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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
Medical necessity determinations must reflect the efficient and cost-effective application of patient
care, including all of the following except _____. - Supplies used for patient treatment
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? -
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: - accuracy
The term "hard coding" refers to: - 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? -
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?" - 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? - 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? - recovery audit contractor
The practice of under-coding can affect a hospital's MS-DRG case mix in which of the following ways? -
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. -
physician advisor
Which of the following payment arrangements is streamlined by the use of chargemasters? - Fee-for-
service
Once all the data has been posted to patient's account, the claim can be reviewed for accuracy and
completeness. Many facilities have an internal auditing system that runs each claim through a set of
edits. This internal auditing system is known as a: - scrubber
A patient was admitted for cellulitis of the right palm of the hand following a non-venomous insect bite
three days prior to the encounter. How would this encounter be coded?
L03.011 Cellulitis of right finger
L03.113 Cellulitis of right upper limb
S60.561A Insect bite (nonvenomous) of right hand, initial encounter
S60.561D Insect bite (nonvenomous) of right hand, subsequent encounter
S60.571A Other superficial bite of hand of right hand, initial encounter
W57.XXXA Bitten or stung by nonvenomous insect and other nonvenomous arthropods, initial
encounter
W57.XXXD Bitten or stung by nonvenomous insect and other nonvenomous arthropods, subsequent
encounter - L03.113, S60.561A, W57.XXXA
Coding accuracy is best determined by: - A predefined audit process
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