TMR Mock exam wrongs

Continuing coding education is required for: a. Certified coders b. Inpatient coders c. All coders d. Inpatient and ambulatory surgery coders

Correct Answer: A A well-trained coding staff helps ensure complete and accurate coding, which is essential for the integrity of the data collected. All coders in the facility should receive continuing education, but certified coders must demonstrate that they are continuing to maintain their knowledge and skill base. To maintain their certification, individuals must complete a designated set of continuing education units (Sayles 2016a, 14).

To clarify documentation, the preferred method of contact between a coder and a physician is: a. Face-to-face communication b. E-mail transmission c. Fax transmission d. Telephone conversation

Correct Answer: A Although physicians may be contacted by phone to clarify documentation, both documentation and coding are most accurate when physicians review the health records face-to-face with coders and then document findings. At the time of the review and discussion, the physician should be asked to add or modify documentation in the record. Codes should be modified, changed, or deleted only after—or when—the physician documents in the health record (Schraffenberger and Kuehn 2011, 21).

Which of the following definitions best describes the concept of confidentiality? a. The expectation that personal information shared by an individual with a healthcare provider during the course of care will be used only for its intended purpose b. The protection of healthcare information from damage, loss, and unauthorized alteration c. The right of individuals to control access to their personal health information d. The expectation that only individuals with the appropriate authority will be allowed to access healthcare information

Correct Answer: A Confidentiality refers to the expectation that the personal information shared by an individual with a healthcare provider during the course of care will be used only for its intended purpose (Rinehart-Thompson 2016b, 214).

A skin lesion was removed from a patient's cheek in the dermatologist's office. The dermatologist documents skin lesion, probable basal cell carcinoma. Which of the following actions should the coding professional take to code this encounter? a. Code skin lesion b. Code benign skin lesion c. Code basal cell carcinoma d. Query the dermatologist

Correct Answer: A In the outpatient setting, do not code a diagnosis documented as "probable." Rather, code the conditions to the highest degree of certainty for the encounter (Schraffenberger and Palkie 2017, 102).

Which of the terms below represents fixed rules that must be followed? a. Standard b. Guidelines c. Forms control program d. Policy

Correct Answer: A Standards are fixed rules that must be followed (Sayles 2016b, 66).

The goal of coding compliance programs is to prevent: a. Accusations of fraud and abuse b. Delays in claims processing c. Billing errors d. Inaccurate code assignments

Correct Answer: A The government and other third-party payers are concerned about potential fraud and abuse in claims processing. Therefore, ensuring that bills and claims are accurate and correctly presented is an important focus of healthcare compliance (Foltz et al. 2016, 462).

A provider's office calls to retrieve emergency room records for a patient's follow-up appointment. The HIM professional refused to release the emergency room records without a written authorization from the patient. Was this action in compliance? a. No; the records are needed for continued care of the patient, so no authorization is required b. Yes; the release of all records requires written authorization from 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

Correct Answer: A Treatment, payment, and operations (TPO) is an important concept because the Privacy Rule provides a number of exceptions for PHI that is being used or disclosed for TPO purposes. Treatment means providing, coordinating, or managing healthcare or healthcare-related services by one or more healthcare providers (Rinehart-Thompson 2016b, 223).

Which of the following statements is true regarding HIPAA security? a. All institutions must implement the same security measures. b. Institutions are allowed flexibility in the way they implement HIPAA standards. c. All institutions must implement all HIPAA specifications. d. A security risk assessment must be performed every year.

Correct Answer: B HIPAA allows a covered entity to adopt security protection measures that are appropriate for its organization as long as they meet the minimum HIPAA security standards. Security protections in a large medical facility will be more complex than those implemented in a small group practice (Rinehart-Thompson 2016c, 271).

The medical transcription improvement team wants to identify the cause of poor transcription quality. Which of the following tools would best aid the team in identifying the root cause of the problem? a. Flowchart b. Fishbone diagram c. Pareto chart d. Scatter diagram

Correct Answer: B A cause-and-effect diagram, also known as a fishbone diagram because of its characteristic fish shape, is an investigation technique that facilitates the identification of the various factors that contribute to a problem. It facilitates root-cause analysis, in order to determine the cause of the problem (Carter and Palmer 2016, 515).

