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RHIA Domain 4 | Questions And Answers Latest {} A+ Graded | 100% Verified
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RHIA Domain 4 | Questions And Answers Latest {} A+ Graded | 100% Verified
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RHIA Domain 4 | Questions And Answers Latest {2024- 2025} A+ Graded | 100% VerifiedCDM maintenance plan should review new technology items for FDA approval, OPPS pass through
assignment, and by coder, but... - Codes for technology should not be included im the CDM until
coverage has been determined.
Patient accounting is reporting an increase in national coverage decisions (NCDs), and local coverage
determinations (LCDs) failed edits in observation accounts. What department will be tasked to resolve
the issue? - Health information management
Discharge Not Final Billed (DNFB) report includes what type of accounts? - Accounts that have been
discharged and have not been billed for a variety of reasons
Patient accounts has submitted a report to the revenue cycle team detailing $100,000 of outpatient
accounts that are failing NCD edits. All attempts to clear the edits have failed. There are no ABNs on file
for these accounts. Based on this info what should the team do: - Write off the failed charges to bad
debt and bill Medicare for the clean charges.
Under RBRVS, which elements are used to calculate a Medicare payment? - Work value and practice
expenses
In reviewing a patient chart the coder finds that the patient x-ray is suggestive of chronic obstructive
pulmonary disease COPD. The attending physician mentions the x-ray findings in one progress note, but
no medication, treatment, or further evaluation is provided. Which of the following actions should the
coder take: - Query the attending physician and ask him to validate a diagnosis based on the chest c-ray
results.
Most common reason for claim denials are: - Billing non-covered services, lack of medical necessity and
beneficiary not covered
If the physician is a non-PAR who accepts assignment, how much can he/she expect to be reimbursed by
Medicare?
Physician normal charge $340
, Medicare fee schedule $300
Patient has met deductible - $228 - the physician will receive 80% of $300 = 240, the non-PAR will
receive 95% of 240 = 228
Long-term care hospitals must meet state requirements for ? and have an agreement with ? in order to
receive payments. - Acute care hospitals, Medicare
The universal protocol requires a "time-out" prior to start of any surgical or invasive procedure to
conduct a verification of: - Patient, procedure and site
Bob Smith was admitted to Mercy Hospital on June 21. The physical examination was completed on June
23. According to Medicare Conditions of Participation, which statement applies to this situation? - The
record is not in compliance because the physical examination must be completed within 24 hours of
admission
A clinical documentation improvement (CDI) program facilitates accurate coding and helps coders avoid:
- Assumption coding
Which of the following is a governmental designation by the state that is necessary for the facility to
offer services? - Licensure
Reviewing claims to ensure appropriate coding for deserved payments is one method of: - Achieving
legitimate optimization
Sue in her role as a patient registration clerk uses a patient's insurance information to see a specialist for
cosmetic surgery. - Medical identity theft
It is the year 201X. The federal government is determined to lower the overall payments to physicians.
To incur the least administrative work, which of the following elements of the physician payment system
would the government reduce? - Conversion factor
The conversion factor is the national dollar multiplier that sets the allowance for the relative values—a
constant (Casto and Forrestal 2013, 157).
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