RHIA Domain 4 Practice Test with Complete Solutions
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Course
RHIA Domain 4
Institution
RHIA Domain 4
RHIA Domain 4 Practice Test with Complete Solutions
A patient is admitted to the hospital with shortness of breath and congestive heart failure. The patient undergoes intubation with mechanical ventilation. The final diagnosis documented by the attending are: Congestive heart failure, mechanical...
RHIA Domain 4 Practice Test with
Complete Solutions
A patient is admitted to the hospital with shortness of breath and congestive heart
failure. The patient undergoes intubation with mechanical ventilation. The final diagnosis
documented by the attending are: Congestive heart failure, mechanical ventilation, and
intubation. Which of the following actions should the coder take in this case? - Answer-
Query the attending physician as to the reason for the intubation and mechanical
ventilation to add as a secondary diagnosis
You are the coding supervisor, and you are doing an audit of outpatient coding. Robert
Thompson was seen in the outpatient department with a chronic cough and the record
states, "rule out lung cancer." What should have been coded as the patient's diagnosis?
- Answer-chronic cough
The practice of coding or charging one or two middle levels of service codes exclusively
under the philosophy that the charges will average out over the extended period. Is an
example of what type of coding error? - Answer-Clustering
Before a hospital is permitted to provide medical services in a particular state, the
organization must first go through which of the following processes? - Answer-Licensure
The health plan reimburses Dr. Tan $15 per patient per month. In January Dr. Tan saw
300 patients so he received $4,500. What method is Heath plan using to reimburse Dr.
Tan? - Answer-Capitated rate - fixed amount
For Medicare patients, how often must the home health agency's assessment and care
plan be updated? - Answer-At least every 60 days or as often as the severity of the
patient's condition requires
A physician query may not be appropriate in which of the following? - Answer-Acute
respiratory failure in a patient whose lab report findings appear not to support this
diagnosis.
A query may not be appropriate because the clinical information or clinical picture does
not appear to support the documentation of a condition or procedure. In situations
where the provider's documented diagnosis does not appear to be supported by clinical
findings, a healthcare entity's policies can provide guidance on a process for addressing
the issue without querying the attending physician.
Healthcare insurance company would be reimbursing the practice for its treatment of
the exacerbation of congestive heart failure that Mr. Zale experienced. The treatment
, and resolution was five weeks. The payment covered all services during the period.
What method of reimbursement was the physician group practice receiving? - Answer-
Episode-of-care - lump sum pay for services
When a coder fails to assign diagnoses or procedures that should be coded, this can
affect a hospital's MS-DRG case mix in which of the following? - Answer-Makes it lower
than warranted by the actual service or resource intensity of the facility
Which of the following conditions would be the most likely to fall into the category of
notifiable disease as defined by the National Notifiable Disease Surveillance System? -
Answer-HIV. Infection
The coding manager at Community Hospital is seeing an increased number of
physicians failing to document the cause and effect of diabetes and its manifestations.
Which of the following will provide the most comprehensive solution to handle this
documentation issue? - Answer-Present this information at the next medical staff
meeting to inform physicians on documentation standards and guidelines
The coder notes the patient is taking prescribed Haldol. The final diagnoses on the
progress notes include diabetes mellitus, acute pharyngitis, and malnutrition. What
condition might the coder suspect the patient has and should query the physician? -
Answer-Mental behavior problems
In conducting a qualitative review the clinical documentation specialist sees the nursing
staff has documented the patient skin integrity on admission to support the presence of
stage 1 pressure ulcer. However the physician's documentation is unclear. How should
the the clinical documentation specialist proceed? - Answer-Query the physician to
determine if the condition was present on admission
Phil White had coronary artery bypass graft surgery. Unfortunately, during the surgery,
Phil suffered a severe stroke. Phil's recovery included several settings in the continuum
of care—acute care hospital, physician office, rehabilitation center, and home health
agency. This initial service and subsequent recovery lasted ten months. As a member of
an MCO in an integrated delivery system, how should Phil expect that his healthcare
billing will be handled? - Answer-One fixed amount for the entire episode that is divided
among all the physicians, facilities, and other healthcare providers
Many facilities have an internal auditing system that runs each claim through a set of
edits. The system is know as: - Answer-Scrubber
Payments arrangements are streamlined by the user of chargemasters? - Answer-Fee-
for-service
CDM maintenance plan should review new technology items for FDA approval, OPPS
pass through assignment, and by coder, but... - Answer-Codes for technology should
not be included im the CDM until coverage has been determined.
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