HIM 1103 FINAL EXAM. QUESTIONS AND ANSWERS.
GRADED A+
1. Which of the following is a covered entity under HIPAA?
A. Life insurance company
B. Physician’s office
C. Workers’ compensation board
D. Employer
Correct Answer: B. Physician’s office
Rationale:
HIPAA applies to covered entities, including healthcare providers who transmit health
information electronically in connection with standard transactions. Physicians’ offices,
hospitals, and health plans are covered entities. Employers and life insurers are not.
2. The minimum necessary standard under HIPAA means:
A. Patients should receive minimal information about their care
B. Only the minimum amount of PHI needed to accomplish the purpose should be used,
disclosed, or requested
C. PHI can be disclosed to anyone involved in care
D. No PHI can ever be disclosed
Correct Answer: B. Only the minimum amount of PHI needed should be used or
disclosed
Rationale:
This principle limits unnecessary sharing of Protected Health Information (PHI). It doesn’t apply
to disclosures for treatment but does apply for payment, operations, or other non-treatment
purposes.
3. In the healthcare revenue cycle, which process involves verifying the patient’s
insurance coverage before services are provided?
,A. Coding
B. Preauthorization
C. Claims submission
D. Accounts receivable follow-up
Correct Answer: B. Preauthorization
Rationale:
Preauthorization (or insurance verification) ensures services are covered and medically necessary
before being rendered, preventing denials and ensuring timely reimbursement.
4. Which of the following codes represents a diagnosis in ICD-10-CM?
A. 99213
B. M54.5
C. 93000
D. J2715
Correct Answer: B. M54.5
Rationale:
• ICD-10-CM codes = diagnoses (e.g., M54.5 – Low back pain)
• CPT codes = procedures (e.g., 99213 – Office visit)
• HCPCS Level II codes = supplies/services (e.g., J2715 – Neostigmine).
5. A patient’s record shows a diagnosis of “acute appendicitis.” The code
assigned is for “chronic appendicitis.” What type of error occurred?
A. Upcoding
B. Under-coding
C. Clinical coding error / data accuracy issue
D. Fraud
Correct Answer: C. Clinical coding error / data accuracy issue
Rationale:
Assigning an incorrect code due to misinterpretation of documentation represents a data quality
issue — not deliberate fraud. HIM professionals ensure data accuracy by validating clinical
documentation.
, 6. Which of the following is NOT a component of the legal health record?
A. History and physical
B. Discharge summary
C. Patient’s personal notes about their care
D. Operative report
Correct Answer: C. Patient’s personal notes about their care
Rationale:
The legal health record includes documents created by the healthcare organization as part of
patient care (e.g., H&P, operative report, lab results). Personal notes kept by the patient are not
part of the legal record.
7. What is the primary purpose of the Master Patient Index (MPI)?
A. Tracks accounts receivable
B. Links a patient to their medical record across encounters
C. Stores physician credentials
D. Manages coding compliance
Correct Answer: B. Links a patient to their medical record across encounters
Rationale:
The MPI uniquely identifies patients and prevents duplicate records, ensuring continuity of care
and accurate data management.
8. Which law created the Office of the National Coordinator for Health
Information Technology (ONC)?
A. HIPAA
B. HITECH Act
C. Affordable Care Act
D. Stark Law
Correct Answer: B. HITECH Act
Rationale:
The Health Information Technology for Economic and Clinical Health (HITECH) Act
GRADED A+
1. Which of the following is a covered entity under HIPAA?
A. Life insurance company
B. Physician’s office
C. Workers’ compensation board
D. Employer
Correct Answer: B. Physician’s office
Rationale:
HIPAA applies to covered entities, including healthcare providers who transmit health
information electronically in connection with standard transactions. Physicians’ offices,
hospitals, and health plans are covered entities. Employers and life insurers are not.
2. The minimum necessary standard under HIPAA means:
A. Patients should receive minimal information about their care
B. Only the minimum amount of PHI needed to accomplish the purpose should be used,
disclosed, or requested
C. PHI can be disclosed to anyone involved in care
D. No PHI can ever be disclosed
Correct Answer: B. Only the minimum amount of PHI needed should be used or
disclosed
Rationale:
This principle limits unnecessary sharing of Protected Health Information (PHI). It doesn’t apply
to disclosures for treatment but does apply for payment, operations, or other non-treatment
purposes.
3. In the healthcare revenue cycle, which process involves verifying the patient’s
insurance coverage before services are provided?
,A. Coding
B. Preauthorization
C. Claims submission
D. Accounts receivable follow-up
Correct Answer: B. Preauthorization
Rationale:
Preauthorization (or insurance verification) ensures services are covered and medically necessary
before being rendered, preventing denials and ensuring timely reimbursement.
4. Which of the following codes represents a diagnosis in ICD-10-CM?
A. 99213
B. M54.5
C. 93000
D. J2715
Correct Answer: B. M54.5
Rationale:
• ICD-10-CM codes = diagnoses (e.g., M54.5 – Low back pain)
• CPT codes = procedures (e.g., 99213 – Office visit)
• HCPCS Level II codes = supplies/services (e.g., J2715 – Neostigmine).
5. A patient’s record shows a diagnosis of “acute appendicitis.” The code
assigned is for “chronic appendicitis.” What type of error occurred?
A. Upcoding
B. Under-coding
C. Clinical coding error / data accuracy issue
D. Fraud
Correct Answer: C. Clinical coding error / data accuracy issue
Rationale:
Assigning an incorrect code due to misinterpretation of documentation represents a data quality
issue — not deliberate fraud. HIM professionals ensure data accuracy by validating clinical
documentation.
, 6. Which of the following is NOT a component of the legal health record?
A. History and physical
B. Discharge summary
C. Patient’s personal notes about their care
D. Operative report
Correct Answer: C. Patient’s personal notes about their care
Rationale:
The legal health record includes documents created by the healthcare organization as part of
patient care (e.g., H&P, operative report, lab results). Personal notes kept by the patient are not
part of the legal record.
7. What is the primary purpose of the Master Patient Index (MPI)?
A. Tracks accounts receivable
B. Links a patient to their medical record across encounters
C. Stores physician credentials
D. Manages coding compliance
Correct Answer: B. Links a patient to their medical record across encounters
Rationale:
The MPI uniquely identifies patients and prevents duplicate records, ensuring continuity of care
and accurate data management.
8. Which law created the Office of the National Coordinator for Health
Information Technology (ONC)?
A. HIPAA
B. HITECH Act
C. Affordable Care Act
D. Stark Law
Correct Answer: B. HITECH Act
Rationale:
The Health Information Technology for Economic and Clinical Health (HITECH) Act
