©PREP4EXAMS@2024[REAL EXAM DUMPS] Thursday, July 25, 2024 6:51 PM
RHIT Domain 5 Practice Test Questions and Answers (100% Pass)
The overutilization or inappropriate utilization of services and misuse of resources,
typically not a criminal or intentional act is called which of the following?
a. Fraud
b. Abuse
c. Waste
d. Audit - ✔️✔️c
Waste is the overutilization or inappropriate utilization of services and misuse of
resources, and typically is not a criminal or intentional act. Waste includes practice
like over prescribing and ordering tests inappropriately (Foltz et al. 2016, 448).
Examples of high-risk billing practices that create compliance risks for healthcare
organizations include all except which of the following?
a. Altered claim forms
b. Returned overpayments
c. Duplicate billings
d. Unbundled procedures - ✔️✔️b
Fraudulent billing practices represent a major compliance risk for healthcare
organizations. High-risk billing practices include: billing for noncovered services,
altered claim forms, duplicate billing, misrepresentation of facts on a claim form,
failing to return overpayments, unbundling, billing for medically unnecessary
1
, ©PREP4EXAMS@2024[REAL EXAM DUMPS] Thursday, July 25, 2024 6:51 PM
services, overcoding and upcoding, billing for items or services not rendered, and
false cost reports (Bowman 2017, 440-441, 466).
Which of the following groups are included in the feedback loop between denials,
management, and clinical documentation improvement (CDI) program staff?
a. Compliance
b. Office of the Inspector General
c. Center for Medicare and Medicaid Services
d. Payers - ✔️✔️a
The clinical documentation improvement (CDI) manager should coordinate a
feedback loop with functional managers that involved reporting data from the
department to CDI and then from CDI back to the department. The three areas for
CDI best practices include operationalizing feedback loops with denials
management, compliance, and HIM (Hess 2015, 242).
Every healthcare organization's risk management plan should include the following
components except:
a. Loss prevention and reduction
b. Safety and security management
c. Peer review
d. Claims management - ✔️✔️c
Risk management programs have three functions: risk identification and analysis,
loss prevention and reduction, and claims management (Carter and Palmer 2016,
522).
2
, ©PREP4EXAMS@2024[REAL EXAM DUMPS] Thursday, July 25, 2024 6:51 PM
A pharmacist who submits Medicaid claims for reimbursement on brand name
drugs when less expensive generic drugs were actually dispensed has committed the
crime of:
a. Criminal negligence
b. Fraud
c. Perjury
d. Products' liability - ✔️✔️b
Fraud in healthcare is defined as a deliberate false representation of fact, a failure
to disclose a fact that is material (relevant) to a healthcare transaction, damage to
another party that reasonably relies on the misrepresentation, or failure to disclose.
This situation would fall under category 2 (Foltz et al. 2016, 448).
A provider's office calls to retrieve emergency room records for a patient's follow-up
appointment. The HIM professional refused to release the emergency room records
without a written authorization from the patient. Was this action in compliance?
a. No; the records are needed for continued care of the patient, so no authorization
is required
b. Yes; the release of all records requires written authorization from the patient
c. No; permission of the ER physician was not obtained
d. Yes; one covered entity cannot request the records from another covered entity -
✔️✔️a
Treatment, payment, and operations (TPO) is an important concept because the
Privacy Rule provides a number of exceptions for PHI that is being used or disclosed
for TPO purposes. Treatment means providing, coordinating, or managing
3
, ©PREP4EXAMS@2024[REAL EXAM DUMPS] Thursday, July 25, 2024 6:51 PM
healthcare or healthcare-related services by one or more healthcare providers
(Rinehart-Thompson 2016b, 223).
A notice that suspends the process or destruction of paper or electronic records is
called:
a. Subpoena
b. Consent form
c. Rule
d. Legal hold - ✔️✔️d
A legal hold (also known as a preservation order, preservation notice, or litigation
hold) basically suspends the processing or destruction of paper or electronic records.
It may be initiated by a court if there is concern that information may be destroyed
in cases of current or anticipated litigation, audit, or government investigation. Or,
it may be initiated by the organization as part of their pre-litigation planning and
duty to preserve information in anticipation of litigation (Klaver 2017a, 86-87).