Each healthcare organization must identify and prioritize which processes and outcomes (in other words, which types of data) are important to monitor. This data collection should be based on the scope of care and services they provide and: a. The number of employees they employ b. Their mission c. The QI methodology used d. Their accreditation status

Correct Answer: B Each healthcare organization must identify and prioritize which processes and outcomes are important to monitor on the basis of its mission and the scope of care and services it provides (Shaw and Carter 2015, 27-28

The facility's Medicare case-mix index has dropped, although other statistical measures appear constant. The CFO suspects coding errors. What type of coding quality review should be performed? a. Random audit b. Focused audit c. Compliance audit d. External audit

Correct Answer: B Focused selections of coded accounts are necessary for deeper understanding of patterns of error or change in high-risk areas or other areas of specific concern, such as a focused audit of cases with no CC/MCC to determine why the case-mix is dropped (Foltz et al. 2016, 459).

The utilization manager's role is essential to: a. Analyze the estimate of benefits (EOBs) received b. Capture all relevant charges for the patient's account c. Prevent denials for inappropriate levels of service d. Verify the patient actually has insurance

Correct Answer: C Front-end utilization management (UM) is essential to the prevention of denials for inappropriate levels of care. UM staff work with the physician to ensure that the requested services meet medical necessity requirements and are provided in the most appropriate setting. When the insurer denies the claim, an appeal may be possible (Gordon and Gordon 2016a, 438).

In developing an internal audit review program, which of the following would be risk areas that should be targeted for audit? a. Admission diagnosis and complaints b. Chargemaster description c. Clinical laboratory results d. Radiology orders

Correct Answer: B One of the elements of the auditing process is identification of risk areas. Selecting the types of cases to review is also important. Examples of various case selection possibilities include chargemaster description for accuracy (Foltz et al. 2016, 458-459).

A medical group practice has contracted with an HIM professional to help define the practice's legal health record. Which of the following should the HIM professional perform first to identify the components of the legal health record? a. Develop a list of all data elements referencing patients that are included in both paper and electronic systems of the practice b. Develop a list of statutes, regulations, rules, and guidelines that contain requirements affecting the release of health records c. Perform a quality check on all health record systems in the practice d. Develop a listing and categorize all information requests for health information over the past two years

Correct Answer: B The HIM professional should advise the medical group practice to develop a list of statutes, regulations, rules, and guidelines regarding the release of the health record as the first step in determining the components of the legal health records (Rinehart-Thompson 2017b, 171

A Staghorn calculus of the left renal pelvis was treated earlier in the week by lithotripsy and is now removed via a percutaneous nephrostomy tube. What is the root operation performed for this procedure? a. Destruction b. Extirpation c. Extraction d. Fragmentation

Correct Answer: B The root operation extirpation is defined as taking or cutting out solid material from a body part. The matter may have been broken into pieces during the lithotripsy previous to this encounter, but at this time the pieces of the calculus are being removed (Kuehn and Jorwic 2017, 86).

City Hospital submitted 175 claims where they unbundled laboratory charges. They were overpaid by $75 on each claim. What is the fine for City Hospital? a. $40,300 b. $39,375 c. $26,250 d. $13,125

Correct Answer: B Unbundling is the practice of using multiple codes to bill for the various individual steps in a single procedure rather than using a single code that includes all of the steps of the comprehensive procedure code. In this situation, the penalty is the overpayment of the $75 for all 175 claims overpaid as well as 3 times the total amount of the overpayment (175 × $75 = $13,125 then; $13,125 × 3 = $39,375) (Foltz et al. 2016, 450).

The risk manager's principal tool for capturing the facts about potentially compensable events is the: a. Accident report b. RM report c. Incident report d. Event report

Correct Answer: C An incident report is a structured data tool that risk managers use to gather information about potentially compensable events. Effective incident reports carefully structure the collection of data, information, and facts in a relatively simple format (Shaw and Carter 2015, 222).

A health data analyst has been asked to compile a report of the percentage of patients who had a baseline partial thromboplastin time (PTT) test performed prior to receiving heparin. What clinical reports in the health record would the health data analyst need to consult in order to prepare this report? a. Physician progress notes and medication record b. Nursing and physician progress notes c. Medication administration record and clinical laboratory reports d. Physician orders and clinical laboratory reports

Correct Answer: C Clinical laboratory reports should be reviewed to determine if a partial thromboplastin time (PTT) test was performed. Medication Administration Records (MAR) should be reviewed to determine if heparin was given after the PTT test was performed (Brickner 2016, 94).

