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RHIA Domain 4 Exam | Questions And Answers Latest {} A+ Graded | 100% Verified
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RHIA Domain 4 Exam | Questions And Answers Latest {} A+ Graded | 100% Verified
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RHIA Domain 4 Exam | Questions And Answers Latest {2024- 2025} A+ Graded | 100%Verified
Hospital-issued notices of noncoverage (HINNs) can be issued at any of the following times except:
a. Prior to admission
b. At admission
c. At any point during the hospital stay
d. After discharge - D
In conducting a qualitative review, the clinical documentation specialist sees that the nursing staff has
documented the patient's skin integrity on admission to support the presence of a stage I pressure ulcer.
However, the physician's documentation is unclear as to whether this condition was present on
admission. How should the clinical documentation specialist proceed?
a. Note the condition as present on admission
b. Query the physician to determine if the condition was present on admission
c. Note the condition as unknown on admission
d. Note the condition as not present on admission - B
Under RBRVS, which elements are used to calculate a Medicare payment?
a. Work value and extent of the physical exam
b. Malpractice expenses and detail of the patient history
c. Work value and practice expenses
d. Practice expenses and review of systems - C
The facility's Medicare case-mix index has dropped, although other statistical measures appear
constant. The CFO suspects coding errors. What type of coding audit review should be performed?
a. Random audit
b. Focused audit
c. Compliance audit
d. External audit - B
,A physician query may not be appropriate in which of the following instances?
a. Diagnosis of viral pneumonia noted in the progress notes and sputum cultures showing Haemophilus
influenzae
b. Discharge summary indicates chronic renal failure but the progress notes document acute renal
failure throughout the stay
c. Acute respiratory failure in a patient whose lab report findings appear to not support this diagnosis
d. Diagnosis of chest pain and abnormal cardiac enzymes indicative of an AMI - C
Which of the following is most applicable to describing utilization management functions?
a. Begins only after patient admission
b. Provides criteria to monitor for the continued appropriateness of the supplies and patient
convenience items
c. Screens for the appropriate use of hospital services and resources
d. Applies criteria to determine medications that should be prescribed - C
Joan is educating the physicians in her hospital about the Medicare Hospital Value-Based Purchasing
(VBP) Program. As part of this education she explains to her audience that the HCAHPS survey results
are a part of the ________ domain in the Medicare VBP program.
a. Safety
b. Clinical Care
c. Efficiency and Cost Reduction
d. Person/Community Engagement - D
A 45-year-old woman is admitted for blood loss anemia due to dysfunctional uterine bleeding.
D25.9 Leiomyoma of uterus, unspecified
D50.0 Iron deficiency anemia secondary to blood loss (chronic)
D62 Acute posthemorrhagic anemia
N93.8 Other specified abnormal uterine and vaginal bleeding
a. D50.0, N93.8
,b. D62, N93.8
c. N93.8, D50.0
d. D50.0, D25.9 - A
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 - B
Which of the following requires financial institutions to develop written medical identity theft
programs?
a. HIPAA Security Rule
b. HITECH Act
c. Fair and Accurate Credit Transactions Act
d. HIPAA Privacy and Security Rule - C
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 - A
The following table is an example of an:
Patient/ Service (A) Total (B) Not Payable Plan
Service Date(s) Charge by Plan Paid Amount
, White, Jane
Office Visit 02/17/201X $56.00 $10.00 CP* $46.00 100%
X-Ray 02/17/201X $268.00 $250.00
$3.60 DD* CI* $14.40 80%
Lab 02/17/201X $20.00 $15.00 CP* $5.00 100%
Total
*CI: Coinsurance; CP: Copayment; DD: Deductible
a. Insurance coverage advanced notice service waiver
b. Explanation of benefits
c. Insurance claim form
d. Encounter form - B
Which of the following terms is used to describe the requirement of the healthcare provider to obtain
permission from the health insurer prior to providing service to the patient?
a. Preauthorization
b. Advance beneficiary notification
c. Point of care collection
d. Local coverage determination - A
The practice of using a code that results in a higher payment to the provider than the code that actually
reflects the service or item provided is known as:
a. Unbundling
b. Billing for services not provided
c. Medically unnecessary services
d. Upcoding - D
Which of the following terms does not describe the requirement for a healthcare provider to obtain
permission from the health insurer in order to provide predefined services to the patient?
a. Preauthorization
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