Study Set

A patient was admitted to an acute care facility for congestive heart failure. The patient stayed in the facility for 3 days. The actual charges incurred were $6,500. The PPS rate is $5,500. The per diem rate is $1,500 per day. For this case, Medicare will most likely pay (assume no patient liability): $4,500. $5,500. $6,500. none of the above.

$5,500.

An example of a CPT-4 (Health Care Common Procedure Coding System [HCPCS] Level 1) code is: C1715. 0DJD8ZZ. 4557003 43251.

43251.

What coding classification or nomenclature system or systems are used to code professional and technical services by physicians and other health care professionals for services performed in outpatient settings? ICD-O CPT-4 ICD-9-CM SNOMED-CT

CPT-4

Which is not an advantage of the EHR? Cost Improvement in quality of health Accessibility Standardization

Cost

The minimum data set used for emergency room departments is also known as the: UHDDS. UACDS. DEEDS. RAI.

DEEDS

True

Evaluating the workflow of any organization is the first step to developing jobs for individuals True False

Which entity fosters collaboration of the public sector and private sector through the "Connecting for Health" initiative to improve patient care by promoting standards for electronic medical information? National Committee on Vital and Health Statistics Consolidated Health Informatics Markle Foundation Institute of Medicine

Markle Foundation

True

Micromotion such as holding an object is the simplest unit of work. True False

False

Pharmaceutical engineering is the mathematical and natural science application to maximize labor efficiency in the drug industry utilizing appropriate equipment and task structure using time and motion studies. True False

Which of the following controls cannot take place retrospectively? Corrective Detective Preventive All of the above

Preventive

Team members are empowered to complete a project with no management input.

Self-directed work teams have the following characteristic(s): Team members have no control over the work schedule Team members are empowered to complete a project with no management input. Team members must report to senior management on a daily basis. All are correct.

It is the coder's responsibility to assign codes completely and accurately so that a facility receives the reimbursement to which it is entitled. To meet this responsibility, a coder must: follow all software prompts that will add a "cc" code. The software program is written so that the coder does not have to review the medical record. use coding software to sequence the best principal diagnosis for the highest reimbursement. code and sequence according to the documentation in the medical record, using the software only to assist this process. none of the above

code and sequence according to the documentation in the medical record, using the software only to assist this process.

The extent and complexity of a history and physical are dictated by: TJC guidelines. data needed to evaluate the patient's problem. DHHS guidelines. all of the above.

data needed to evaluate the patient's problem.

The individual or organization that is ultimately responsible for paying a hospital bill is called the: patient guarantor employer spouse

guarantor

Which one of the following is NOT considered a health care facility? skilled nursing facility primary care physician's office Ambulatory surgery center gym

gym

Another term for demographic data is: global explanatory referral indicative

indicative

The laboratory department and radiology department of Hospital B have their own computer software programs that generate their departmental reports that automatically move to the HIM electronic record. These software systems communicate with the HIM software system through a(n): algorithm. integrity interface. Longitudinal

interface.

SNOMED-CT is a(n) _____ system. multiaxial classification nomenclature alphanumeric

nomenclature

All of the following are examples of demographic data, EXCEPT: home phone number birth date social security number occupation

occupation

A patient who visited a clinic saw two physicians and had an x-ray and a blood test. This patient can be said to have had _____ visits and _____ encounters. two; two two; four one; four one; three

one; four

The prioritization of patients presenting for treatment in an emergency department (ED) is determined by: patient's condition upon arrival. encounter. arrival time. appointment time.

patient's condition upon arrival.

The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted in the ED setting to: prevent hospitals from refusing to treat indigent patients and transferring them to charity care hospitals. enable the hospital to apply for reimbursement from CMS for services rendered to indigent patients. require hospitals to provide community services during nonpeak, routine daytime hours. ensure that indigent patients are not billed for EMTALA authorized services.

prevent hospitals from refusing to treat indigent patients and transferring them to charity care hospitals.

All of the following are always elements of a physician's order, EXCEPT: date. initials/signature of the individual executing the order. reason/rationale for the order. physician's signature.

reason/rationale for the order.

