RHIT Domain 5 Exam: Questions & Answers
The national patient safety goals score organizations on areas that:
a. Affect the financial stability of the organization
b. Commonly lead to overpayment
c. Affect compliance with state law
d. Commonly lead to patient injury - ANSWER:d. Commonly lead to patient injury
The national patient safety goals outline for healthcare organizations the areas of organizational practice
that most commonly lead to patient injury or other negative outcomes that can be prevented when staff
utilize standardized procedures
Which item below is not recommended by the HHS and the OIG for minimum compliance with clinical
documentation regulations?
a. Physicians should include vaccination records
b. Progress, response, and changes are to be documented
c. Health record should be completely legible
d. Past and present diagnosis should be easily accessible - ANSWER:a. Physicians should include
vaccination records
Progress, response, and changes to the patient's condition must be documented. All health records
should be completely legible and accessible to patient and present diagnosis information. These are all
required elements of the Medicare Conditions of Participation. Physician inclusion of vaccination records
is not mandated
A facility recently submitted two claims for the same service for a patient's recent encounter for
chemotherapy. If the third-party payer pays both of these claims, the facility will receive a higher
reimbursement than deserved. This is called:
a. Appropriate payment
b. Overpayment
c. Unbundling
d. Waste - ANSWER:b. Overpayment
An overpayment occurs when a facility receives higher reimbursement than the facility deserves. One
example of this is when a facility submits two or more claims for the same service
A group practice has hired an HIT as its chief compliance officer. The current compliance program
includes written standards of conduct and policies, and procedures that address specific areas of
,potential fraud. It also has audits in place to monitor compliance. Which of the following should the
compliance officer also ensure are in place?
a. A bonus program for coders who code charts with higher paying MS-DRGs
b. A hotline to receive complaints and adoption of procedures to protect whistleblowers from retaliation
c. Procedures to adequately identify individuals who make complaints so that appropriate followup can
be conducted
d. A corporate compliance committee that reports directly to the CFO - ANSWER:b. A hotline to receive
complaints and adoption of procedures to protect whistleblowers from retaliation
The OIG has outlined seven elements as the minimum necessary for a comprehensive compliance
program. One of the seven elements is the maintenance of a process, such as a hotline, to receive
complaints and the adoption of procedures to protect the anonymity of complainants and to protect
whistleblowers from retaliation
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 - ANSWER:c. Waste
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
One way for a hospital to demonstrate compliance with OIG guidelines is to:
a. Designate a privacy officer
b. Continuously monitor PEPPER reports
c. Develop, implement, and monitor written policies and procedures
d. Obtain ABNs for all Medicare registrations - ANSWER:c. Develop, implement, and monitor written
policies and procedures
Over the past several years, the OIG has published several documents to help providers develop internal
programs that include elements for ensuring compliance. One of the elements included is written
policies and procedures
The nursing staff routinely sends text messages to attending physicians to clarify orders during the night
shift. The HIM professional should recommend which of the following to refine the policy as the best
practice for protecting information that is text messaged.
a. Send a text message to more than one person
,b. Enter a person's telephone number each time a text message is sent to him
c. Encrypt text messages during transmission
d. Presume that telephone numbers stored in memory remain valid - ANSWER:c. Encrypt text messages
during transmission
Although text messaging is often used in healthcare, it presents privacy and security risks. One best
practice for text messaging in healthcare is to use encryption during transmission
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 - ANSWER:a. Compliance
The clinical documentation improvement (CDI) manager should coordinate a feedback look 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
Which of the following is a legal concern regarding the EHR?
a. Ability to subpoena audit trails
b. Template design
c. ANSI standards
d. Data sets - ANSWER:a. Ability to subpoena audit trails
There are a number of legal issues facing the electronic health record (EHR). State laws vary as to what is
and is not acceptable in a court of law regarding EHRs. Healthcare providers frequently receive
subpoenas requesting the production of the health record. The subpoena may require the production of
audit trails
What is the goal of the clinical documentation improvement (CDI) compliance review?
