RHIA Domain 4 Exam Questions With All Correct Detailed Answers 2025 New Update A+ Pass

RHIA Domain 4 Exam Questions With All Correct Detailed Answers 2025 New Update A+ Pass Part of the coding supervisor's responsibility is to review accounts that have not been final billed due to errors. One of the accounts on the list is a same-day procedure. Upon review, the coding supervisor notices that the charge code on the bill was hard-coded. The ambulatory procedure coder added the same CPT code to the abstract. How should this error be corrected? a. Delete the code from the CDM because it should not be there. b. Refer the case to the chargemaster coordinator. c. Force a final bill on the accounts since the duplication will not affect the UB-04. d. Remove the code from the abstract and counsel the coder regarding CDM hard codes in this service. - Answer - Answer: D If a service is hard-coded into the charge description master (CDM), it is important that this decision is communicated to the coding staff. If the decision is not effectively communicated, the result could be duplicate billing that in turn could result in overpayment to the facility What are the distinctions between hard and soft coding? - Answer - Coding occurs in two ways: hard coding and soft coding. Hard coding is when codes are assigned by the CDM without human intervention, whereas soft coding is when codes are manually assigned by a coding specialist. Exploding charges - Answer - The charge description master can provide a method for grouping items that are frequently reported together. Items that must be reported separately but are used together, such as interventional radiology imaging and injection procedures, are called exploding charge Reviewing claims to ensure appropriate coding for deserved payments is one method of: a. Achieving legitimate optimization b. Improving documentation c. Ensuring compliance d. Using data monitors - Answer - Answer: A When coders "optimize" the coding process, they attempt to make coding for reimbursement as accurate as possible. In this way, the healthcare facility can obtain the highest dollar amount justified within the terms of the government program or the insurance policy involved In terms of grouping and reimbursement, how are the MS-LTC-DRGs and acute-care MS-DRGs similar? a. Relative weights b. Based on principal diagnosis c. Categorization of low-volume groups into quintiles d. Classification of short-stay outliers - Answer - Answer: B Under RBRVS, which elements are used to calculate a Medicare payment? - Answer - Work Value Practice expenses Which of the following can be a tool for recovery audit contractors' (RAC) preparation because they outline the hospital's Medicare payment patterns compared to other hospitals in the state? a. PEPPER b. HITECH c. HIPAA d. MEDPAR - Answer - Answer: A Hospitals should take the opportunity to review old Program for Evaluation Payment Patterns Electronic Reports (PEPPERs) to identify those claims that could be targeted by the recovery audit contractors (RACs) In the HHPPS system, which home healthcare services are consolidated into a single payment to home health agencies? - Answer - Under the home health prospective payment system (HHPPS), CMS has accounted for nonroutine medical supplies, home health aide visits, medical social services, and nursing and therapy services (Casto and Forrestal 2015, 235). . In the APC system, a high-cost outlier payment is paid when which of the following occurs? a. The cost of the service is greater than the APC payment by a fixed ratio and exceeds the APC payment plus a threshold amount. b. The LOS is greater than expected. c. The charges for the services provided are greater than the expected payment. d. The total cost of all the services is greater than the sum of APC payments by a fixed ratio and exceeds the sum of APC payments plus a threshold amount. - Answer - Answer: A An outlier payment is paid when the cost of the service is greater than the ambulatory payment classification (APC) payment by a fixed ratio and exceeds the APC payment plus a threshold amount (Casto and Forrestal 2015, 175). What are elements found in a charge description master? - Answer - The charge description master contains elements such as department and item number, item description, revenue code, HCPCS code, price, and activity status The accounts receivable collection cycle involves the time from: - Answer - Admission to deposit in the bank The Medicare programs that encourage patients to review provider bills carefully and to report any discrepancies to the Secretary of HHS are called: Beneficiary incentive programs - Answer - Beneficiary incentive programs encourage Medicare beneficiaries to review their bills for discrepancies. QIO reviews can be prompted by a Medicare beneficiary through a complaint or a request for appeal, by federal agencies, or as a routine review of care and billing patterns under the Medicare program. All of these functions are referred to as "case review" Using the information provided, if the physician is a non-PAR 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 - Answer - Nonparticipating providers (nonPARs) do not sign a participation agreement with Medicare but may or may not accept assignment. If the nonPAR physician elects to accept assignment, he or she is paid 95 percent (5 percent less than participating physicians) of the Medicare fee schedule (MFS). For example, if the MFS amount is $200, the PAR provider receives $160 (80 percent of $200), but the nonPAR provider receives only $152 (95 percent of $160). In this case the physician is nonparticipating so he or she will receive 95 percent of the 80 percent of the MFS or 80 percent of 300, which is $240; 95 percent of the $240 is $228 A patient is admitted to the hospital with shortness of breath and congestive heart failure. The patient undergoes intubation with mechanical ventilation. The final diagnoses documented by the attending physician are: Congestive heart failure, mechanical ventilation, and intubation. Which of the following actions should the coder take in this case? a. Code congestive heart failure, respiratory failure, mechanical ventilation, and intubation b. Query the attending physician as to the reason for the intubation and mechanical ventilation to add as a secondary diagnosis c. Query the attending physician about the adding the symptom of shortness of breath as a secondary diagnosis d. Code shortness of breath, congestive heart failure, mechanical ventilation, and intubation - Answer - Answer: B As a result of the disparity in documentation practices by providers, querying has become a common communication and educational method to advocate proper documentation practices. Queries can be made in situations when there is clinical evidence for a higher degree of specificity or severity. In this situation the reason for the mechanical ventilation and intubation, most likely, is respiratory failure and the physician would need to be queried for validation of that diagnosis in order for it to be coded