None are correct

A job description contains the following information: None are correct Skills Knowledge Abilities

Representatives of which of the following groups of entities or organizations comprise the "cooperating parties?" AHA, AHIMA, CMS, NCHS AHA, AHIMA, AMA, NCHS AHA, AMA, CMS, NCHS AHIMA, AMA, CMS, NCHS

AHA, AHIMA, CMS, NCHS

Which of the following is an example of demographic data? Admitting physician diagnosis procedure Address

Address

Medicare is administered by: Centers for Medicare and Medicaid (CMS) . individual states. National Committee for Quality Assurance (NCQA). Food and Drug Administration (FDA).

Centers for Medicare and Medicaid (CMS).

Which of the following processes will not be performed for electronic health records? Chart analysis Retrospective review Error corrections Chart assembly

Chart assembly

False

Codes of ethics provide a legal standard for operation so that all participants understand that if they do not adhere to this code, there may be negative consequences. True False

A. Programs that focus on improving an employee's skill for their job

Employee development consists of: A. Programs that focus on improving an employee's skill for their job B. Programs that focus on emotional intelligence C. Programs that focus on an employee's career D. All are correct

A. The concept of ethical standards applies to actions that are hoped for and expected by individuals.

Ethical standards are considered: A. The concept of ethical standards applies to actions that are hoped for and expected by individuals. B.the minimal standard of action. C.one level below legal standards. D.There is one definition of ethics universally accepted by all cultures.

False

Frederick Taylor developed an accountable care organization that rewarded workers who performed at a higher level. This type of human resource management is still used today. True False

False

From a legal perspective, the Civil Rights Act of 1964, Title VII requires organizations to identify the essential job functions or the fundamental activities of a position to ensure that individuals who are disabled can be included in a job recruitment process and that they can perform the major job activities in a position. True False

False

Healthcare personnel are Not one of the largest labor groups in the United States True False

Hospital B has a medical record that has computerized the progress notes, physician orders, ancillary reports, and nursing notes. The coders must review the record and enter abstracting data into the coding system. What type of record is being used at this facility? Paper record All of the above Electronic record Hybrid record

Hybrid record

Current code sets under the Health Insurance Portability and Accountability Act (HIPAA) include all of the following, EXCEPT: SNOMED-CT. National Drug Codes. HCPCS and CPT-4. ICD-10-CM and ICD-CM-PCS.

ICD-10-CM and ICD-CM-PCS.

0D5N4ZZ Destruction of Sigmoid Colon, Perc Endo Approach, is an example of a code from which code set? ICD-9-PCS ICD-10-PCS SNOMED-CT DSM-IV

ICD-10-PCS

True

Informed consent requires a provider to obtain the approval of a patient who has been provided adequate information to make a decision regarding their medical intervention. True False

Chapone Health Care is an organization that owns a number of different health care facilities: three acute care hospitals, two long-term care facilities, and a number of physician offices. Chapone also owns a rehabilitation hospital and an assisted living facility, which also delivers home care. The organization delivers care to patients at every point along the continuum of care. Chapone Health Care can be described as a(n): chain hospital integrated health care delivery system fiscal intermediary

Integrated health care

All are correct

Job analysis can be performed by: All are correct Observing a person working in their job Interviewing employees Having employees write a journal of their activities

False

Job rotation increases the responsibility of the employee by increasing decision-making power within the employee's job. True False

all of the above

Job specifications identify: licensing experience Education all of the above

True

Lateral violence also occurs in health care, which is defined as "nurse to nurse" aggression, demonstrated by both verbal and non-verbal behavior. True False

Correct! False

Law is created so that there is a maximum standard of action required by individuals and organizations. True False

HCPCS is composed of Level I and Level II codes; the differences between the two levels are: Level I codes are used to report outpatient procedures and services, whereas Level II codes are used to report products, supplies, and services not included in Level I. Level I codes are maintained by the AMA, whereas Level II codes are developed by hospitals as part of their chargemaster. Level I codes are submitted separately from Level II codes for reimbursement. Insurance companies need Level II codes to process claims; insurers do not process Level I codes.

Level I codes are used to report outpatient procedures and services, whereas Level II codes are used to report products, supplies, and services not included in Level I.

