RHIA Part 3

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?

$40

Sue, the HIM manager is writing a contract for transcription services. She asks her legal counsel to provide her with a sample for her to use that describes standard contract provision. Sue is using a type of contract provision?

Boilerplate

The standard that requires covered entities and business associates to have an agreement regarding use, disclosure, and security of protected health information is the:

Business Associate Contracts and Other Arrangements Standard

Aimed at increasing the affordability and rate of health insurance coverage for Americans and reducing the overall costs of health care

ACA

Which of the following is supported by a tactical database?

ADT

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.

$60

From the information provided, What is the debt ratio?

0.59

Urban Clinic is establishing a new Women's Breast Center at an initial investment cost of $2,000,000. Monthly operating expenses are expected to be $100,000, and the center is expected to generate $20,000 in profits each month. What is the estimated return on investment of this project for one year?

12%

Medicare requires that a history and physical examination be completed within what time frame after a patient's admission to a hospital?

24 hours

If a patient is readmitted to a facility after a recent admission, Joint Commission allows the facility to use the existing history and physical from the first admission if it is for a related condition and was completed within _____ of the second admission and if an interval note updating any changes to the patient's condition has been documented.

30 days

Which of the following purchases would most likely be considered a capital budget item?

A cost of more than $1,000 wilth a life expectancy of 3 years

Which of the following would be part of the release of information system?

A letter notifying an individual that the authorization was invalid

Coding accuracy is best determined by:

A predefined audit process

Which of the following statements is true regarding HIPAA security?

A security risk assessment must be performed every year.

Which of the following statements describes a critical skill to ensure a successful implementation of a strategic plan?

Ability to develop performance metrics and track them on a balanced scorecard

During the voluntary review process, the performance of a healthcare entity is measured against:

Accreditation standards

TJC requests to view a patient's health record, which contains a diagnosis of AIDS. The director of health information should:

Allow access to the record upon request of TJC

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?

Allowable charge

The MPI is necessary to physically locate health records within the paper-based storage system for all types of filing systems except which of the following?

Alphabetical

Facility-based cancer registries receive approval as part of the facility cancer program from which of the following agencies?

American College of Surgeons

In data quality management the purpose for which data are collected is:

Application

A visitor to the hospital looks at the screen of the admitting clerk's computer workstation when the clerk leaves her desk to copy some documents. What security mechanism would best have minimized this security breach?

Automatic logoff controls

The period of time between discharge and claim submission, which a facility defines by policy, is called the:

Bill hold

Which of the following can be used to show the frequency for each interval or category of nominal, ordinal, and discrete data?

Bar graph

A medical staff committee wants to compare long-term survival rates for breast cancer by comparing outcomes for the mastectomy versus lumpectomy approaches. The best source of this information is the:

Cancer registry

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?

Claims processing

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?

Code skin lesion

St. Mary's Hospital has recently had a shortage of coding staff due to one coder being out on maternity leave and two open positions that have been posted for over a month with no experienced applicant at this time. As a result, a coding backlog has occurred. What action could the coding manager take to mitigate this coding backlog?

Contract with a vendor that provides temporary coding services

Documentation from various sources is intermingled and organized in strict chronological or reverse chronological order

integrated health record

Nurse Bob wants a multidisciplinary approach to outline individualized patient goals and an appropriate time frame for expected optimal efficiency patient care. Which should he use?

Critical pathways

interprets the law

judicial

The HIM manager is conducting a study that compares the ICD-9-CM and ICD-10-CM diabetes mellitus codes and documents variations in order to assess the impact on the organization. This process creates a:

Data map

When the Medicare Recovery Audit Contractor has determined that incorrect payment has been made to an organization what document is sent to the provider notifying them of this determination?

Demand letter

An adult patient's daughter who identifies herself as the patient's representative requests to access her father's health information. The patient has not been treated in this health care organization for the last three years. How should you respond to this request?

Determine whether the daughter has documentation that identifies her as the patient's representative.

The utilization review coordinator reviews inpatient records at regular intervals to justify necessity and appropriateness of care to warrant further hospitalization. The utilization review activities being performed constitute a:

Discharge review

What information might be displayed on a histogram?

Discharges by age

When managing the master patient index (MPI) which of the following would be the biggest concern for the health information technician?

Duplicate record numbers

Allowing employees to solve problems within the scope of their job is a characteristic of:

Empowerment

The distinguishing feature of a results management application is that it:

Enables results of a diagnostic study to be compared and displayed with other data

The first and most fundamental strategy for minimizing security threats is to:

Establish a security organization

Monitoring turnover is a retention strategy that organizations use to reduce the need to recruit new employees. Which of the following is a tool that might be used to help monitor turnover?

Exit interviews

A hospital is reviewing the quantity and type of resources being used in the provision of chemotherapy treatments. This is an example of:

FOCUS-PDCA review

Of the following disclosures of PHI, which one allows an individual the option to agree or disagree with the disclosure of the information?

