RHIT - Revenue Domain 7 Exam Solution Manual Fully Solved Latest Update 2025 Already Passed
The Correct Coding Initiative (CCI) edits contain a listing of codes under two columns titled
"comprehensive codes" and "component codes." According to the CCI edits, when a provider bills
Medicare for a procedure that appears in both columns for the same beneficiary on the same date of
service
A. do not code either one.
B. code only the component code.
C. code only the comprehensive code.
D. code both the comprehensive code and the component code.
REFERENCE:
Green, pp 395-398
Green and Rowell, p 333 - Answers code only the comprehensive code.
This program, formerly called CHAMPUS (Civilian Health and Medical Program—Uniformed Services), is
a health care program for active members of the military and other qualified family members.
A. TRICARE
B. Indian Health Service
C. workers'compensation
D. CHAMPVA
REFERENCE:
Green and Rowell, p 602
Johns, p 736 - Answers TRICARE
,Home Health Agencies (HHAs) utilize a data entry software system developed by the Centers for
Medicare and Medicaid Services (CMS). This software is available to HHAs at no cost through the CMS
Web site or on a CD-ROM.
A. PEPP (Payment Error Prevention Program)
B. PACE (Patient Assessment and Comprehensive Evaluation)
C. HHASS (Home Health Agency Software System)
D. HAVEN (Home Assessment Validation and Entry)
REFERENCE:
Green and Rowell, p 367
LaTour, Eichenwald-Maki, and Oachs, p 438
Sayles, p 278 - Answers HAVEN (Home Assessment Validation and Entry)
________ is knowingly making false statements or representation of material facts to obtain a benefit or
payment for which no entitlement would otherwise exist.
A. Assault
B. Fraud
C. Abuse
D. Whistle-blowing
REFERENCE:
Abdelhak, Gorstick, and Hanken, p 672 - Answers Fraud
CMS assigns one ________ to each APC and each ________ code.
A. MS-DRG, CPT
B. payment status indicator, ICD-9-CM
,C. payment status indicator, HCPCS
D. CPT code, HCPCS
REFERENCE:
Kirchoff, p 11 - Answers payment, status indicator, HCPCS
The prospective payment system based on resource utilization groups (RUGs) is used for reimbursement
to ________ for patients with Medicare.
A. skilled nursing facilities
B. freestanding ambulatory surgery centers
C. intermediate care facilities
D. hospital-based outpatients
REFERENCE:
Schraffenberger and Kuehn, p 212 - Answers skilled nursing facilities
This law prohibits a physician from referring Medicare patients to clinical laboratory services where the
doctor or a member of their family has a financial interest.
A. the Stark I Law
B. the Federal Antikickback Statute
C. the Civil Monetary Penalties Act
D. the False Claims Act
REFERENCE:
Green, p 884
Green and Bowie, p 325 - Answers the Stark I Law
This is the difference between what is charged and what is paid.
A. contractual allowance
, B. costs
C. reimbursement
D. charges
REFERENCE:
Schraffenberger and Kuehn, p 433 - Answers contractual allowance
A patient is admitted to the hospital for a coronary artery bypass surgery. Postoperatively, he develops a
pulmonary embolism. The present on admission (POA) indicator is
A. Y = Present at the time of inpatient admission.
B. N = Not present at the time of inpatient admission.
C. U = Documentation is insufficient to determine if condition was present at the time of admission.
D. W = Provider is unable to clinically determine if condition was present at the time of admission.
REFERENCE:
Green, p 861
LaTour, Eichenwald-Maki, and Oachs, pp 433-434 - Answers N = Not present at the time of inpatient
admission.
The pulmonary embolism is an acute condition that was not present on admission because it developed
after the patient was admitted and after the patient had surgery.
________ is a joint federal and state program that provides health care coverage to low-income
populations and certain aged and disabled individuals.
A. Medicare Part A
B. TRICARE
C. Medicare Part B
The Correct Coding Initiative (CCI) edits contain a listing of codes under two columns titled
"comprehensive codes" and "component codes." According to the CCI edits, when a provider bills
Medicare for a procedure that appears in both columns for the same beneficiary on the same date of
service
A. do not code either one.
B. code only the component code.
C. code only the comprehensive code.
D. code both the comprehensive code and the component code.
REFERENCE:
Green, pp 395-398
Green and Rowell, p 333 - Answers code only the comprehensive code.
This program, formerly called CHAMPUS (Civilian Health and Medical Program—Uniformed Services), is
a health care program for active members of the military and other qualified family members.
A. TRICARE
B. Indian Health Service
C. workers'compensation
D. CHAMPVA
REFERENCE:
Green and Rowell, p 602
Johns, p 736 - Answers TRICARE
,Home Health Agencies (HHAs) utilize a data entry software system developed by the Centers for
Medicare and Medicaid Services (CMS). This software is available to HHAs at no cost through the CMS
Web site or on a CD-ROM.
A. PEPP (Payment Error Prevention Program)
B. PACE (Patient Assessment and Comprehensive Evaluation)
C. HHASS (Home Health Agency Software System)
D. HAVEN (Home Assessment Validation and Entry)
REFERENCE:
Green and Rowell, p 367
LaTour, Eichenwald-Maki, and Oachs, p 438
Sayles, p 278 - Answers HAVEN (Home Assessment Validation and Entry)
________ is knowingly making false statements or representation of material facts to obtain a benefit or
payment for which no entitlement would otherwise exist.
A. Assault
B. Fraud
C. Abuse
D. Whistle-blowing
REFERENCE:
Abdelhak, Gorstick, and Hanken, p 672 - Answers Fraud
CMS assigns one ________ to each APC and each ________ code.
A. MS-DRG, CPT
B. payment status indicator, ICD-9-CM
,C. payment status indicator, HCPCS
D. CPT code, HCPCS
REFERENCE:
Kirchoff, p 11 - Answers payment, status indicator, HCPCS
The prospective payment system based on resource utilization groups (RUGs) is used for reimbursement
to ________ for patients with Medicare.
A. skilled nursing facilities
B. freestanding ambulatory surgery centers
C. intermediate care facilities
D. hospital-based outpatients
REFERENCE:
Schraffenberger and Kuehn, p 212 - Answers skilled nursing facilities
This law prohibits a physician from referring Medicare patients to clinical laboratory services where the
doctor or a member of their family has a financial interest.
A. the Stark I Law
B. the Federal Antikickback Statute
C. the Civil Monetary Penalties Act
D. the False Claims Act
REFERENCE:
Green, p 884
Green and Bowie, p 325 - Answers the Stark I Law
This is the difference between what is charged and what is paid.
A. contractual allowance
, B. costs
C. reimbursement
D. charges
REFERENCE:
Schraffenberger and Kuehn, p 433 - Answers contractual allowance
A patient is admitted to the hospital for a coronary artery bypass surgery. Postoperatively, he develops a
pulmonary embolism. The present on admission (POA) indicator is
A. Y = Present at the time of inpatient admission.
B. N = Not present at the time of inpatient admission.
C. U = Documentation is insufficient to determine if condition was present at the time of admission.
D. W = Provider is unable to clinically determine if condition was present at the time of admission.
REFERENCE:
Green, p 861
LaTour, Eichenwald-Maki, and Oachs, pp 433-434 - Answers N = Not present at the time of inpatient
admission.
The pulmonary embolism is an acute condition that was not present on admission because it developed
after the patient was admitted and after the patient had surgery.
________ is a joint federal and state program that provides health care coverage to low-income
populations and certain aged and disabled individuals.
A. Medicare Part A
B. TRICARE
C. Medicare Part B
