WGU C807 – Healthcare Compliance | Bachelor of
Science in Health Information Management Original
Practice Questions & Answers | Comprehensive
WGU C807 Study Guide & Assessment Preparation |
Healthcare Compliance, Coding Compliance,
Compliance Plans, Regulatory Requirements,
Noncompliance Risks, Internal & External Audits,
Healthcare Information Management, Coding
Professional Responsibilities, Compliance
Monitoring & Detailed Rationales
Question 1: Which of the following is the primary function of a Clinical
Documentation Improvement (CDI) program in a healthcare organization?
A. To assign diagnostic and procedure codes for billing purposes
B. To review documentation to ensure every diagnosis is clinically supported and
properly documented
C. To manage the release of patient information to external requestors
D. To maintain the security and integrity of the electronic health record
CORRECT ANSWER: B. To review documentation to ensure every diagnosis is
clinically supported and properly documented
Rationale: A CDI specialist reviews health record documentation to ensure that every
diagnosis documented is supported clinically and that every condition being treated,
monitored, or evaluated is properly documented . This process helps improve the
accuracy of the patient's clinical picture and supports accurate coding. Coders assign
codes, not CDI specialists (A), and ROI and EHR security are separate HIM functions (C,
D) .
Question 2: An inpatient coder at a hospital is reviewing a patient's health
record to assign codes. Which of the following documents is most critical for
the coder to review to understand the full scope of the patient's hospital stay?
A. The patient's driver's license and insurance card
B. The initial emergency department triage note
C. The discharge summary, history and physical, and operative notes
D. The patient's social media activity related to their health
CORRECT ANSWER: C. The discharge summary, history and physical, and
operative notes
Rationale: Inpatient coders use documents that include the history and physical exam,
progress notes, consultations, operative notes, and discharge summaries to assign codes
for all relevant diagnoses and procedures for the entire length of stay . These documents
contain the comprehensive clinical information necessary for accurate code assignment.
The other options are not relevant clinical documents used for coding.
,Question 3: Which of the following best describes the role of outpatient coders
in relation to Evaluation and Management (E/M) codes?
A. They assign E/M codes to reflect the amount of time and resources the provider
spent on the patient
B. They are not responsible for E/M codes, as these are only for inpatient settings
C. They only assign E/M codes for surgical procedures
D. They use E/M codes to bill for laboratory and ancillary services
CORRECT ANSWER: A. They assign E/M codes to reflect the amount of time
and resources the provider spent on the patient
Rationale: Outpatient coders may be responsible for coding evaluation and management
codes to reflect the amount of time and resources the provider spent on the patient
during the encounter . This is a key part of outpatient coding for provider services.
Question 4: The goal of a CDI specialist performing a concurrent review is to:
A. Increase the length of stay to improve hospital revenue
B. Decrease the amount of time between the patient's discharge and the billing process
C. Assign final diagnosis codes before the patient is discharged
D. Identify patients who are readmitted within 30 days
CORRECT ANSWER: B. Decrease the amount of time between the patient's
discharge and the billing process
Rationale: CDI specialists often review cases concurrently, meaning while the patient is
still in the hospital . The goal of this concurrent review is to decrease the amount of time
between the patient's discharge and the billing process .
Question 5: Which strategy can a coding manager implement to improve both
coding accuracy and productivity?
A. Discourage coders from using Coding Clinic guidance to save time
B. Require coders to query providers for every documented diagnosis
C. Provide ongoing education through webinars and lunch-and-learns
D. Reduce the number of charts each coder reviews per day
CORRECT ANSWER: C. Provide ongoing education through webinars and
lunch-and-learns
Rationale: Another strategy for improving both accuracy and production is providing
access to ongoing education . This education could be provided through an external
source or internally through lunch-and-learns or monthly webinars .
Question 6: What is the main purpose of a health information exchange (HIE)?
A. To replace the need for electronic health records
B. To enable the secure electronic sharing of clinical information among authorized
healthcare organizations
,C. To allow patients to update their own medical records
D. To conduct medical research using de-identified patient data
CORRECT ANSWER: B. To enable the secure electronic sharing of clinical
information among authorized healthcare organizations
Rationale: The primary purpose of a health information exchange (HIE) is to enable the
secure electronic sharing of clinical information among authorized healthcare
organizations . This facilitates care coordination and improves patient outcomes by
providing timely access to patient data across different care settings.
Question 7: Under HIPAA, the term "designated record set" refers to:
A. Only the documents used for billing purposes
B. The legal health record as defined by state law
C. A group of records that includes medical and billing records used to make decisions
about an individual
D. Any document that contains a patient's name
CORRECT ANSWER: C. A group of records that includes medical and billing
records used to make decisions about an individual
Rationale: Under HIPAA, the designated record set includes medical and billing records,
as well as other records used by or for the covered entity to make decisions about an
individual . It is broader than the legal health record and determines what records a
patient has the right to access and request amendments to.
