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RHIT Domain 5 Exam With Complete Solutions Latest Update
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RHIT Domain 5 Exam With Complete SolutionsLatest Update
Which of the following is the overutilization or inappropriate utilization of services and
misuse of resources, typically not a criminal or intentional act?
a. Fraud
b. Abuse
c. Waste
d. Audit - ANSWER c
Waste is typically defined as the overutilization or inappropriate utilization of services
and misuse of resources, and typically is not a criminal or intentional act. Examples of
practice that constitute waste include over-prescribing and ordering tests
inappropriately Foltz et al. 2016, 448.
Examples of high-risk billing practices that create compliance risks for health care
organizations include all except which of the following?
a. Altered claim forms
b. Returned overpayments
c. Duplicate billings
d. Unbundled procedures - ANSWER b
Fraudulent billing practices are considered the major compliance risk for healthcare
organizations. The following are high-risk billing practices: billing for noncovered
services, altered claim forms, duplicate billing, misrepresentation of facts on a claim
form, failing to return overpayments, unbundling, billing for medically unnecessary
services, overcoding and upcoding, billing for items or services not rendered, and false
cost reports (Bowman 2017, 440-441, 466).
,Which of the following groups are included in the feedback loop between denials,
management, and CDI program staff?
a. Compliance
b. Office of the Inspector General
c. Center for Medicare and Medicaid Services
d. Payers - ANSWER a
It is the responsibility of the CDI manager to implement a feedback loop with the
functional managers. This includes reporting data from the department to CDI and then
from CDI to the department. In implementing best practices in CDI, three areas involve
operationalizing feedback loops with denials management, compliance, and HIM Hess
2015, 242.
The following are components of every health care organization's risk management plan
except
a. Loss prevention and reduction
b. Management of safety and security
c. Peer review
d. Claims management - ANSWER c
There are three functions of risk management programs: identification and analysis of
risk, prevention and reduction of loss and claims management (Carter and Palmer 2016,
522).
A pharmacist who submits Medicaid claims for reimbursement on brand name drugs
when less expensive generic drugs were actually dispensed has committed the crime
of:
a. Criminal negligence
b. Fraud
c. Perjury
d. Products' liability - ANSWER b
,Healthcare fraud can be defined as an intentional false representation of a fact or failure
to disclose a fact material-relevant to a healthcare transaction based on damage to
another party that reasonably relies on the misrepresentation or failure to disclose. In
such a situation, category 2 would most probably apply.
A provider's office calls to obtain a copy of the emergency room records for the
patient's follow-up visit. The HIM professional denied the request for the emergency
room records without a written authorization from the patient. Was this compliant?
a. No; the records are to be used to continue care of the patient so no authorization is
required
b. Yes; the disclosure of all records must have written authorization by the patient
c. No; permission of the ER physician was not obtained
d. Yes; one covered entity cannot request the records from another covered entity -
ANSWER a
TPO is an important concept because the Privacy Rule provides a series of exceptions
for how PHI may be used or disclosed for TPO. Treatment is defined as: the provision,
coordination, or management of healthcare or healthcare-related services among one
or more healthcare providers (Rinehart-Thompson 2016b, 223).
A notice that halts processing or destruction of paper or electronic records. Such a
notice is known as:
a. Subpoena
b. Consent form
c. Rule
d. Legal hold - ANS d
A legal hold, also known as a preservation order, preservation notice, or litigation hold,
basically suspends the processing or destruction of paper or electronic records. It may
be initiated by a court if there is concern that information may be destroyed in cases of
current or anticipated litigation, audit, or government investigation. Or, it can be started
by the organization as part of their pre-litigation strategy and obligation to preserve
, information when litigation is anticipated (Klaver 2017a, 86-87).
Which of the following is a type of identity theft in which a patient uses another person's
name and insurance information to receive health benefits?
a. Medical
b. Financial
c. Criminal
d. Health - ANS a
Medical identity theft occurs when a patient uses another person's name and insurance
information to receive healthcare benefits. Most often this is done so a person can
receive healthcare with an insurance benefit and pay less or nothing for the care
received (Rinehart- Thompson 2016b, 247).
Which of the following is a breach of PHI?
a. A nurse sees the record of a patient that she is not caring for
b. A patient's attorney is sent records not authorized by that patient
c. A nurse starts to place PHI in a public area where a patient is standing and
immediately picks it up
d. An HIM employee keys in the wrong health record number but closes it out as soon as
it is realized - ANSWER b
There are three exceptions to a breach. All of these answers fall into one of these
categories with the exception of the records sent to the patient's attorney. He does not
work for the covered entity and an authorization is required (Rinehart-Thompson 2016b,
240).
Coding policies should include which of the following elements?
a. Lunch or break schedule
b. How to access the computer system
c. AHIMA Standards of Ethical Coding
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