RHIT DOMAIN 4 |ACTUAL QUESTIONS AND
VERIFIED ANSWERS 2026-2027 UPDATED
EDITION|GRADED A+
Question 1
In analyzing the reason for changes in a hospital's Medicare case-mix index over time, the
analyst should start with which of the following levels of detail?
Account level
MS-DRG level
MDC level
MS-DRG triples, pairs, and singles
CORRECT ANSWER
MS-DRG triples, pairs, and singles
Question 2
What is the term that means evaluating the appropriateness of the setting for the
healthcare service and the level of service?
Coordination of service benefits
Community rating
Outcomes assessment
1
@https://www.stuvia.com/user/thestudyvault
,Utilization review
CORRECT ANSWER
Utilization review
Question 3
Which of the following actions would be best to determine whether present on admission
(POA) indicators for the conditions selected by CMS are having a negative impact on the
hospital's Medicare reimbursement?
Identify all records for a period having these indicators for these conditions and determine
whether these conditions are the only secondary diagnoses present on the claim that will
lead to higher payment.
Identify all records for a period that have these indicators for these conditions.
Identify all records for a period that have these indicators for these conditions and
determine whether or not additional documentation can be submitted to Medicare to
increase reimbursement.
Take a random sample of records for a period of records having these indicators for these
conditions and extrapolate the negative impact on Medicare reimbursement.
CORRECT ANSWER
Identify all records for a period having these indicators for these conditions and
determine whether these conditions are the only secondary diagnoses present on the
claim that will lead to higher payment.
Question 4
2
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,A patient is admitted to the hospital with acute lower abdominal pain. The principal
diagnosis is acute appendicitis. The patient also has a diagnosis of diabetes. The patient
undergoes an appendectomy and subsequently develops two wound infections. Which of
the following could be considered a comorbid condition?
Acute appendicitis
Acute lower abdominal pain
Diabetes
Wound infection
CORRECT ANSWER
Diabetes
Question 5
A coding audit shows that an inpatient coder is using multiple codes that describe the
individual components of a procedure rather than using a single code that describes all the
steps of the procedure performed. Which of the following should be done in this case?
Counsel the coder and stop the practice immediately
Report the practice to the OIG
Require all coders to implement this practice
Put the coder on unpaid leave of absence
CORRECT ANSWER
3
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, Counsel the coder and stop the practice immediately
Question 6
Diagnosis-related groups are organized into:
Case-mix classifications
Geographic practice cost indices
Major diagnostic categories
Resource-based relative values
CORRECT ANSWER
Major diagnostic categories
Question 7
NCCI edits prevent improper payments in which of the following cases?
Medical necessity has not been justified by a diagnosis.
The account is potentially up coded.
The claim contains any of a variety of errors.
Incorrect code combinations are on the claim
4
@https://www.stuvia.com/user/thestudyvault
VERIFIED ANSWERS 2026-2027 UPDATED
EDITION|GRADED A+
Question 1
In analyzing the reason for changes in a hospital's Medicare case-mix index over time, the
analyst should start with which of the following levels of detail?
Account level
MS-DRG level
MDC level
MS-DRG triples, pairs, and singles
CORRECT ANSWER
MS-DRG triples, pairs, and singles
Question 2
What is the term that means evaluating the appropriateness of the setting for the
healthcare service and the level of service?
Coordination of service benefits
Community rating
Outcomes assessment
1
@https://www.stuvia.com/user/thestudyvault
,Utilization review
CORRECT ANSWER
Utilization review
Question 3
Which of the following actions would be best to determine whether present on admission
(POA) indicators for the conditions selected by CMS are having a negative impact on the
hospital's Medicare reimbursement?
Identify all records for a period having these indicators for these conditions and determine
whether these conditions are the only secondary diagnoses present on the claim that will
lead to higher payment.
Identify all records for a period that have these indicators for these conditions.
Identify all records for a period that have these indicators for these conditions and
determine whether or not additional documentation can be submitted to Medicare to
increase reimbursement.
Take a random sample of records for a period of records having these indicators for these
conditions and extrapolate the negative impact on Medicare reimbursement.
CORRECT ANSWER
Identify all records for a period having these indicators for these conditions and
determine whether these conditions are the only secondary diagnoses present on the
claim that will lead to higher payment.
Question 4
2
@https://www.stuvia.com/user/thestudyvault
,A patient is admitted to the hospital with acute lower abdominal pain. The principal
diagnosis is acute appendicitis. The patient also has a diagnosis of diabetes. The patient
undergoes an appendectomy and subsequently develops two wound infections. Which of
the following could be considered a comorbid condition?
Acute appendicitis
Acute lower abdominal pain
Diabetes
Wound infection
CORRECT ANSWER
Diabetes
Question 5
A coding audit shows that an inpatient coder is using multiple codes that describe the
individual components of a procedure rather than using a single code that describes all the
steps of the procedure performed. Which of the following should be done in this case?
Counsel the coder and stop the practice immediately
Report the practice to the OIG
Require all coders to implement this practice
Put the coder on unpaid leave of absence
CORRECT ANSWER
3
@https://www.stuvia.com/user/thestudyvault
, Counsel the coder and stop the practice immediately
Question 6
Diagnosis-related groups are organized into:
Case-mix classifications
Geographic practice cost indices
Major diagnostic categories
Resource-based relative values
CORRECT ANSWER
Major diagnostic categories
Question 7
NCCI edits prevent improper payments in which of the following cases?
Medical necessity has not been justified by a diagnosis.
The account is potentially up coded.
The claim contains any of a variety of errors.
Incorrect code combinations are on the claim
4
@https://www.stuvia.com/user/thestudyvault
