RHIA EXAMINATION PREP SHEET 2026
FULLY SOLVED GRADED A+
◍ When the Medicare Recovery Audit Contractor (RAC) has
determined that incorrect payment has been made to an organization
what document is sent to the provider notifying them of this
determination? Answer: Demand letter
◍ 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: Answer:
accuracy
◍ The term "hard coding" refers to: Answer: CPT codes that appear
in the hospital's chargemaster
◍ The health plan reimburses Dr. Tan $15 per patient per month. In
January, Dr. Tan saw 300 patients so he received $4,500 from the
health plan. What method is the health plan using to reimburse Dr.
Tan? Answer: Traditional retrospective
◍ A patient saw a neurosurgeon for treatment of a nerve that was
severed in an industrial accident. The patient worked for Basic
Manufacturing Company where the industrial accident occurred.
Basic Manufacturing carried workers' compensation insurance. The
workers' compensation insurance paid the neurosurgeon fees. Which
entity is the "third party?" Answer: Workers' compensation insurance
, ◍ A physician performed a total abdominal hysterectomy with
bilateral salpingo-oophorectomy on his patient at Community
Hospital. His office billed the following:
58150 = Total abdominal hysterectomy (corpus and cervix), with or
without the removal of tube(s), with or without removal of ovary(s)
58720 = Salpingo-oophorectomy, complete or partial, unilateral or
bilateral (separate procedure)
Why was this claim rejected? Answer: Unbundled procedures
◍ Which of the following healthcare entities' mission is to reduce
Medicare improper payments through detection and collection of
over-payments, identification of underpayments, and implementation
of actions that will prevent future improper payments? Answer:
recovery audit contractor
◍ The practice of under-coding can affect a hospital's MS-DRG case
mix in which of the following ways? Answer: Makes it lower than
warranted by the actual service or resource intensity of the facility
◍ A _________ assists in educating medical staff members on
documentation needed for accurate billing. Answer: physician advisor
◍ Which of the following payment arrangements is streamlined by
the use of chargemasters? Answer: Fee-for-service
FULLY SOLVED GRADED A+
◍ When the Medicare Recovery Audit Contractor (RAC) has
determined that incorrect payment has been made to an organization
what document is sent to the provider notifying them of this
determination? Answer: Demand letter
◍ 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: Answer:
accuracy
◍ The term "hard coding" refers to: Answer: CPT codes that appear
in the hospital's chargemaster
◍ The health plan reimburses Dr. Tan $15 per patient per month. In
January, Dr. Tan saw 300 patients so he received $4,500 from the
health plan. What method is the health plan using to reimburse Dr.
Tan? Answer: Traditional retrospective
◍ A patient saw a neurosurgeon for treatment of a nerve that was
severed in an industrial accident. The patient worked for Basic
Manufacturing Company where the industrial accident occurred.
Basic Manufacturing carried workers' compensation insurance. The
workers' compensation insurance paid the neurosurgeon fees. Which
entity is the "third party?" Answer: Workers' compensation insurance
, ◍ A physician performed a total abdominal hysterectomy with
bilateral salpingo-oophorectomy on his patient at Community
Hospital. His office billed the following:
58150 = Total abdominal hysterectomy (corpus and cervix), with or
without the removal of tube(s), with or without removal of ovary(s)
58720 = Salpingo-oophorectomy, complete or partial, unilateral or
bilateral (separate procedure)
Why was this claim rejected? Answer: Unbundled procedures
◍ Which of the following healthcare entities' mission is to reduce
Medicare improper payments through detection and collection of
over-payments, identification of underpayments, and implementation
of actions that will prevent future improper payments? Answer:
recovery audit contractor
◍ The practice of under-coding can affect a hospital's MS-DRG case
mix in which of the following ways? Answer: Makes it lower than
warranted by the actual service or resource intensity of the facility
◍ A _________ assists in educating medical staff members on
documentation needed for accurate billing. Answer: physician advisor
◍ Which of the following payment arrangements is streamlined by
the use of chargemasters? Answer: Fee-for-service