Which of the following is NOT a common coding function? Reimbursement Compliance Medical testing Research

Medical testing

True

Medical tourism is the medical travel of U.S. patients outside the U.S. borders to receive medical treatment because the U.S. cost is so high. True False

Which of the following is an element of an acute care admission record? Type of dwelling in which the patient lives Patient's height and weight Name of patient's employer Patient's previous operations

Name of patient's employer

True

Observing an individual in the job or interviewing employees are examples of job analysis. True False

Which of the following is a requirement of obtaining the Registered Health Information Technician (RHIT) credential? Medical coding experience Having work experience in Health Information Technology Having an Associate's Degree in Health Information Technology Obtaining an Associate's degree from a CAHIIM accredited Health Information Technology Program

Obtaining an Associate's degree from a CAHIIM accredited Health Information Technology Program

True

Personal effectiveness competencies are located at the base of the pyramid and influence the other competencies. These competencies include interpersonal skills, initiative, dependability, willingness to learn. These represent generic types of traits and motivation that can be applied to many different industries. True False

What is the correct way to modify a paper medical record? Use white out. Scratch out the error and have the physician initial it. Put one line through the error and write the correct data near it. Black out the error and indicate the time.

Put one line through the error and write the correct data near it.

What type of facility provides cognitive remediation? Behavioral Health OASIS Specialized clinic Rehabilitation

Rehabilitation

Which of the following is NOT an example of clinical data? Hemoglobin 10.1 Appendectomy 3 years ago Smokes 2 packs of cigarettes daily Blood pressure 120/80

Smokes 2 packs of cigarettes daily

True

The Department of Labor provides current statistics about employment, union representation, earnings, and workplace trends for many industries including healthcare. True False

Correct! True

The HR department is responsible for performing job analyses? True False

True

The Position Analysis Questionnaire (PAQ) is one of the best quantitative instruments that may be used to analyze jobs. True False

B. Increases the number of tasks in a job.

The concept of job enlargement focuses on A. Decreasing the number of tasks in a job B. Increases the number of tasks in a job. C. Increasing job responsibilities D. Developing career programs for employees

Which of the following is NOT a way in which managed care organizations may influence and/or control the patient's choices in selecting health care services? The patient's PCP must be a participating provider. Only approved services may be reimbursed. The managed care organization decides what services are "medically necessary." The managed care organization only pays for services provided by the PCP.

The managed care organization only pays for services provided by the PCP.

True

The minimal standard for action is federal law, although state law may be more stringent. True False

Correct! All are correct statements

The recruitment and selection process of new employees must be legally defensible which means: The process is fair The process adheres to legal standards The process is systematic All are correct statements

Correct! False

There have been no passage of any federal and or state laws to protect healthcare workers or customers? True False

Why would a coder or coding manager automatically review and/or revise patients assigned to DRG 469 and/or DRG 470? The hospital might not be entitled to the reimbursement for these DRGs. The federal government reviews these DRGs for fraud and abuse. There is something incorrect with the codes assigned and/or data when a patient is grouped into either of these DRGs. All of the above are true.

There is something incorrect with the codes assigned and/or data when a patient is grouped into either of these DRGs.

D. The Joint Commission

This nongovernmental organization, _________________________ , reviews health and safety standards for both patients and employees. A. Occupational Safety and Health Administration B. Equal Employment Opportunity Commission C. US Department of Labor D. The Joint Commission

C. adopt a zero-tolerance policy against this type of behavior

To reduce or eliminate workplace bullying, the organization should: A. fire workplace bullies because it is an illegal activity B. encourage all employees to be bullies so no one feels left out C. adopt a zero-tolerance policy against this type of behavior D. bully the workplace bully so the bully will understand their actions

The minimum data set used for ambulatory care settings is also known as the: UHDDS. UACDS. MDS. RAI.

UACDS.