Facility directory

At the end of March, the HIM department has a YTD payroll budget of $100,000. The actual YTD amount paid is $95,000 because a coder resigned in February. For the past two months, the position has been filled through outsourcing. Therefore, the actual YTD amount for consulting services is $5,000, although no money was budgeted for consulting services. The reporting threshold for variances is 4%. The fiscal year-end is December. What is the best description of the payroll variance for this year?

Favorable, permanent

Medical identity theft includes all of the following except use of another person's:

Financial information to purchase expensive handbags

The medical transcription improvement team wants to identify the cause of poor transcription quality. Which tool could help them accomplish this objective?

Fishbone diagram

The HIM manager at Anywhere Hospital has contracted with an outside vendor to handle the complete cancer registry function for the facility. This type of contract for services would be considered:

Full service

In this level of interoperability, the receiving computer has some information regarding the nature of the information being exchanged, but does not have complete and shared understanding with the sending system.

Functional

A standardized set of performance measures designed to allow purchasers and consumers to compare the performance of managed care plans

HEDIS

Which of the following is a retention concern with electronic health records?

Hardware obsolescence

Cecile, a 78-year-old female, needs intermittent skilled nursing care. Which facility would best meet her needs?

Home health care

The designated record set:

Includes medical and billing records

It is important for an HIM manager to intercede quickly with early intervention and provide additional training, support, or resources as necessary when an employee is experiencing _____________.

Individual variances in job performance

Providers should be queried regarding information in the health record for all of the following except.

Insignificant information

A database rule that states "patient gender must be recorded as M=male, F=female, and U= unknown" is referred to as:

Integrity constraint

The HIM department has undergone a job evaluation update. As a result, the data analysts were determined to be of greater importance to the organization than the scanning clerks, therefore, their positions were upgraded and pay was increased. The method of job evaluation illustrated here is:

Job ranking

The IT department of an academic medical center has created a project management office (PMO) in order to help manage the many projects relating to implementing an EHR that have been underway for a few years already. After a few months, the chief information officer is concerned that many tasks the PMO was expected to perform have not been accomplished. In addition, the chairs of the domain teams continue to work independently and directly with the vendor. The project management mistake illustrated in this scenario is:

Lack of ownership

If the agreement rate on retrospective queries for a physician is 100 percent, this could be a sign of:

Leading queries

To promote comparability and compatibility of data by using standard data items with uniform definitions

MDS

A transcription manager is assigned to a project team that is implementing a voice-recognition system. He reports to the director of health information services for regular job functions and to the project manager for tasks related to the project. This is an example of which type of project management structure?

Matrixed

The Joint Commission requires a varying number of safety functions and plans depending on the license or services provided by an organization. The standards require the assessment of safety features for patients, staff, and visitors. Which of the following lists are required safety standard plans for the environment of care?

Medical equipment management, life safety management, and emergency management

Compliance with the Conditions of Participation allows a hospital to achieve:

Medicare certification

Which one of the following facility types is required to release information under the Freedom of Information Act?

Military

Comprehensive assessment for adult home care patient and forms the basis for measuring patient outcomes

OASIS

The technology that allows a healthcare organization to logically (or conceptually) link multiple physical data repositories is:

OLTP

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?

Office of the Inspector General (OIG)

Which RFP component would fit the following description? Describe the EHR product's data architecture, analytical processes supported, necessary interfaces, reliability and security features, system capacity, expansion capabilities, response time, downtime, and other issues associated with system maintenance.

Operational requirements

The CPT codes for Emergency Department visits are: 99281 - Level 1 Emergency Department Visit 99282 - Level 2 Emergency Department Visit 99283 - Level 3 Emergency Department Visit 99284 - Level 4 Emergency Department Visit 99285 - Level 5 Emergency Department Visit This set of CPT codes is an example of:

Ordinal data

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?

Patient registration

Which of the following is an example of a 1:M relationship?

Patients to hospital admissions

Stephen (an HIM coding manager) has been tracking Gina's coding productivity and quality over the past several months. Gina has experienced increasing variances in her work performance and is not meeting the coding benchmarks in terms of productivity or quality. Stephen has been sharing the data with Gina on a regular basis and Gina promises she will improve. Stephen realizes that Gina's work is becoming substandard and is not meeting the coding area standards. Stephen will need to initiate an employee________________.

Performance improvement plan

Electronic prescribing is used in:

Physician's office prescription writing

The performance standard to"Deliver the record to the requester of a STAT request within 10 minutes of receiving the request" is an example of a:

Quality standard

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?

Query the physician

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?

Query the physician to ask if the patient has septicemia because of the symptomatology.

The primary purpose of a Minimum Data Set in healthcare is to:

Recommend common data elements to be collected in health records

The charge description master relieves the HIM department of ________ that does not require documentation analysis.

Repetitive coding

Which of the following would likely head the list of important performance measures for evaluating the results of strategic change?

Results compared to the performance targets

Which of the following procedures regarding physician orders is no longer common practice in healthcare facilities?

