RHIT Exam Practice Questions Domain 5
The evaluation of coders is recommended at least quarterly for the purpose of measurement and
assurance of:
A. Speed
B. Data quality and integrity
C. Accuracy
D. Effective relationships with physicians and facility personnel - ANSWER:Data quality and integrity
Coders should be evaluated at least quarterly, with appropriate training needs identified, facilitated, and
reassessed over time. Only through this continuous process of evaluation can data quality and integrity
be accurately measured and ensured.
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: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 subpoenas may require the production
of audit trails.
Healthcare fraud is all except which of the following?
A. Damage to another party that reasonably relied on misrepresentation
B. False representation of fact
C. Failure to disclose a material fact
D. Unnecessary costs to a program - ANSWER:Unnecessary costs to a program
,Healthcare fraud is the intentional deception or misrepresentation that an individual knows (or should
know) to be false, or does not believe to be true, and makes, knowing the deception could result in some
unauthorized benefit to himself or some other person(s). Unnecessary costs to a program, in and of
itself, would not be healthcare fraud, there would need to be some intentional deception for it to be
considered fraud.
Corporate compliance programs became common after adoption of which of the following?
A. False Claims Act.
B. Federal Sentencing Guidelines
C. Office of the Inspector General for HHS
D. Federal Physician Self-Referral Statute - ANSWER:Federal Sentencing Guidelines
The U.S. Federal Sentencing Guidelines outline seven steps as the hallmark of an effective program to
prevent and detect violations of law. These seven steps were the basis for the OIG's recommendations
regarding the fundamental elements of an effective compliance program.
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 follow-up can
be conducted
D. A corporate compliance committee that reports directly to CFO - ANSWER: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 complaints and to protect
whistleblowers from retaliation.
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 - ANSWER:Returned overpayments
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 services, overcoding and upcoding, billing for items or services not rendered, and
false cost reports.
Which of the following issues compliance program guidance?
A. AHIMA
B. CMS
C. Federal Register
D. HHS Office of Inspector General - ANSWER:HHS Office of Inspector General
From February 1998 until the present, the Office of Inspector General (OIG) continues to issue
compliance program guidance for various types of healthcare organizations. The OIG website
(www.oig.hhs.gov) posts the documents that most healthcare organizations need to develop fraud and
abuse compliance plans.
In developing a coding compliance program, which of the following would NOT be ordinarily included as
participants in coding compliance education?
A. Current coding personnel
B. Medical staff
C. Newly hired coding personnel
D. Nursing staff - ANSWER:Nursing staff
In conjunction with the corporate compliance officer, the health information manager should provide
education and training related to the importance of complete and accurate coding, documentation, and
, billing on an annual basis. Technical education for all coders should be provided. Documentation
education is also part of compliance education. A focused effort should be made to provide
documentation education to the medical staff.
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 - ANSWER:Medical
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 person can receive healthcare with an insurance
benefit and pay less or nothing for the care received.
The Medicare Integrity Program was established to battle fraud and abuse and is charged with which of
the following responsibilities?
A. Audit of expense reports and notifying beneficiaries of their rights
B. Payment determinations and audit of cost reports.
C. Publishing of new coding guidelines and code changes
D. Monitoring of physician credentials and payment determinations - ANSWER:Payment determinations
and audit of cost reports
The Medicare Integrity Program was established under the HIPAA legislation to battle healthcare fraud
and abuse. Not only did medicare continue to review provider claims for fraud and abuse, but the focus
expanded to cost reports, payment determinations and the need for ongoing compliance education.
Coding policies should include which of the following elements?
A. Lunch or break schedule
B. How to access the computer system
C. AHIMA Standards of Ethical Coding
D. Nonofficial coding guidelines - ANSWER:AHIMA Standards of Ethical Coding
The evaluation of coders is recommended at least quarterly for the purpose of measurement and
assurance of:
A. Speed
B. Data quality and integrity
C. Accuracy
D. Effective relationships with physicians and facility personnel - ANSWER:Data quality and integrity
Coders should be evaluated at least quarterly, with appropriate training needs identified, facilitated, and
reassessed over time. Only through this continuous process of evaluation can data quality and integrity
be accurately measured and ensured.
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: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 subpoenas may require the production
of audit trails.
Healthcare fraud is all except which of the following?
A. Damage to another party that reasonably relied on misrepresentation
B. False representation of fact
C. Failure to disclose a material fact
D. Unnecessary costs to a program - ANSWER:Unnecessary costs to a program
,Healthcare fraud is the intentional deception or misrepresentation that an individual knows (or should
know) to be false, or does not believe to be true, and makes, knowing the deception could result in some
unauthorized benefit to himself or some other person(s). Unnecessary costs to a program, in and of
itself, would not be healthcare fraud, there would need to be some intentional deception for it to be
considered fraud.
Corporate compliance programs became common after adoption of which of the following?
A. False Claims Act.
B. Federal Sentencing Guidelines
C. Office of the Inspector General for HHS
D. Federal Physician Self-Referral Statute - ANSWER:Federal Sentencing Guidelines
The U.S. Federal Sentencing Guidelines outline seven steps as the hallmark of an effective program to
prevent and detect violations of law. These seven steps were the basis for the OIG's recommendations
regarding the fundamental elements of an effective compliance program.
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 follow-up can
be conducted
D. A corporate compliance committee that reports directly to CFO - ANSWER: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 complaints and to protect
whistleblowers from retaliation.
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 - ANSWER:Returned overpayments
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 services, overcoding and upcoding, billing for items or services not rendered, and
false cost reports.
Which of the following issues compliance program guidance?
A. AHIMA
B. CMS
C. Federal Register
D. HHS Office of Inspector General - ANSWER:HHS Office of Inspector General
From February 1998 until the present, the Office of Inspector General (OIG) continues to issue
compliance program guidance for various types of healthcare organizations. The OIG website
(www.oig.hhs.gov) posts the documents that most healthcare organizations need to develop fraud and
abuse compliance plans.
In developing a coding compliance program, which of the following would NOT be ordinarily included as
participants in coding compliance education?
A. Current coding personnel
B. Medical staff
C. Newly hired coding personnel
D. Nursing staff - ANSWER:Nursing staff
In conjunction with the corporate compliance officer, the health information manager should provide
education and training related to the importance of complete and accurate coding, documentation, and
, billing on an annual basis. Technical education for all coders should be provided. Documentation
education is also part of compliance education. A focused effort should be made to provide
documentation education to the medical staff.
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 - ANSWER:Medical
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 person can receive healthcare with an insurance
benefit and pay less or nothing for the care received.
The Medicare Integrity Program was established to battle fraud and abuse and is charged with which of
the following responsibilities?
A. Audit of expense reports and notifying beneficiaries of their rights
B. Payment determinations and audit of cost reports.
C. Publishing of new coding guidelines and code changes
D. Monitoring of physician credentials and payment determinations - ANSWER:Payment determinations
and audit of cost reports
The Medicare Integrity Program was established under the HIPAA legislation to battle healthcare fraud
and abuse. Not only did medicare continue to review provider claims for fraud and abuse, but the focus
expanded to cost reports, payment determinations and the need for ongoing compliance education.
Coding policies should include which of the following elements?
A. Lunch or break schedule
B. How to access the computer system
C. AHIMA Standards of Ethical Coding
D. Nonofficial coding guidelines - ANSWER:AHIMA Standards of Ethical Coding