When a staff member documents in the health record that an incident report was completed about a specific incident, in a legal proceeding how is the confidentiality of the incident report affected? a. There is no impact. b. The person making the entry in the health record may not be called as a witness in trial. c. The incident report likely becomes discoverable because it is mentioned in a discoverable document. d. The incident report cannot be discovered even though it is mentioned in a discoverable document.

Correct Answer: C Hospitals strive to keep incident reports confidential, and in some states, incident reports are protected under statutes protecting quality improvement studies and activities. Incident reports themselves should not be considered a part of the health record. Because the staff member mentioned in the record that an incident report was completed, it will likely be discoverable as the health record is already a discoverable document (Carter and Palmer 2016, 522).

Which of the following is a positive aspect of using employee self-appraisal as a source of data for performance appraisal? a. Employees are in the best position to provide objective review without overstatement b. The supervisor is kept informed of the employee's accomplishments c. Appraiser and employee training on the purpose and procedures of this process is essential d. Peer pressure of evaluation can motivate team members to be more productive

Correct Answer: C Maintaining some type of accounting procedure for monitoring and tracking PHI disclosures has been a common practice in departments that manage health information. However, the Privacy Rule has a specific standard with respect to such record keeping. Disclosures for which an accounting is not required and which are therefore exempt include some of the following examples: TPO disclosures, pursuant to an authorization, and to meet national security or intelligence requirements. PHI sent to a physician that has not treated the patient would need to be accounted for (Rinehart-Thompson 2017d, 247-248).

Which of the following is the approved method for implementing an organization's formal position? a. Hierarchy chart b. Organizational chart c. Policy and procedure d. Mission statement

Correct Answer: C Policies and procedures also can be considered organizational tools. Policies are written descriptions of the organization's formal positions. Procedures are the approved methods for implementing those positions. Together, they spell out what the organization expects employees to do and how they are expected to do it (Gordon and Gordon 2016b, 537-538).

A health information technician receives a subpoena ad testificandum. To respond to the subpoena, which of the following should the technician do? a. Review the subpoena to determine what documents must be produced b. Review the subpoena and notify the hospital administrator c. Review the subpoena and appear at the time and place supplied to give testimony d. Review the subpoena and alert the hospital's risk management department

Correct Answer: C Sometimes HIM professionals are subpoenaed to testify as to the authenticity of the health records by confirming that they were compiled in the normal course of business and have not been altered in any way. A subpoena that is issued to elicit testimony is a subpoena ad testificandum (Rinehart-Thompson 2016b, 215).

In designing input by clinicians for an EHR system, which of the following would be effective for a clinician when the data are repetitive and the vocabulary used is fairly limited? a. Drop-down menus b. Point and click fields c. Speech recognition d. Structured templates

Correct Answer: C Speech recognition can be very effective in certain situations when data entry is fairly repetitive and the vocabulary used is fairly limited. As speech recognition improves, it is becoming a replacement for other forms of dictation. In some cases, the user reviews the speech as it is being converted to type and makes any needed corrections; in other cases, the speech is sent to a special device where it generates type for another individual to review and edit (Sayles and Trawick 2014, 189-191).

Community Hospital wants to compare its hospital-acquired urinary tract infection (UTI) rate for Medicare patients with the national average. The hospital is using the MEDPAR database for its comparison. The MEDPAR database contains 13,000,000 discharges. Of these individuals, 200,000 were admitted with a principal diagnosis of UTI; another 300,000 were admitted with a principal diagnosis of infectious disease, and 700,000 had a diagnosis of hypertension. Given this information, which of the following would provide the best comparison data for Community Hospital? a. All individuals in the MEDPAR database b. All individuals in the MEDPAR database except those admitted with a principal diagnosis of UTI c. All individuals in the MEDPAR database except those admitted with a principal diagnosis of UTI or infectious disease d. All individuals in the MEDPAR database except those admitted with a diagnosis of hypertension

Correct Answer: C The Medicare Provider Analysis and Review (MEDPAR) file is made up of acute care hospital and skilled nursing facility (SNF) claims data for all Medicare claims. The MEDPAR file is frequently used for research on topics such as charges for particular types of care and DRGs. The limitation of the MEDPAR data for research purposes is that the file contains only Medicare patients. Community Hospital is excluding MEDPAR data of those patients with a principal diagnosis of UTI or infectious disease because these would not represent a hospital acquired condition (HAC) because the patients were admitted with those diagnoses. Community Hospital is looking for comparative secondary diagnosis data of Medicare patients from the MEDPAR file to compare their HAC rate for UTIs to the national average from the MEDPAR data (Gordon and Gordon 2016a, 437; Sharp 2016, 185).

