RHIT Domain 5 Exam 2023 With Complete Solution (VERIFIED) 100% Correct.

RHIT Domain 5 Exam 2023 With Complete Solution (VERIFIED) 100% Correct. 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 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 (Foltz et al. 2016, 448). 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 b 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 (Bowman 2017, 440-441, 466). 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 The clinical documentation improvement (CDI) manager should coordinate a feedback loop 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 (Hess 2015, 242). Every healthcare organization's risk management plan should include the following components except: a. Loss prevention and reduction b. Safety and security management c. Peer review d. Claims management - Answer c Risk management programs have three functions: risk identification and analysis, loss prevention and reduction, and claims management (Carter and Palmer 2016, 522). A pharmacist who submits Medicaid claims for reimbursement on brand name drugs when less expensive generic drugs were actually dispensed has committed the crime of: a. Criminal negligence b. Fraud c. Perjury d. Products' liability - Answer b Fraud in healthcare is defined as a deliberate false representation of fact, a failure to disclose a fact that is material (relevant) to a healthcare transaction, damage to another party that reasonably relies on the misrepresentation, or failure to disclose. This situation would fall under category 2 (Foltz et al. 2016, 448). A provider's office calls to retrieve emergency room records for a patient's follow-up appointment. The HIM professional refused to release the emergency room records without a written authorization from the patient. Was this action in compliance? a. No; the records are needed for continued care of the patient, so no authorization is required b. Yes; the release of all records requires written authorization from the patient c. No; permission of the ER physician was not obtained d. Yes; one covered entity cannot request the records from another covered entity - Answer a Treatment, payment, and operations (TPO) is an important concept because the Privacy Rule provides a number of exceptions for PHI that is being used or disclosed for TPO purposes. Treatment means providing, coordinating, or managing healthcare or healthcare-related services by one or more healthcare providers (Rinehart-Thompson 2016b, 223). A notice that suspends the process or destruction of paper or electronic records is called: a. Subpoena b. Consent form c. Rule d. Legal hold - Answer d A legal hold (also known as a preservation order, preservation notice, or litigation hold) basically suspends the processing or destruction of paper or electronic records. It may be initiated by a court if there is concern that information may be destroyed in cases of current or anticipated litigation, audit, or government investigation. Or, it may be initiated by the organization as part of their pre-litigation planning and duty to preserve information in anticipation of litigation (Klaver 2017a, 86-87). 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 a 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 (Rinehart- Thompson 2016b, 247). Which of the following situations is considered a breach of PHI? a. A nurse sees the record of a patient that she is not caring for b. A patient's attorney is sent records not authorized by that patient c. A nurse starts to place PHI in a public area where a patient is standing and immediately picks it up d. An HIM employee keys in the wrong health record number but closes it out as soon as it is realized - Answer b There are three exceptions to a breach. All of these answers fall into one of these categories with the exception of the records sent to the patient's attorney. He does not work for the covered entity and an authorization is required (Rinehart-Thompson 2016b, 240). 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 c Coding policies should include the following components: AHIMA Code of Ethics, AHIMA Standards of Ethical Coding, Official Coding Guidelines, applicable federal and state regulations, internal documentation policies requiring the presence of physician documentation to support all coded diagnosis and procedure code assignments (Schraffenberger and Kuehn 2011, 384). A postoperative patient was prescribed Lortab prn. Nurse Jones documented in the patient record that she administered one dose of Lortab to the patient, but never actually administered this medication. Nurse Jones then took the Lortab herself. This action would be called? a. Drug prescribing b. Adverse drug reaction c. Sentinel event d. Drug diversion - Answer d Drug diversion is the removal of a medication from its usual stream of preparation, dispensing, and administration by personnel involved in those steps in order to use or sell the medication in non-healthcare settings. An individual might take the medication for personal use, to sell on the street, to sell directly to a user as a dealer or to sell to others who will redistribute for the diverting individual (Shaw and Carter 2015, 253). The leaders of a healthcare organization are expected to select an organization-wide performance improvement approach and to clearly define how all levels of the organization will monitor and address improvement issues. The Joint Commission requires ongoing data collection that might require improvement for which of the following areas? a. Operative and other invasive procedures, medication management, and blood and blood product use b. Blood and blood product use, medication management, and appointment to the board of directors c. Medication management, marketing strategy, and blood use d. Operative and other invasive procedures, appointments to the board of directors, and restraint and seclusion use - Answer a Appointments to the Board of Directors is important information, but the Joint Commission requires detailed information on the responsibilities and actions of the Board, not necessarily its composition. The Joint Commission requires healthcare organizations to collect data on each of these areas: medication management, blood and blood product use, restraint and seclusion use, behavior management and treatment, operative and other invasive procedures, and resuscitation and its outcomes (Shaw and Carter 2015, 378, 382). Quality Improvement Organizations perform medical peer review of Medicare and Medicaid claims through a review of which of the following? a. Validity of hospital diagnosis and procedure coding data completeness b. Appropriateness of EHR used c. Policies, procedures and standards of conduct d. Professional standards - Answer a The responsibilities of the quality improvement organizations include reviewing health records to confirm the validity of hospital diagnosis and procedure coding data completeness (Foltz et al. 2016, 454). The National Patient Safety Goals (NPSGs) have effectively mandated all healthcare organizations to examine care processes that have a potential for error that can cause injury to patients. Which of the following processes are included in the NPSGs? a. Identify patients correctly, prevent infection, and file claims for reimbursement b. Check patient medicines, prevent infection, and identify patients correctly c. File claims for reimbursement, check patient medicines, and improve staff communication d. Improve staff communication, process claims timely, and prevent infection - Answer b The National Patient Safety Goals (NPSGs) have effectively mandated all healthcare organizations examine care processes that have a potential for error and can cause injury to patients. The NPSGs include identifying patients correctly, improving staff communication, using medicines safely, preventing infection, checking patient medicines, preventing patients from falling, preventing bed sores, and identifying patient safety risks (Shaw and Carter 2015, 174).