Question 8: What is the primary purpose of an audit trail in an Electronic
Health Record (EHR) system?
A. To reduce storage costs by compressing historical data
B. To provide a chronological record of who accessed or modified a patient's record and
when
C. To automatically correct documentation errors
D. To generate patient satisfaction surveys
CORRECT ANSWER: B. To provide a chronological record of who accessed or
modified a patient's record and when
Rationale: An audit trail is a security and compliance feature that logs all access and
modifications to electronic health records, including user identity, timestamp, and action
performed . This supports accountability and deters inappropriate access.
Question 9: Which documentation principle requires that entries be made at or
near the time of the event?
A. Legibility
B. Timeliness
C. Confidentiality
D. Permanence
, CORRECT ANSWER: B. Timeliness
Rationale: Timeliness is a core documentation standard requiring that entries be
recorded as soon as possible after care is provided . This enhances accuracy, reduces
recall bias, supports continuity of care, and meets regulatory requirements.
Question 10: In health information management, what does the acronym
"ROI" stand for?
A. Return on Investment
B. Release of Information
C. Record of Incidents
D. Registry of Individuals
CORRECT ANSWER: B. Release of Information
Rationale: In HIM, ROI stands for Release of Information—the process by which
protected health information is disclosed to authorized individuals or entities in
compliance with HIPAA, state law, and organizational policy .
Question 11: Which of the following is NOT a valid reason to deny a patient's
request for access to their PHI under HIPAA?
A. The request is for psychotherapy notes
B. The information was compiled for use in a legal proceeding
C. The patient has not paid their medical bill
D. Access would reasonably endanger the life or safety of the patient or another person
CORRECT ANSWER: C. The patient has not paid their medical bill
Rationale: HIPAA permits denial of access only in specific, limited circumstances, such
as for psychotherapy notes, information compiled for legal proceedings, or when access
would endanger safety . Non-payment of bills is not a permissible reason to deny a
patient's right to access their own protected health information.
Question 12: What is the primary purpose of a record retention schedule?
A. To determine which staff members can access patient records
B. To specify how long different types of health records must be kept before destruction
C. To assign medical record numbers to new patients
D. To track the number of pages in each patient's chart
CORRECT ANSWER: B. To specify how long different types of health records
must be kept before destruction
Rationale: A record retention schedule specifies how long different types of health
records must be kept before destruction . However, organizations must always comply
with applicable state and federal regulations, which may require longer retention.
Question 13: Which of the following is a required element for authentication of
a health record entry?
Science in Health Information Management Original
Practice Questions & Answers | Comprehensive
WGU C807 Study Guide & Assessment Preparation |
Healthcare Compliance, Coding Compliance,
Compliance Plans, Regulatory Requirements,
Noncompliance Risks, Internal & External Audits,
Healthcare Information Management, Coding
Professional Responsibilities, Compliance
Monitoring & Detailed Rationales
Question 1: Which of the following is the primary function of a Clinical
Documentation Improvement (CDI) program in a healthcare organization?
A. To assign diagnostic and procedure codes for billing purposes
B. To review documentation to ensure every diagnosis is clinically supported and
properly documented
C. To manage the release of patient information to external requestors
D. To maintain the security and integrity of the electronic health record
CORRECT ANSWER: B. To review documentation to ensure every diagnosis is
clinically supported and properly documented
Rationale: A CDI specialist reviews health record documentation to ensure that every
diagnosis documented is supported clinically and that every condition being treated,
monitored, or evaluated is properly documented . This process helps improve the
accuracy of the patient's clinical picture and supports accurate coding. Coders assign
codes, not CDI specialists (A), and ROI and EHR security are separate HIM functions (C,
D) .
Question 2: An inpatient coder at a hospital is reviewing a patient's health
record to assign codes. Which of the following documents is most critical for
the coder to review to understand the full scope of the patient's hospital stay?
A. The patient's driver's license and insurance card
B. The initial emergency department triage note
C. The discharge summary, history and physical, and operative notes
D. The patient's social media activity related to their health
CORRECT ANSWER: C. The discharge summary, history and physical, and
operative notes
Rationale: Inpatient coders use documents that include the history and physical exam,
progress notes, consultations, operative notes, and discharge summaries to assign codes
for all relevant diagnoses and procedures for the entire length of stay . These documents
contain the comprehensive clinical information necessary for accurate code assignment.
The other options are not relevant clinical documents used for coding.
,Question 3: Which of the following best describes the role of outpatient coders
in relation to Evaluation and Management (E/M) codes?
A. They assign E/M codes to reflect the amount of time and resources the provider
spent on the patient
B. They are not responsible for E/M codes, as these are only for inpatient settings
C. They only assign E/M codes for surgical procedures
D. They use E/M codes to bill for laboratory and ancillary services
CORRECT ANSWER: A. They assign E/M codes to reflect the amount of time
and resources the provider spent on the patient
Rationale: Outpatient coders may be responsible for coding evaluation and management
codes to reflect the amount of time and resources the provider spent on the patient
during the encounter . This is a key part of outpatient coding for provider services.
