RHIA Exam 2 Domain 4 Questions and Answers 2024

RHIA Exam 2 Domain 4 Questions and Answers 2024 A coding supervisor audits coded records to ensure the codes reflect the actual documentation in the health record. This coding auditing process addresses the data quality element of: a. Granularity b. Reliability c. Timeliness d. Accuracy D. Accuracy After a claim has been filed with Medicare, a healthcare entity had late charges posted to a patient's outpatient account that changed the calculation of the ambulatory payment classification (APC). What is the best practice for this entity to receive the correct reimbursement from Medicare? a. Nothing, because the claim has already been submitted b. Bill the patient for any remaining balance after payment from Medicare is received c. Submit an adjusted claim to Medicare d. Return the account to coding for review C. Submit an adjusted claim to Medicare The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is available for: a. Veterans of the Armed Forces b. Spouses or widow(er)s of veterans meeting specific criteria c. Active-duty service members d. Spouses of active-duty service members B. Spouses or widow(er)s of veterans meeting specific criteria Which of the following is the definition of revenue cycle management? a. The regularly repeating set of events that produce revenue or income b. The method by which patients are grouped together based on a set of characteristics c. The systematic comparison of the products, services, and outcomes of one healthcare entity with those of a similar entity d. The coordination of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue D. The coordination of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue Which of the following lists contains only entities that have roles in the various Medicare Improper Payment Review processes? a. MAC, RAC, and QIO b. AMA, AHA, and RAC c. MAC, AMA, and QIO d. ACS, MAC, and RAC A. MAC, RAC, and QIO What is the benefit of comparing the coding assigned by coders to the coding that appears on the claim? a. May find that more codes are required to support the claim b. May find that the charge description master soft coding is inaccurate c. Serves as a way for HIM to take over the management of patient financial services d. May find claim generation issues that cannot be found in other ways D. May find claim generation issues that cannot be found in other ways A polyp was removed from a patient's colon during a colonoscopy procedure. The physician and pathologist document the polyp as probable adenocarcinoma of the colon. Which of the following actions should the coding professional take to code this encounter? a. Code "polyp" b. Code "adenoma of the colon" c. Code "adenocarcinoma of the colon" d. Query the physician A. Code "polyp" Which of the following accreditation categories would the Joint Commission assign to a hospital that did not meet all of the standards at the time of the initial on-site survey, had a level of standards in noncompliance, had Requirements for Improvements (RFIs) in excess of the published level for the year, and subsequently underwent an additional on-site, follow-up survey? a. Accreditation with follow-up survey b. Preliminary accreditation c. Accredited d. Contingent accreditation D. Contingent Accreditation When the physician does not specify the method used to remove a lesion during an endoscopy, what action should the coder take? a. Assign the removal by snare technique code b. Assign the removal by hot biopsy forceps code c. Assign the ablation code d. Query the physician as to the method used D. Query the physician as to the method used 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 D. Nursing staff The term "hard coding" refers to: a. ICD-10-CM codes that are coded by the coders b. CPT codes that appear in the hospital's chargemaster c. CPT codes that are coded by the coders d. ICD-10-CM codes that appear in the hospital's chargemaster B. CPT codes that appear in the hospital's chargemaster Aging of accounts is the practice of counting the days, generally in increments, from the time a bill has been sent to the payer to the current day. What is the standard increment, in days, that most healthcare entities use for the aging of accounts? a. 7-day increment b. 14-day increment c. 30-day increment d. 90-day increment C. 30-day increment The physician's office sent a request for payment to Able Insurance Company. The term used in the healthcare industry for this request for payment is a(n): a. Allowance b. Reimbursement c. Block grant d. Claim D. Claim Using the information provided, if this is a participating physician who accepts assignment, how much can he or she expect to be reimbursed by Medicare? Physician's normal charge = $340 Medicare fee schedule = $300 Patient has met his deductible a. $140 b. $240 c. $300 d. $340 B. $240 When documentation in the health record is not clear, the coding professional should: a. Query the physician who originated the progress note or other report in question b. Refer to dictation from other encounters with the patient to get clarification c. Submit the question to the coding clinic d. Query a physician who consistently responds to queries in a timely manner A. Query the physician who originated the progress note or other report in question A comprehensive retrospective review should be conducted at least once a year of what aspect of the CDI program? a. Proficiency statistics b. Compliance issues c. All query opportunities d. Core key measures C. All query opportunities What type of organization works under contract with CMS to conduct Medicare and Medicaid certification surveys for hospitals? a. Accreditation organizations b. Certification organizations c. State licensure agencies d. Conditions of Participation agencies C. State licensure agencies The most recent coding audit has revealed a tendency to miss secondary diagnoses that would have increased the reimbursement for the case. Which of the following strategies will help to identify and correct these cases in the short term? a. Focus reviews on lower-weighted MS-DRGs from triples and pairs b. Identify the facility's top 10 to 15 APCs by volume and charges c. Contract with a larger consulting firm to do audits and education d. Focus reviews on surgical complications A. Focus reviews on lower-weighted MS-DRGs from triples and pairs