RHIT Domain 4a: Questions & Answers
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. - ANSWER: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 - ANSWER: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. - ANSWER: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. - ANSWER: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 - ANSWER:1. air embolism
** With proper training of health care professionals, an air embolism should not occur.
** breech birth: a delivery of a baby which is so positioned in the uterus that the buttocks or feet are
delivered first.
A Medicare Summary Notice (MSN) is sent to ________ as their EOB.
1. skilled nursing facilities
2. hospitals
3. physicians
4. patients (beneficiaries) - ANSWER:4. patients (beneficiaries)
** The Medicare Summary Notice functions as the explanation of benefits to Medicare benficiaries.
This is a 10-digit, intelligence-free, numeric identifier designed to replace all previous provider legacy
numbers. This number identifies the physician universally to all payers. This number is issued to all
HIPAA-covered entities. It is mandatory on the CMS-1500 and UB-04 claim forms.
1. Master Patient Index (MPI)
2. National Practitioner Data Bank (NPD)
3. National Provider Identifier (NPI)
, 4. Universal Physician Number (UPN) - ANSWER:3. National Provider Identifier (NPI)
HIPAA administrative simplification provisions require all of the following code sets to be used EXCEPT
1. CPT.
2. DSM.
3. CDT.
4. ICD-10-CM. - ANSWER:2. DSM.
** The Diagnostic and Statistical Manual for mental disorders is not actually a code set and not required
by HIPAA.
* CDT - Current Dental Terminology
There are times when documentation is incomplete or insufficient to support the diagnoses found in the
chart. The most common way of communicating with the physician for answers is by
1. calling the physician's office.
2. using established physician query protocols.
3. leaving notes in the chart.
4. e-mailing physicians. - ANSWER:2. using established physician query protocols.
** The Query process must follow legal guidelines.
Under APCs, payment status indicator "T" means
1. significant procedure, multiple procedure reduction applies.
2. clinic or emergency department visit (medical visits).
3. significant procedure, not discounted when multiple.
4. ancillary services. - ANSWER:1. significant procedure, multiple procedure reduction applies.
** Under the APC (Ambulatory Payment Classifications) system, there exists a list of status indicators
(also called service indicators, payment status indicators, or payment indicators). This indicator is
provided for every HCPCS/CPT code and identifies how the service or procedure would be paid (if
covered) by Medicare for hospital outpatient visits. Payment Status Indicator (PSI) "T" means that if a
patient has more than one CPT code with this PSI, the procedure with the highest weight will be paid at
100% and all others will be reduced or discounted and paid at 50%.
The process by which health care facilities and providers ensure their financial viability by increasing
revenue, improving cash flow, and enhancing the patient's experience is called
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. - ANSWER: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 - ANSWER: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. - ANSWER: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. - ANSWER: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 - ANSWER:1. air embolism
** With proper training of health care professionals, an air embolism should not occur.
** breech birth: a delivery of a baby which is so positioned in the uterus that the buttocks or feet are
delivered first.
A Medicare Summary Notice (MSN) is sent to ________ as their EOB.
1. skilled nursing facilities
2. hospitals
3. physicians
4. patients (beneficiaries) - ANSWER:4. patients (beneficiaries)
** The Medicare Summary Notice functions as the explanation of benefits to Medicare benficiaries.
This is a 10-digit, intelligence-free, numeric identifier designed to replace all previous provider legacy
numbers. This number identifies the physician universally to all payers. This number is issued to all
HIPAA-covered entities. It is mandatory on the CMS-1500 and UB-04 claim forms.
1. Master Patient Index (MPI)
2. National Practitioner Data Bank (NPD)
3. National Provider Identifier (NPI)
, 4. Universal Physician Number (UPN) - ANSWER:3. National Provider Identifier (NPI)
HIPAA administrative simplification provisions require all of the following code sets to be used EXCEPT
1. CPT.
2. DSM.
3. CDT.
4. ICD-10-CM. - ANSWER:2. DSM.
** The Diagnostic and Statistical Manual for mental disorders is not actually a code set and not required
by HIPAA.
* CDT - Current Dental Terminology
There are times when documentation is incomplete or insufficient to support the diagnoses found in the
chart. The most common way of communicating with the physician for answers is by
1. calling the physician's office.
2. using established physician query protocols.
3. leaving notes in the chart.
4. e-mailing physicians. - ANSWER:2. using established physician query protocols.
** The Query process must follow legal guidelines.
Under APCs, payment status indicator "T" means
1. significant procedure, multiple procedure reduction applies.
2. clinic or emergency department visit (medical visits).
3. significant procedure, not discounted when multiple.
4. ancillary services. - ANSWER:1. significant procedure, multiple procedure reduction applies.
** Under the APC (Ambulatory Payment Classifications) system, there exists a list of status indicators
(also called service indicators, payment status indicators, or payment indicators). This indicator is
provided for every HCPCS/CPT code and identifies how the service or procedure would be paid (if
covered) by Medicare for hospital outpatient visits. Payment Status Indicator (PSI) "T" means that if a
patient has more than one CPT code with this PSI, the procedure with the highest weight will be paid at
100% and all others will be reduced or discounted and paid at 50%.
The process by which health care facilities and providers ensure their financial viability by increasing
revenue, improving cash flow, and enhancing the patient's experience is called
