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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 identity thefts are situations in which the following occurs: - When demographic and financial
information is used to acquire medical services
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: - Upcoding
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? - Chronic cough
Before Central Hospital is permitted to open and provide medical services in a particular state, the
healthcare entity must first go through which of the following processes? - Licensure
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? -
Capitated rate
For Medicare patients, how often must the home health agency's assessment and care plan be
updated? - At least every 60 days or as often as the severity of the patient's condition requires
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 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
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 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. Acute respiratory
failure in a patient whose lab report findings appear to not support this diagnosis
The financial manager of the physician group practice explained that the healthcare insurance company
would be reimbursing the practice for its treatment of the exacerbation of congestive heart failure that
Mrs. Zale experienced. The exacerbation, treatment, and resolution covered approximately five weeks.
The payment covered all the services that Mrs. Zale incurred during the period. What method of
reimbursement was the physician group practice receiving? - Episode-of-care
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 ways? - Makes it lower than warranted by the actual service
or resource intensity of the facility
Which of the following healthcare entities' mission is to reduce Medicare improper payments through
detection and collection of overpayments, identification of underpayments, and implementation of
actions that will prevent future improper payments?
a. Accountable care entity
b. Managed care entity
c. Revenue reduction contractor
d. Recovery audit contractor - d. Recovery audit contractor
Which of the following conditions would be the most likely to fall into the category of notifiable diseases
as defined by the National Notifiable Diseases Surveillance System?
a. Diabetes mellitus
b. Coronary artery disease
, c. Fracture of major bones
d. HIV infection - d. 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?
a. Have coders continue to query the attending physician for this documentation.
b. Present this information at the next medical staff meeting to inform physicians on documentation
standards and guidelines.
c. Do nothing because coding compliance guidelines do not allow any action.
d. Place all offending physicians on suspension if the documentation issues continue. - b. Present this
information at the next medical staff meeting to inform physicians on documentation standards and
guidelines.
A coder notes that 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 that the physician should be queried to confirm? - Mental or behavior problems
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? - 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 10 months. As a member of a managed care organization in an integrated delivery
system, how should Phil expect that his healthcare billing will be handled? - One fixed amount for the
entire episode that is divided among all the physicians, facilities, and other healthcare providers
The coding supervisor has compiled a report on the number of coding errors made each day by the
coding staff. The report data show that Tim makes an average of six errors per day, Jane makes an
average of five errors per day, and Bob and Susan each make an average of two errors per day. Given
this information, what action should the coding supervisor take? - Take no action since not enough
information is given to make a judgment
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