Question 4: The goal of a CDI specialist performing a concurrent review is to:
A. Increase the length of stay to improve hospital revenue
B. Decrease the amount of time between the patient's discharge and the billing process
C. Assign final diagnosis codes before the patient is discharged
D. Identify patients who are readmitted within 30 days
CORRECT ANSWER: B. Decrease the amount of time between the patient's
discharge and the billing process
Rationale: CDI specialists often review cases concurrently, meaning while the patient is
still in the hospital . The goal of this concurrent review is to decrease the amount of time
between the patient's discharge and the billing process .
Question 5: Which strategy can a coding manager implement to improve both
coding accuracy and productivity?
A. Discourage coders from using Coding Clinic guidance to save time
B. Require coders to query providers for every documented diagnosis
C. Provide ongoing education through webinars and lunch-and-learns
D. Reduce the number of charts each coder reviews per day
CORRECT ANSWER: C. Provide ongoing education through webinars and
lunch-and-learns
Rationale: Another strategy for improving both accuracy and production is providing
access to ongoing education . This education could be provided through an external
source or internally through lunch-and-learns or monthly webinars .
Question 6: What is the main purpose of a health information exchange (HIE)?
A. To replace the need for electronic health records
B. To enable the secure electronic sharing of clinical information among authorized
healthcare organizations
,C. To allow patients to update their own medical records
D. To conduct medical research using de-identified patient data
CORRECT ANSWER: B. To enable the secure electronic sharing of clinical
information among authorized healthcare organizations
Rationale: The primary purpose of a health information exchange (HIE) is to enable the
secure electronic sharing of clinical information among authorized healthcare
organizations . This facilitates care coordination and improves patient outcomes by
providing timely access to patient data across different care settings.
Question 7: Under HIPAA, the term "designated record set" refers to:
A. Only the documents used for billing purposes
B. The legal health record as defined by state law
C. A group of records that includes medical and billing records used to make decisions
about an individual
D. Any document that contains a patient's name
CORRECT ANSWER: C. A group of records that includes medical and billing
records used to make decisions about an individual
Rationale: Under HIPAA, the designated record set includes medical and billing records,
as well as other records used by or for the covered entity to make decisions about an
individual . It is broader than the legal health record and determines what records a
patient has the right to access and request amendments to.
Question 8: What is the primary purpose of an audit trail in an Electronic
Health Record (EHR) system?
A. To reduce storage costs by compressing historical data
B. To provide a chronological record of who accessed or modified a patient's record and
when
C. To automatically correct documentation errors
D. To generate patient satisfaction surveys
CORRECT ANSWER: B. To provide a chronological record of who accessed or
modified a patient's record and when
Rationale: An audit trail is a security and compliance feature that logs all access and
modifications to electronic health records, including user identity, timestamp, and action
performed . This supports accountability and deters inappropriate access.
Question 9: Which documentation principle requires that entries be made at or
near the time of the event?
A. Legibility
B. Timeliness
C. Confidentiality
D. Permanence
, CORRECT ANSWER: B. Timeliness
Rationale: Timeliness is a core documentation standard requiring that entries be
recorded as soon as possible after care is provided . This enhances accuracy, reduces
recall bias, supports continuity of care, and meets regulatory requirements.
Question 10: In health information management, what does the acronym
"ROI" stand for?
A. Return on Investment
B. Release of Information
C. Record of Incidents
D. Registry of Individuals
CORRECT ANSWER: B. Release of Information
Rationale: In HIM, ROI stands for Release of Information—the process by which
protected health information is disclosed to authorized individuals or entities in
compliance with HIPAA, state law, and organizational policy .
Question 11: Which of the following is NOT a valid reason to deny a patient's
request for access to their PHI under HIPAA?
A. The request is for psychotherapy notes
B. The information was compiled for use in a legal proceeding
C. The patient has not paid their medical bill
D. Access would reasonably endanger the life or safety of the patient or another person
CORRECT ANSWER: C. The patient has not paid their medical bill
Rationale: HIPAA permits denial of access only in specific, limited circumstances, such
as for psychotherapy notes, information compiled for legal proceedings, or when access
would endanger safety . Non-payment of bills is not a permissible reason to deny a
patient's right to access their own protected health information.
Question 12: What is the primary purpose of a record retention schedule?
A. To determine which staff members can access patient records
B. To specify how long different types of health records must be kept before destruction
C. To assign medical record numbers to new patients
D. To track the number of pages in each patient's chart
CORRECT ANSWER: B. To specify how long different types of health records
must be kept before destruction
Rationale: A record retention schedule specifies how long different types of health
records must be kept before destruction . However, organizations must always comply
with applicable state and federal regulations, which may require longer retention.
Question 13: Which of the following is a required element for authentication of
a health record entry?