Which of the following data sets is used by acute care facilities? MDS UHDDS ICD-10-CM OASIS

UHDDS

C. common law

When the court system interprets previous legal decisions with respect to a case, they create A. criminal law B. civil law C. common law D. tort reform

A.The American Medical Association

Which healthcare membership organization established a code of ethics in the 1800s? A.The American Medical Association B.The American College of Physicians C.The Nurses Association D.The Joint Commission

B. There is a shortage of physicians in certain geographic areas in the U.S.

Which of these statements is correct about the healthcare industry? A. There is a decrease in the life expectancy in the U.S. so less healthcare services will be needed B. There is a shortage of physicians in certain geographic areas in the U.S. C. are correct D. There is a surplus of nurses in the health care industry

A. All are correct statements.

Which one of these statements is true? A. All are correct statements. B. The healthcare industry is one of the most heavily regulated industries in the U.S. C.An IRB is a group that has been formally designated to review and monitor medical research involving human subjects. D. Workplace bullying is common in health care.

True

Workflow is the activities that combine the processes, tools, and labor working toward achieving the stated goal of an organization. True False

Correct! industrial engineering ergonomics

_________________ is the mathematical and natural science application to maximize labor efficiency utilizing appropriate equipment and task structure using time and motion studies. competency model job analysis industrial engineering ergonomics

A facility is reviewing its policies and procedures to ensure that it complies with The Joint Commission (TJC) standards. This facility is concerned about its: accreditation licensure certification registration

accreditation

In an electronic environment, changes to a patient's record should be tracked in: an audit trail. an exception file. a duplicate file. nowhere; electronic changes completely wipe out prior entries.

an audit trail.

The following are types of physician specialties that can be found in a primary care group practice, EXCEPT: dermatologist. pediatrician. gynecologist. anesthesiologist.

anesthesiologist.

A process that tracks the activity of users in the system, storing what the user accessed and when the user accessed it, is: scanning. digitized. audit trail. integrity.

audit trail.

The data quality characteristic associated with the collection of data in its entirety is: completeness. reliability. timeliness. validity.

completeness.

The patient was admitted to the hospital in congestive heart failure with the approval of the patient's insurer. After 3 days, utilization review, in conjunction with the patient's insurer, informed the physician that there was insufficient documentation in the patient's record to justify further hospitalization and that no additional charges would be reimbursed. Utilization review's action in this case is called: discharge planning. admission denial. continued stay denial. managed care.

continued stay denial.

The physician charged the patient $75 for an office visit. The patient paid the physician $5 and the patient's insurance company paid the physician $70. The patient's portion of the payment is called: discounted fee for service. wraparound policy. fee for service copayment.

copayment.

The process of recording data into an information system is called: data entry. utilization review. detective control. collection.

data entry.

The extracorporeal elimination of waste products from blood is most likely to be performed at a: dialysis center. laboratory. radiology center. rehabilitation center.

dialysis center.

You are an auditor reviewing a spreadsheet that shows all of the records for the year in which the patient was on a mechanical ventilator. You are reviewing these records because, in every case, the coder has assigned a procedure code indicating that the patient was on mechanical ventilation for over 96 hours. When queried, the coder remarked that the hospital gets a higher reimbursement for that code than for a lower number of hours. You should: accept the coder's explanation, because it is up to the coder to decide what codes to assign to a case. discuss the finding with the Health Information Management Director as a potential abuse or fraud issue. change some of the procedure codes so at least some of them are under 96 hours. ask the coder to re-review all of the records.

discuss the finding with the Health Information Management Director as a potential abuse or fraud issue.

A predetermined set of instructions for a specific set of blood tests, x-rays, or other procedures is called: utilization review. plan of care. verbal orders. protocol.

protocol.

When hospitals began being reimbursed based on DRG assignment, patient length of stay decreased because: coding became more timely and accurate. there was a financial incentive to discharge patients sooner. patients were less sick. all of the above are correct.

there was a financial incentive to discharge patients sooner.

The data quality characteristic associated with the capture of data concurrently with its observation is: completeness. reliability. timeliness. validity.

timeliness.

The Joint Commission (TJC) requires that acute care records be completed: within 15 days of discharge. in whatever time period the facility requires. within 30 days of discharge. in whatever time period the state requires.

within 30 days of discharge.

The 82-year-old patient presented in the physician's office for a routine physical examination. He gave the receptionist two cards, evidencing his primary, government-funded insurance plan that pays for most of the bill and an additional, private plan that covers the remaining charges. The patient's secondary insurance is called: discounted fee for service. wraparound policy. Medicare. capitation.

wraparound policy.