
suffered a severe stroke. Phil’s recovery included several settings in the continuum of care: acute-care hospital, physician office, rehabilitation center, and home health agency. This initial service and subsequent recovery lasted 10 months. As a member of a managed care organization in an integrated delivery system, how should Phil expect that his healthcare billing will be handled?
a. Bills for each service from each physician, each facility, and each other healthcare provider from every encounter
b. Bills for each service from each physician, each facility, and each other healthcare provider at the end of the 10-month period
c. Consolidated billing for each encounter that includes the bills from all the physicians, facilities, and other healthcare providers involved in the encounter
d. One fixed amount for the entire episode that is divided among all the physicians, facilities, and other healthcare providers
d. One fixed amount for the entire episode that is divided among all the physicians, facilities, and other healthcare providers
The coding supervisor has compiled a report on the number of coding errors made each day by the coding staff. The report data show that Tim makes an average of six errors per day, Jane makes an average of five errors per day, and Bob and Susan each make an average of two errors per day. Given this information, what action should the coding supervisor take?
a. Counsel Tim and Jane because they have the highest error rates
b. Encourage Tim and Jane to get additional training
c. Provide Bob and Susan with incentive pay for low coding error rates
d. Take no action since not enough information is given to make a judgment
d. Take no action since not enough information is given to make a judgment
Once all data has been posted to patient’s account, the claim can be reviewed for accuracy and completeness. Many facilities have an internal auditing system that runs each claim through a set of edits. This internal auditing system is known as a:
a. Chargemaster
b. Superbill
c. Scrubber
d. Grouper
c. Scrubber
Which of the following terms is used to describe the requirement of the healthcare provider to obtain permission from the health insurer prior to providing service to the patient?
a. Preauthorization
b. Advance beneficiary notification
c. Point of care collection
d. Local coverage determination
a. Preauthorization
Joan is educating the physicians in her hospital about the Medicare Hospital Value-Based
Purchasing (VBP) Program. As part of this education she explains to her audience that the HCAHPS survey results are a part of the ________ domain in the Medicare VBP program.
a. Safety
b. Clinical Care
c. Efficiency and Cost Reduction
d. Person/Community Engagement
d. Person/Community Engagement
A series of terms in parentheses that sometimes directly follow main terms in the alphabetic index to diseases ICD-10-CM coding system is called:
a. exclude note
b. subterm
c. nonessential modifier
d. essential modifier
c. nonessential modifier
This law prohibits a physician from referring Medicare patients to clinical laboratory services where the doctor or a member of his family has a financial interest.
1. the Federal Anti-Kickback Statute
2. The False Claims Act
3. The Civil Monetary Penalties Act
4. The Stark I Law
- The Stark I Law
When the MS-DRG payment received by the hospital is lower than the actual charges for providing the inpatient services for a patient with Medicare, then the hospital
1. can bill the patient for the difference
2. absorbs the loss
3. can bill Medicare for the difference
4. makes a profit
- absorbs the loss