a. Compliant MS-DRG assignment between CDI program staff
b. To ensure corrective action for any compliance concerns
c. Compliant query generation and physician responses
d. To ensure compliance between CDI program staff - ANSWER:c. Compliant query generation and
physician responses
Clinical documentation improvement (CDI) should be part of the organizational compliance program. The
goal of a CDI compliance review is to monitor compliant query generation and physician responses
, The deception or misrepresentation by a healthcare provider that may result in a false or fictitious claim
for inappropriate payment by Medicare or other insurers for items or services either not rendered or
rendered to a lesser extent than described in the claim is:
a. Healthcare fraud
b. Optimization
c. Upcoding
d. Healthcare abuse - ANSWER:a. Healthcare fraud
Healthcare fraud is defined as an intentional misrepresentation that an individual knows to be false or
does not believe to be true and makes, knowing that the representation could result in some
unauthorized benefit to himself or herself or some other person. An example of fraud is billing for a
service that was not furnished
If a patient notices an unknown item in the explanation of benefits they receive from an insurance
company and they do not recognize the service being paid for, the patient should:
a. Not do anything
b. Contact the insurer and the provider who billed for the services to correct the information
c. Contact the police
d. Contact human resources and let them know there has been a mistake - ANSWER:b. Contact the
insurer and the provider who billed for the services to correct the information
Patients should review and monitor the information found within their explanation of benefits (EOBs).
Patients should not assume that their healthcare services have been accurately submitted to and paid by
their insurance companies as claims submission is an error-prone
Sarah, a new graduate of a health information technology program, sits for the registered health
information technician (RHIT) exam and fails. She does not want her employer to know she failed and
tells her coworkers she passed the examination. Sarah then starts using the RHIT credential after her
name in work correspondence. A coworker, Nancy, discovers that Sarah is using the RHIT credential
fraudulently and notifies the supervisor, Joan. What is the responsibility of Nancy and Joan in this
situation?
a. Contact AHIMA and report the abuse
b. Contact the state licensing division
c. Contact the office of the inspector general
d. Contact the HIT program - ANSWER:a. Contact AHIMA and report the abuse
HIM professionals should be guided by the AHIMA Code of Ethics in making ethical decisions that relate
to the HIM profession. In this situation, Joan and Nancy should contact AHIMA and report the abus
The national patient safety goals score organizations on areas that:
a. Affect the financial stability of the organization
b. Commonly lead to overpayment
c. Affect compliance with state law
d. Commonly lead to patient injury - ANSWER:d. Commonly lead to patient injury
The national patient safety goals outline for healthcare organizations the areas of organizational practice
that most commonly lead to patient injury or other negative outcomes that can be prevented when staff
utilize standardized procedures
Which item below is not recommended by the HHS and the OIG for minimum compliance with clinical
documentation regulations?
a. Physicians should include vaccination records
b. Progress, response, and changes are to be documented
c. Health record should be completely legible
d. Past and present diagnosis should be easily accessible - ANSWER:a. Physicians should include
vaccination records
Progress, response, and changes to the patient's condition must be documented. All health records
should be completely legible and accessible to patient and present diagnosis information. These are all
required elements of the Medicare Conditions of Participation. Physician inclusion of vaccination records
is not mandated
A facility recently submitted two claims for the same service for a patient's recent encounter for
chemotherapy. If the third-party payer pays both of these claims, the facility will receive a higher
reimbursement than deserved. This is called:
a. Appropriate payment
b. Overpayment
c. Unbundling
d. Waste - ANSWER:b. Overpayment
An overpayment occurs when a facility receives higher reimbursement than the facility deserves. One
example of this is when a facility submits two or more claims for the same service
A group practice has hired an HIT as its chief compliance officer. The current compliance program
includes written standards of conduct and policies, and procedures that address specific areas of
,potential fraud. It also has audits in place to monitor compliance. Which of the following should the
compliance officer also ensure are in place?