An outpatient clinic is reviewing the functionality of an EHR it is considering for purchase. Which of the following data sets should the clinic consult to ensure that all the federally recommended data elements for Medicare and Medicaid outpatients are collected by the system? a. DEEDS b. EMEDS c. UACDS d. UHDDS

Correct Answer: C The Uniform Ambulatory Care Data Set (UACDS) data characteristics include patient-specific items for outpatient care (Russo 2013a, 295-297).

Which of the following is characteristic of the legal health record? a. It must be electronic b. It includes the designated record set c. It is the record disclosed upon request d. It includes a patient's personal health record

Correct Answer: C The legal health record distinction is important for several reasons. First, it is important to an organization's business and legal processes. Second, because the legal health record is the record that is produced upon request, including legal requests, it becomes important to ensure that the legal health record is legally sound and defensible as a valid document in legal situations (Rinehart-Thompson 2016a, 206).

What resource should the facility compliance officer consult to provide information on new and ongoing reviews or audits each year in programs administered by the Department of Health and Human Services? a. Regional health information organizations b. Corporate compliance plans c. OIG workplans d. Federal register

Correct Answer: C The resource that the facility compliance officer should consult to provide information on ongoing reviews and audits each year in programs administered by the department of Health and Human Services (HHS) is the OIG workplan (Foltz et al. 2016, 457).

How many identifiers must be removed for a data to be considered deidentified under the Safe Harbor Method? a. 12 b. 15 c. 18 d. 20

Correct Answer: C The safe harbor method of deidentification requires the removal of 18 specific identifiers from the protect health information (Marc and Sandefer 2016, 22).

One release of information (ROI) specialist handles requests from insurance and managed care companies. Another handles requests from attorneys and courts. Each completes all steps in the business process from beginning to end. This is an example of which of the following? a. Serial work division b. Job sharing c. Job rotation d. Parallel work division

Correct Answer: D In parallel work division, the same tasks are handled simultaneously by several workers; each completes all steps in the process from beginning to end, working independently of the other employees (Prater 2016, 584).

Which of the following is true about a primary key in a database table? a. Usually is not a unique number b. Changes in value c. Is dependent on the data in the table d. Uniquely identifies each row in a table

Correct Answer: D Primary keys ensure that each row in a table is unique. A primary key must not change in value. Typically, a primary key is a number that is a one-up counter or a randomly generated number in large databases. A number is used because a number processes faster than an alphanumeric character. In large tables, this makes a difference. In the PATIENTS table, the PATIENT_ID is the primary key. It is good programming practice to create a primary key that is independent of the data in a table (Johns 2015, 127-128).

When reviewing the monthly performance report, a manager noticed the coding accuracy rate was below standard. She considered whether this difference might be related to a recent change in systems or attributed to another factor. This manager is performing which of the following? a. Performance measurement b. Workforce planning c. Work observation study d. Variance analysis

Correct Answer: D Reported performance data are regularly analyzed for variance. Variance—where actual performance does not meet, varies, or is significantly different from the standard—should be further assessed (Prater 2016, 588).

A health record technician has been asked to review the discharge patient abstracting module of a proposed new EHR. Which of the following data sets would the technician consult to ensure the system collects all federally required discharge data elements for Medicare and Medicaid inpatients in an acute-care hospital? a. CARF b. DEEDS c. UACDS d. UHDDS

Correct Answer: D The Uniform Hospital Discharge Data Set (UHDDS) data characteristics include patient-specific items on every inpatient (Giannangelo 2016a, 133-134).

The HIM department is developing a system to track coding productivity. The director wants the system to track the productivity of each coder by productive hours worked per day, health record ID, type of records coded, and to provide weekly productivity reports and analyses. Which of the following tools would be best to use for this purpose? a. Word-processing documents b. Paper log book c. Spreadsheet d. Database management system

Correct Answer: D The database management system is the best option to collect, store, manipulate, and retrieve data for this situation. Paper and word-processing documents cannot sort and store the data in a meaningful way for this purpose. Spreadsheets should be used for accounting-type functions and not for data storage (Brinda 2016, 146).