Which type of identity theft occurs when a patient uses another person's name and
insurance information to receive healthcare benefits?
a. Medical
b. Financial
c. Criminal
d. Health - ✔️✔️a
Medical identity theft occurs when a patient uses another person's name and
insurance information to receive healthcare benefits. Most often this is done so a
4
RHIT Domain 5 Practice Test Questions and Answers (100% Pass)
The overutilization or inappropriate utilization of services and misuse of resources,
typically not a criminal or intentional act is called which of the following?
a. Fraud
b. Abuse
c. Waste
d. Audit - ✔️✔️c
Waste is the overutilization or inappropriate utilization of services and misuse of
resources, and typically is not a criminal or intentional act. Waste includes practice
like over prescribing and ordering tests inappropriately (Foltz et al. 2016, 448).
Examples of high-risk billing practices that create compliance risks for healthcare
organizations include all except which of the following?
a. Altered claim forms
b. Returned overpayments
c. Duplicate billings
d. Unbundled procedures - ✔️✔️b
Fraudulent billing practices represent a major compliance risk for healthcare
organizations. High-risk billing practices include: billing for noncovered services,
altered claim forms, duplicate billing, misrepresentation of facts on a claim form,
failing to return overpayments, unbundling, billing for medically unnecessary
1
, ©PREP4EXAMS@2024[REAL EXAM DUMPS] Thursday, July 25, 2024 6:51 PM
services, overcoding and upcoding, billing for items or services not rendered, and
false cost reports (Bowman 2017, 440-441, 466).
Which of the following groups are included in the feedback loop between denials,
management, and clinical documentation improvement (CDI) program staff?
a. Compliance
b. Office of the Inspector General
c. Center for Medicare and Medicaid Services
d. Payers - ✔️✔️a
The clinical documentation improvement (CDI) manager should coordinate a
feedback loop with functional managers that involved reporting data from the
department to CDI and then from CDI back to the department. The three areas for
CDI best practices include operationalizing feedback loops with denials
management, compliance, and HIM (Hess 2015, 242).
Every healthcare organization's risk management plan should include the following
components except:
a. Loss prevention and reduction
b. Safety and security management
c. Peer review
d. Claims management - ✔️✔️c
Risk management programs have three functions: risk identification and analysis,
loss prevention and reduction, and claims management (Carter and Palmer 2016,
522).
2
, ©PREP4EXAMS@2024[REAL EXAM DUMPS] Thursday, July 25, 2024 6:51 PM
A pharmacist who submits Medicaid claims for reimbursement on brand name
drugs when less expensive generic drugs were actually dispensed has committed the
crime of:
a. Criminal negligence
b. Fraud
c. Perjury
d. Products' liability - ✔️✔️b
Fraud in healthcare is defined as a deliberate false representation of fact, a failure
to disclose a fact that is material (relevant) to a healthcare transaction, damage to
another party that reasonably relies on the misrepresentation, or failure to disclose.
This situation would fall under category 2 (Foltz et al. 2016, 448).
A provider's office calls to retrieve emergency room records for a patient's follow-up
appointment. The HIM professional refused to release the emergency room records
without a written authorization from the patient. Was this action in compliance?
a. No; the records are needed for continued care of the patient, so no authorization
is required
b. Yes; the release of all records requires written authorization from the patient
c. No; permission of the ER physician was not obtained
d. Yes; one covered entity cannot request the records from another covered entity -
✔️✔️a
Treatment, payment, and operations (TPO) is an important concept because the
Privacy Rule provides a number of exceptions for PHI that is being used or disclosed
for TPO purposes. Treatment means providing, coordinating, or managing
3
, ©PREP4EXAMS@2024[REAL EXAM DUMPS] Thursday, July 25, 2024 6:51 PM
healthcare or healthcare-related services by one or more healthcare providers
(Rinehart-Thompson 2016b, 223).
A notice that suspends the process or destruction of paper or electronic records is
called:
a. Subpoena
b. Consent form
c. Rule
d. Legal hold - ✔️✔️d
A legal hold (also known as a preservation order, preservation notice, or litigation
hold) basically suspends the processing or destruction of paper or electronic records.
It may be initiated by a court if there is concern that information may be destroyed
in cases of current or anticipated litigation, audit, or government investigation. Or,
it may be initiated by the organization as part of their pre-litigation planning and
duty to preserve information in anticipation of litigation (Klaver 2017a, 86-87).
Which type of identity theft occurs when a patient uses another person's name and
insurance information to receive healthcare benefits?
a. Medical
b. Financial
c. Criminal
d. Health - ✔️✔️a
Medical identity theft occurs when a patient uses another person's name and
insurance information to receive healthcare benefits. Most often this is done so a
4