a. A bonus program for coders who code charts with higher paying MS-DRGs
b. A hotline to receive complaints and adoption of procedures to protect whistleblowers from retaliation
c. Procedures to adequately identify individuals who make complaints so that appropriate followup can
be conducted
d. A corporate compliance committee that reports directly to the CFO - ANSWER:b. A hotline to receive
complaints and adoption of procedures to protect whistleblowers from retaliation
The OIG has outlined seven elements as the minimum necessary for a comprehensive compliance
program. One of the seven elements is the maintenance of a process, such as a hotline, to receive
complaints and the adoption of procedures to protect the anonymity of complainants and to protect
whistleblowers from retaliation
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 - ANSWER:c. Waste
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
One way for a hospital to demonstrate compliance with OIG guidelines is to:
a. Designate a privacy officer
b. Continuously monitor PEPPER reports
c. Develop, implement, and monitor written policies and procedures
d. Obtain ABNs for all Medicare registrations - ANSWER:c. Develop, implement, and monitor written
policies and procedures
Over the past several years, the OIG has published several documents to help providers develop internal
programs that include elements for ensuring compliance. One of the elements included is written
policies and procedures
The nursing staff routinely sends text messages to attending physicians to clarify orders during the night
shift. The HIM professional should recommend which of the following to refine the policy as the best
practice for protecting information that is text messaged.
a. Send a text message to more than one person
,b. Enter a person's telephone number each time a text message is sent to him
c. Encrypt text messages during transmission
d. Presume that telephone numbers stored in memory remain valid - ANSWER:c. Encrypt text messages
during transmission
Although text messaging is often used in healthcare, it presents privacy and security risks. One best
practice for text messaging in healthcare is to use encryption during transmission
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 - ANSWER:a. Compliance
The clinical documentation improvement (CDI) manager should coordinate a feedback look 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
Which of the following is a legal concern regarding the EHR?
a. Ability to subpoena audit trails
b. Template design
c. ANSI standards
d. Data sets - ANSWER:a. Ability to subpoena audit trails
There are a number of legal issues facing the electronic health record (EHR). State laws vary as to what is
and is not acceptable in a court of law regarding EHRs. Healthcare providers frequently receive
subpoenas requesting the production of the health record. The subpoena may require the production of
audit trails
What is the goal of the clinical documentation improvement (CDI) compliance review?
a. Compliant MS-DRG assignment between CDI program staff
b. To ensure corrective action for any compliance concerns
c. Compliant query generation and physician responses
d. To ensure compliance between CDI program staff - ANSWER:c. Compliant query generation and
physician responses
Clinical documentation improvement (CDI) should be part of the organizational compliance program. The
goal of a CDI compliance review is to monitor compliant query generation and physician responses
, The deception or misrepresentation by a healthcare provider that may result in a false or fictitious claim
for inappropriate payment by Medicare or other insurers for items or services either not rendered or
rendered to a lesser extent than described in the claim is:
a. Healthcare fraud
b. Optimization
c. Upcoding
d. Healthcare abuse - ANSWER:a. Healthcare fraud
Healthcare fraud is defined as an intentional misrepresentation that an individual knows to be false or
does not believe to be true and makes, knowing that the representation could result in some
unauthorized benefit to himself or herself or some other person. An example of fraud is billing for a
service that was not furnished
If a patient notices an unknown item in the explanation of benefits they receive from an insurance
company and they do not recognize the service being paid for, the patient should:
a. Not do anything
b. Contact the insurer and the provider who billed for the services to correct the information
c. Contact the police
d. Contact human resources and let them know there has been a mistake - ANSWER:b. Contact the
insurer and the provider who billed for the services to correct the information
Patients should review and monitor the information found within their explanation of benefits (EOBs).
Patients should not assume that their healthcare services have been accurately submitted to and paid by
their insurance companies as claims submission is an error-prone
Sarah, a new graduate of a health information technology program, sits for the registered health
information technician (RHIT) exam and fails. She does not want her employer to know she failed and
tells her coworkers she passed the examination. Sarah then starts using the RHIT credential after her
name in work correspondence. A coworker, Nancy, discovers that Sarah is using the RHIT credential
fraudulently and notifies the supervisor, Joan. What is the responsibility of Nancy and Joan in this
situation?
a. Contact AHIMA and report the abuse
b. Contact the state licensing division
c. Contact the office of the inspector general
d. Contact the HIT program - ANSWER:a. Contact AHIMA and report the abuse
HIM professionals should be guided by the AHIMA Code of Ethics in making ethical decisions that relate
to the HIM profession. In this situation, Joan and Nancy should contact AHIMA and report the abus