The RHIT supervisor for the filing and retrieval section of Community Clinic is developing a staffing schedule for the year. The clinic is open 260 days per year and has an average of 500 clinic visits per day. The standard for filing records is 50 records per hour. The standard for retrieval of records is 40 records per hour. Given these standards, how many filing hours will be required daily to retrieve and file records for each clinic day? a. 10 hours per day b. 11.11 hours per day c. 12.5 hours per day d. 22.5 hours per day

Correct Answer: D Timeliness of the storage and retrieval processes should be monitored. In this situation, each clinic visit represents a patient record that will need to be retrieved (or pulled) and stored (filed back). The calculation is: (500 / 50) + (500 / 40) = 22.5 hours per day (Sayles 2016b, 66-67).

. An HIM technician is paid an hourly rate and is eligible for overtime pay, consistent with the Fair Labor Standards Act. Her position would be classified as which of the following? a. Exempt b. Nonexempt c. Full-time d. Professional Correct Answer: B Nonexempt employees are covered by FLSA overtime provisions; this includes hourly-paid jobs (Prater 2016, 558).

r

. In this experimental study, blood pressure is taken before and after an experimental medication is used as the intervention in a sample of participants that were previously unable to control their blood pressure with other medications. In this example, the independent variable is the ________ and the dependent variable is the________. a. Experimental medication; blood pressure b. Blood pressure; experimental medication c. Blood pressure; heart disease d. Experimental medication; heart disease Correct Answer: A The independent variable in this example is the intervention used (medication) and the dependent variable is the disease that is being assessed (blood pressure) (Watzlaf 2016, 366).

r

A hospital can monitor its performance under the MS-DRG system by monitoring its: a. Accounts receivable b. Operating costs c. RBRVS payments d. Case-mix index Correct Answer: D A hospital can monitor its performance under the MS-DRG system by monitoring its case-mix index (CMI). The CMI is the average of the relative MS-DRG weights of all cases treated at a given hospital. The CMI can be used to make comparisons between hospitals and to assess the quality of documentation and coding at a particular hospital (Gordon and Gordon 2016a, 441).

r

A newborn is treated for pulmonary valve stenosis, with stretching of the valve opening accomplished via a percutaneous balloon pulmonary valvuloplasty. In ICD-10-PCS, what root operation would be coded for this procedure? a. Alteration b. Dilation c. Repair d. Restriction Correct Answer: B Though the term valvuloplasty in the index leads to Repair, Replacement, or Supplement, this procedure was performed as a percutaneous Dilation. The root operation Dilation is expanding an orifice or the lumen of a tubular body part (Kuehn and Jorwic 2017, 117-118).

r

An HIM supervisor is revising job descriptions for record scanning positions. These positions have been in existence for just over one year. Which of the following would be the most appropriate action to take to make sure all tasks being performed are included in the new job descriptions? a. Ask current staff members to keep a diary for a certain period of time on how they spend their time b. Review job descriptions from other hospitals c. Make random observations of job tasks d. Refer the matter to the human resources department Correct Answer: A Collecting data on current performance and tasks allows the HIM supervisor to include all tasks that are being performed in the new job descriptions. When more than one person is performing a task, the data could be collected over time and averaged. One method of doing this is to keep a diary for a period of time on how they spend their time. The experience and overall performance of each person must be considered in setting the standard (Prater 2016, 588).

r

City Hospital has implemented a procedure that allows inpatients to decide whether they want to be listed in the hospital's directory. The directory information includes the patient's name, location in the hospital, and general condition. If a patient elects to be in the directory, this information is used to inform callers who know the patient's name. Some patients have requested that they be listed in the directory but information is to be released to only a list of specific people the patient provides. A hospital committee is considering changing the policy to accommodate these types of patients. In this case, what type of advice should the HIM director provide? a. Approve the requests because this is a patient right under HIPAA regulations. b. Deny these requests because screening of calls is difficult to manage and if information is given in error, this would be considered a violation of HIPAA. c. Develop two different types of directories—one directory for provision of all information and one directory for provision of information to selected friends and family of the patient. d. Deny these requests and seek approval from the Office for Civil Rights. Correct Answer: B The HIPAA Privacy Rule allows individuals to decide whether they want to be listed in a facility directory when they are admitted to a facility. If the patient decides to be listed in the facility directory, the patient should be informed that only callers who know his or her name will be given any of this limited information. Covered entities generally do not, however, have to provide screening of visitors or calls for patients because such an activity is too difficult to manage with the number of employees and volunteers involved in the process of forwarding calls and directing visitors. If the covered entity agreed to the screening and could not meet the agreement, it could be considered a violation of this standard of the Privacy Rule (Thomason 2013, 105).

