RHIT Domain 5 Exam: 100% Verified Questions & Answers: Guaranteed A+ Score

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 (Ans- 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 (Ans- 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 (Ans- 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 (Ans- c Risk management p