Retrospective closed review of the record after the patient's discharge in order to identify all unsigned orders

An activity useful in diversity training that involves learners acting out a response to a hypothetical situation is known as:

Roleplaying

Site surveyors always look for evidence of three trigger issues including very high percentages of patients suffering from dehydration, decubitus ulcers in low-risk residents, and fecal impaction within which type of healthcare setting?

Skilled nursing facility

Which work design tool uses an office layout to visualize the interaction of various work procedures?

Spaghetti diagram

Medical necessity determinations must reflect the efficient and cost-effective application of patient care, including all of the following except:

Supplies used for patient treatment

Emphasis on group rather than individual achievement is stressed in the training topic called:

Team-building

Which of the following is a solution to the problem of staff recruitment for coding and transcription?

Telecommuting

What factor is medical necessity based on?

The beneficial effects of a service for the patient's physical needs and quality of life

Which of the following statements about compiling a directory of patients being treated in the hospital is true?

The covered entity must inform the individual what information is maintained in a directory and to whom this information may be disclosed.

Which of the following is not an element of the external environmental assessment that should be part of a manager's routine scanning?

The opinions of the employees

Key to the implementation of an effective performance improvement program is a written plan that systematically describes the structure and approaches the organization will follow in the continuous assessment and improvement of its important systems, processes, and outcomes of care. Which of the following activities should be included in this plan?

The organization sets priorities for performance improvement, ensuring that the scope of care, treatment, and services are represented across all disciplines.

Which of the following statements most accurately characterize the primary reason why today's managers must be able to think and act strategically?

The pace of change has compressed organizational response times.

A patient was admitted to the hospital for treatment of 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?

The sepsis was not coded and so an MCC was missed.

What information does not have to be included in a covered entity's notice of privacy practice? A. A description with one example of disclosures made for treatment, payment, and healthcare operations B. A description of all the other purposes for which a covered entity is permitted or required to disclose PHI without consent or authorization C. A statement of individual's rights with respect to PHI and how the individual can exercise these rights D. The signature of the patient and date the notice was given to the patient

The signature of the patient and date the notice was given to the patient

As the corporate director of HIM Services and enterprise privacy officer, you are asked to review a patient's health record in preparation for a legal proceeding for a malpractice case. The lawsuit was brought by the patient 72 days after the procedure. Health information contains a summary of two procedures that were dictated 95 days after the procedure. The physician in question has a longstanding history of being lackadaisical with record completion practices. Previous concerns regarding this physician's record maintenance practices had been reported to the facility's Credentialing Committee. Are the summaries of the two procedures admissible in court?

This information could be rejected since the physician dictated the procedure note after the malpractice suit was filed.

An element of Helen's SWOT analysis mentions the hospital across town recently sent all their coders home to code remotely. Currently, all coding done at Helen's hospital is done in-house. In a SWOT analysis, remote coding done by the other hospital would be a(n):

Threat

Data collection utilized by peer review organizations to determine the quality of patient care

UCDS

Martha has several interviews set up to fill the position of the second shift supervisor. Martha doesn't plan to ask each candidate the same questions, rather she would like to format the interview as a conversation. In this way she hopes to identify the best candidate for the position. This type of interviewing technique is called _________________.

Unstructured interview

The director of Health Information Services is allowed access to the health record tracking system when providing the proper login and password. Under what kind of access security mechanism is the director allowed access to the system?

User-based

A system in which purchasers hold providers of healthcare accountable for both the costs of healthcare and its quality is called:

Value-based purchasing

structured plans of care

clinical pathways

Barbette, director of HIM, writes a proposal for an electronic chart tracking system. She states that the purchase of the $30,000 system will save approximately $9000 per year in personnel time. She has conducted a:

cost-benefit analysis

display goals for patients and provide the corresponding ideal sequence and timing of staff actions to achieve those goals with optimal efficiency

critical paths

The members of which group are responsible for recommending clinical privileges to the governing body?

executive committee

Made up of several characters such as name, age, or gender

field

The HIM Manager at Anywhere Hospital has contracted with an outside vendor to handle the complete cancer registry function for the facility. This type of contract for services would be considered:

full service

Utilization management is the:

group of processes used to measure how efficiently health care is managed

A list of proper names for diseases and operations

nomenclature

According to TJC standards, a hospital is required to:

promote performance improvement

Who owns the physical health record?

provider or facility

hearsay statements made during an incident are admissible as evidence

res gestae

Something is self evident

res ipsa loquitor

The final judgment of a competent court is conclusive

res judicata

You are assisting the nursing department in writing indicators to determine appropriate ratios and formulas and to determine data collection time frames. One important aspect of care is the documentation of patients' education. More specifically, the nursing department would like to assess its documentation of education on colostomy care for patients with new colostomies. Concerning the preceding scenario, what would be the most effective time frame for collecting the requested data?

retrospectively

Covered entities are required to assign a unique name and/or number for identifying and tracking user identity

security rule

samples of a population that consists of a number of subgroups or strata that may differ in characteristics being studied (e.g., ethnic groups)

stratified sample

average length of stay

total los/total discharges