RHIA Domain IV

D

138. The period of time between discharge and claim submission, which a facility defines by policy, is called the: A. Denial period B. AR days C. Cash flow days D. Bill hold

D

139. The charge description master relieves the HIM department of ________ that does not require documentation analysis. A. Manual coding B. Procedure coding C. Duplicate coding D. Repetitive coding

A

126. A pharmacist who submits Medicaid claims for reimbursement of brand name drugs when less expensive generic drugs were actually dispensed has committed the crime of: A. Fraud B. Perjury C. Criminal negligence D. Products' liability

B

127. 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? A. S60.561A, W57.XXXA B. L03.113, S60.561A, W57.XXXA C. L03.113, S60.561D, W57.XXXD D. L03.011, S60.571A, W57.XXXD

A

128. Placing a condition about the award of a contract for laboratory services on the provision of an "under the table" percentage payback to a physician who has the ability to influence the decision about who is awarded the contract is called a(n): A. Kickback B. Solicitation C. Arbitration D. Criminal bribery

A

129. A 27-year-old female has a vaginal delivery with a single liveborn female at 40 weeks gestation. Episiotomy and repair. What diagnosis and procedure codes would be assigned for this patient? A. O80, Z37.0, Z3A.40, 0W8NXZZ B. O80, Z37.0, Z3A.40, 0W8NXZZ, 0WQNXZZ C. O70.9. Z37.0, 0WQNXZZ D. O70.0, Z37.0, Z3A.40, 0WQNXZZ

C

130. Refer to the 0CQ table below. Which of the following codes would be considered invalid? A. 0CQ80ZZ B. 0CQWXZ2 C. 0CQ9XZZ D. 0CQ3XZZ

B

131. Use the following custom revenue production report to determine which of the following evaluations is apparent to the practice-coding manager about the consultation codes (99241-99245). A. The charges appear to be much lower than expected. B. The charges are not being paid appropriately. C. The consultation codes appear clustered. D. The consultation codes are being used more frequently than expected.

D

132. What is the correct CPT code assignment for electrosurgical removal of three (3) nevi of the arm (size approximately 2.0 cm, 1.5 cm, 0.5 cm)? A. 11056 B. 11200 C. 11400, 11402, 11402 D. 17000, 17003, 17003

C

133. Coding compliance programs focus on preventing accusations of fraud and abuse in healthcare. Which organization from the Department of Health and Human Services provides guidance for healthcare organizations in developing compliance programs? A. Joint Commission B. American Health Information Management Association (AHIMA) C. Office of the Inspector General (OIG) D. Centers for Medicare and Medicaid Services (CMS)

C

134. Coding accuracy is best determined by: A. Payer audits B. Joint Commission Standards for Accreditation C. A predefined audit process D. Medicare Conditions of Participation

B

135. A hospital has experienced an increase in third-party payer denials for lack of pre-authorization for certain services. Which of the following departments should hospital administration scrutinize to ensure that proper procedures are in place? A. Health information management B. Patient registration C. Patient accounts D. Utilization management

D

136. In a typical acute-care setting, which revenue cycle area uses an internal auditing system (scrubber) to ensure that error-free claims (clean claims) are submitted to third-party payers? A. Pre-claims submission B. Accounts receivable C. Claims reconciliation or collections D. Claims processing

A

137. Carolyn works as a coder in a hospital inpatient department. She sees a lab report in a patient's health record that is positive for staph infection. However, there is no mention of staph in the physician's documentation. What should Carolyn do? A. Query the physician B. Tell her supervisor C. Assign a code for the staph infection D. Put a note in the chart

C

140. An 80-year-old female is admitted with fever, lethargy, hypotension, tachycardia, oliguria, and elevated WBC. The patient has more than 100,000 organisms of Escherichia coli per cc of urine. The attending physician documents "urosepsis." How should the coder proceed to code this case? A. Code urinary tract infection with sepsis as the principal diagnosis. B. Query the physician to ask if the patient had septic shock so that this may be used as the principal diagnosis. C. Query the physician to ask if the patient has septicemia because of the symptomatology. D. Code sepsis as the principal diagnosis with urinary tract infection due to E. coli as secondary diagnosis.

B

141. Using the information provided, if a participating physician accepts the assignment then what is the patient's liability to the physician? Physician's normal charge = $340 Medicare Fee Schedule = $300 Patient has met his deductible. A. $100 B. $60 C. $160 D. The patient has no further financial liability.

A

142. 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? A. Demand letter B. Medicare Summary Notice C. Appeal request D. Claims denial

C

143. Medical identity theft includes all of the following except use of another person's: A. Identity to falsify claims for medical services B. Name to obtain durable medical equipment C. Financial information to purchase expensive handbags D. Insurance policy number to undergo reconstructive surgery

B

144. A child's prescription drug is not on the healthcare plan's formulary. The pharmacist states that the drug's cost is $113.45. Using the information provided on the patient's prescription coverage, how much should the guarantor expect to pay for the prescription? A. $113.45 B. $40 C. $10 D. $25

D

145. What factor is medical necessity based on? A. The reimbursement available for a given service B. The cost of a service compared with the beneficial effects on the patient's health C. The availability of a service at the facility D. The beneficial effects of a service for the patient's physical needs and quality of life

C

146. A patient was admitted to the hospital for treatment of a myocardial infarction (heart attack) and the MS-DRG assigned was 236 Coronary bypass without cardiac cath without MCC. During the patient's admission a bypass procedure was performed on day 2. On day 4, the patient was diagnosed with sepsis that was not present on admission. Sepsis is a major complication. This case was identified as coded incorrectly in a recent audit by the coding manager. What error was made by the coder? A. The claim was coded correctly, and no error was made. B. The coronary bypass procedure was coded incorrectly. C. The sepsis was not coded and so an MCC was missed. D. The cardiac catheterization procedure was not coded.

B

147. If the agreement rate on retrospective queries for a physician is 100 percent, this could be a sign of: A. Cooperation B. Leading queries C. Exceptionally well-written queries D. A lack of responsiveness

C

148. In its payment notice (remittance advice), the healthcare plan lists that the payment for an individual laboratory test is $39. The bill that the pathologist's office submitted for the laboratory test was $45. What does the amount of $39 represent? A. Cost B. Capitated rate C. Allowable charge D. Premium

D

149. A system in which purchasers hold providers of healthcare accountable for both the costs of healthcare and its quality is called: A. Quality assurance B. Total quality management C. Retrospective payment system D. Value-based purchasing

C

150. Compliance with the Conditions of Participation allows a hospital to achieve: A. Commercial insurance reimbursement B. Joint Commission accreditation C. Medicare certification D. State licensure

C

151. Medical necessity determinations must reflect the efficient and cost-effective application of patient care, including all of the following except _____. A. Therapies and procedures B. Levels of hospital care C. Supplies used for patient treatment D. Diagnostic testing

B

152. Providers should be queried regarding information in the health record for all of the following except: A. Incomplete information B. Insignificant information C. Conflicting documentation D. Ambiguous documentation

A

153. In a recent coding audit, the coding manager discovered the following issue: A skin lesion was removed from a patient's cheek in the dermatologist's office. The dermatologist documented skin lesion, probable basal cell carcinoma. Which of the following actions should the coding professional take in order to correctly code this encounter? A. Code skin lesion B. Query the dermatologist C. Code benign skin lesion D. Code basal cell carcinoma