RHIT Domain 4a: Questions & Answers: Updated A+ Solutions

The term used to indicate that the service or procedure is reasonable and necessary for the diagnosis or treatment of illness or injury consistent with generally accepted standards of care is 1. appropriateness. 2. evidence-based medicine. 3. benchmarking. 4. medical necessity. (Ans- 4. medical necessity. Use the following table to answer the question. (See the word file) This information is the numerical identification of the service or supply. Each item has a unique number with a prefix that indicates the department number (the number assigned to a specific ancillary department) and an item number (the number assigned by the accounting department or the business office) for a specific procedure or service represented on the chargemaster. 1. HCPCS code 2. revenue code 3. general ledger key 4. charge/service code (Ans- 4. charge/service code ** This number is used for internal process. All of the following statements are true of MS-DRGs, EXCEPT 1. there are several types of hospitals that are excluded from the Medicare inpatient PPS. 2. the MS-DRG payment received by the hospital may be lower than the actual cost of providing the services. 3. a patient claim may have multiple MS-DRGs. 4. special circumstances can result in a cost outlier payment to the hospital. (Ans- 3. a patient claim may have multiple MS-DRGs. ** Only one MS-DRG is assigned per inpatient hospitalization. The category "Commercial payers" includes private health insurance companies and 1. Blue Cross Blue Shield. 2. Medicare/Medicaid. 3. employer-based group health insurers. 4. TriCare. (Ans- 3. employer-based group health insurers. ** Employer-based group health insurers are commercial and not government-run agencies. Of the following, which is a hospital-acquired condition (HAC)? 1. air embolism 2. traumatic wound infection 3. stage I pressure ulcer 4. breech birth (Ans- 1. air embolism