RHIA STUDY SHEET SOLUTIONS 2026
CORRECT ANSWERS VERIFIED
◍ The prospective payment system used to reimburse home health
agencies for patients with Medicare utilizes data from the:
A. MDS (Minimum Data Set).
B. OASIS (Outcome and Assessment Information Set).
C. UHDDS (Uniform Hospital Discharge Data Set).
D. UACDS (Uniform Ambulatory Core Data Set).. Answer: B.
OASIS (Outcome and Assessment Information Set).
◍ Under APCs, the payment status indicator "N" means that the
payment
A. is for ancillary services.
B. is for a clinic or an emergency visit.
C. is discounted at 50%.
D. is packaged into the payment for other services.. Answer: D. is
packaged into the payment for other services.
◍ All of the following items are "packaged" under the Medicare
outpatient prospective payment system, EXCEPT for
A. recovery room.
B. medical supplies.
C. anesthesia.
,D. medical visits.. Answer: D. medical visits.
◍ Under the RBRVS, each HCPCS/CPT code contains three
components, each having assigned relative value units. These three
components are
A. geographic index, wage index, and cost of living index.
B. fee-for-service, per diem payment, and capitation.
C. conversion factor, CMS weight, and hospital-specific rate.
D. physician work, practice expense, and malpractice insurance
expense.. Answer: D. physician work, practice expense, and
malpractice insurance expense.
◍ The prospective payment system used to reimburse hospitals for
Medicare hospital outpatients is called
A. APGs.
B. RBRVS.
C. APCs.
D. MS-DRGs.. Answer: C. APCs.
◍ A Medicare patient was seen by Dr. Zachary, who is a
nonparticipating physician. The charge for the office visit was $125.
The Medicare beneficiary had already met his deductible. The
Medicare Fee Schedule amount is $100. Dr. Zachary does not accept
assignment. The office manager will apply a practice termed as
"balance billing," which means that the patient is
A. financially liable for the Medicare Fee Schedule amount.
,B. financially liable for charges in excess of the Medicare Fee
Schedule, up to a limit.
C. not financially liable for any amount.
D. financially liable for only the deductible.. Answer: B. financially
liable for charges in excess of the Medicare Fee Schedule, up to a
limit.
◍ The prospective payment system based on resource utilization
groups (RUGs) is used for reimbursement to _______________ for
patients with Medicare.
A. freestanding ambulatory surgery centers
B. hospital-based outpatients
C. intermediate care facilities
D. skilled nursing facilities. Answer: D. skilled nursing facilities
◍ The _____________ is a statement sent to the provider to explain
payments made by third-party payers.
A. remittance advice
B. advance beneficiary notice
C. attestation statement
D. acknowledgement notice. Answer: A. remittance advice
◍ HIPAA administrative simplification provisions require all of the
following code sets to be used EXCEPT
A. ICD-10-CM
B. CDT
, C. DSM
D. CPT. Answer: C. DSM
◍ The computer-to-computer transfer of data between providers and
third-party payers in a data format agreed upon by both parties is
called
A. HIPAA (Health Insurance Portability and Accountability Act).
B. electronic data interchange (EDI).
C. heath information exchange (HIE).
D. health data exchange (HDE).. Answer: B. electronic data
interchange (EDI).
◍ A computer software program that assigns appropriate MS-DRGs
according to the information provided for each episode of care is
called a(n)
A. encoder.
B. case-mix analyzer.
C. grouper.
D. scrubber.. Answer: C. grouper.
◍ The standard claim form used by hospitals to request
reimbursement for inpatient and outpatient procedures performed or
services provided is called the
A. UB-04.
B. CMS-1500.
C. CMS-1491.
CORRECT ANSWERS VERIFIED
◍ The prospective payment system used to reimburse home health
agencies for patients with Medicare utilizes data from the:
A. MDS (Minimum Data Set).
B. OASIS (Outcome and Assessment Information Set).
C. UHDDS (Uniform Hospital Discharge Data Set).
D. UACDS (Uniform Ambulatory Core Data Set).. Answer: B.
OASIS (Outcome and Assessment Information Set).
◍ Under APCs, the payment status indicator "N" means that the
payment
A. is for ancillary services.
B. is for a clinic or an emergency visit.
C. is discounted at 50%.
D. is packaged into the payment for other services.. Answer: D. is
packaged into the payment for other services.
◍ All of the following items are "packaged" under the Medicare
outpatient prospective payment system, EXCEPT for
A. recovery room.
B. medical supplies.
C. anesthesia.
,D. medical visits.. Answer: D. medical visits.
◍ Under the RBRVS, each HCPCS/CPT code contains three
components, each having assigned relative value units. These three
components are
A. geographic index, wage index, and cost of living index.
B. fee-for-service, per diem payment, and capitation.
C. conversion factor, CMS weight, and hospital-specific rate.
D. physician work, practice expense, and malpractice insurance
expense.. Answer: D. physician work, practice expense, and
malpractice insurance expense.
◍ The prospective payment system used to reimburse hospitals for
Medicare hospital outpatients is called
A. APGs.
B. RBRVS.
C. APCs.
D. MS-DRGs.. Answer: C. APCs.
◍ A Medicare patient was seen by Dr. Zachary, who is a
nonparticipating physician. The charge for the office visit was $125.
The Medicare beneficiary had already met his deductible. The
Medicare Fee Schedule amount is $100. Dr. Zachary does not accept
assignment. The office manager will apply a practice termed as
"balance billing," which means that the patient is
A. financially liable for the Medicare Fee Schedule amount.
,B. financially liable for charges in excess of the Medicare Fee
Schedule, up to a limit.
C. not financially liable for any amount.
D. financially liable for only the deductible.. Answer: B. financially
liable for charges in excess of the Medicare Fee Schedule, up to a
limit.
◍ The prospective payment system based on resource utilization
groups (RUGs) is used for reimbursement to _______________ for
patients with Medicare.
A. freestanding ambulatory surgery centers
B. hospital-based outpatients
C. intermediate care facilities
D. skilled nursing facilities. Answer: D. skilled nursing facilities
◍ The _____________ is a statement sent to the provider to explain
payments made by third-party payers.
A. remittance advice
B. advance beneficiary notice
C. attestation statement
D. acknowledgement notice. Answer: A. remittance advice
◍ HIPAA administrative simplification provisions require all of the
following code sets to be used EXCEPT
A. ICD-10-CM
B. CDT
, C. DSM
D. CPT. Answer: C. DSM
◍ The computer-to-computer transfer of data between providers and
third-party payers in a data format agreed upon by both parties is
called
A. HIPAA (Health Insurance Portability and Accountability Act).
B. electronic data interchange (EDI).
C. heath information exchange (HIE).
D. health data exchange (HDE).. Answer: B. electronic data
interchange (EDI).
◍ A computer software program that assigns appropriate MS-DRGs
according to the information provided for each episode of care is
called a(n)
A. encoder.
B. case-mix analyzer.
C. grouper.
D. scrubber.. Answer: C. grouper.
◍ The standard claim form used by hospitals to request
reimbursement for inpatient and outpatient procedures performed or
services provided is called the
A. UB-04.
B. CMS-1500.
C. CMS-1491.