r

Community Hospital is implementing a hybrid record. Some documentation will be paper-based and digitally scanned postdischarge. Other parts of the record will be totally electronic. The Medical Record Committee is discussing how interim reports in the health record should be handled. Some on the committee think that all interim reports should be discarded and only the final reports retained in the scanned record. Others take the opposite position. What should the HIM director recommend? a. Maintaining only the final results provides the greatest measure of security. b. Maintain only the interim reports and discard the final reports. c. Maintaining all interim reports provides the greatest measure of security. d. Maintaining only final reports results in a high volume of duplicate reports. Correct Answer: C Maintaining all interim reports provides the greatest measure of security. Managing health information in a hybrid record environment is challenging, but by maintaining the reports, the facility will reduce some potential problems (AHIMA E-HIM Taskforce Report 2010).

r

In developing an internal coding audit review program, which of the following would be risk areas that should be targeted for audit? a. Admission diagnosis and complaints b. Chargemaster description and medical necessity c. Clinical laboratory results d. Radiology orders Correct Answer: B An auditing process identifies risk areas such as chargemaster description, medical necessity, MS-DRG coding accuracy, variations in case mix, and the like. Admission diagnosis and complaints, clinical laboratory results, and radiology orders are not risk areas that should be targeted for audit (Foltz et al. 2016, 458-459).

r

In reviewing a patient chart, the coder finds that the patient's chest x-ray is suggestive of chronic obstructive pulmonary disease (COPD). The attending physician mentions the x-ray finding in one progress note, but no medication, treatment, or further evaluation is provided. Which of the following actions should the coder take in this case? a. Query the attending physician and ask him to validate a diagnosis based on the chest x-ray results b. Code the COPD because the documentation substantiates it c. Query the radiologist to determine whether the patient has the COPD d. Assign a code from the abnormal findings to reflect the condition Correct Answer: A This is an example of a circumstance in which the chronic condition must be verified. All secondary conditions must match the definition in the UHDDS, and whether the COPD does is not clear (Schraffenberger and Palkie 2017, 96-97; Brinda 2016, 163).

r

Patient had a laparoscopic incisional herniorrhaphy for a recurrent reducible hernia. The repair included insertion of mesh. What is the correct code assignment?49560Repair initial incisional or ventral hernia; reducible49565Repair recurrent incisional or ventral hernia; reducible49568Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft-tissue infection49656Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible a. 49565 b. 49565, 49568 c. 49656 d. 49560, 49568 Correct Answer: C Begin with the main term of Hernia repair; incisional. The fact that the hernia is recurrent, done via a laparoscope, and is reducible makes the answer 49656. Notice that the use of mesh is included in the code (Kuehn 2017, 22, 24, 168-170).

r

Suppose that you want to display the number of deaths due to breast cancer for the years 2005 through 2015. What is the best graphic technique to use? a. Table b. Histogram c. Line graph d. Bar chart Correct Answer: C A line graph may be used to display time trends. A line graph is especially useful for plotting a large number of observations. It also allows several sets of data to be presented on one graph (Watzlaf 2016, 351).

r

The Patient Accounting department at Wildcat Hospital is concerned because last night's bill drop contained half the usual number of inpatient cases. Which of the following reports will be most useful in determining the reason for the low volume of bills? a. Accounts receivable aging report b. Accounts not selected for billing report c. Case-mix index report d. Discharge summary report Correct Answer: B The accounts not selected for billing report is a daily report used to track the many reasons that accounts may not be ready for billing. This report is also called the discharged not final billed (DNFB) report. Accounts that have not met all facility-specified criteria for billing are held and reported on this daily tracking list (Schraffenberger and Kuehn 2011, 436).

r

The leader of the coding performance improvement team wants all of her team members to clearly understand the coding process. Which of the following would be the best tool for accomplishing this objective? a. Scatter diagram b. Force-field analysis c. Pareto chart d. Flow chart Correct Answer: D When a team examines a process with the intention of making improvements, it must first understand the process thoroughly. Each team member has a unique perspective and significant insight about how a portion of the process works. Flow charts help all the team members understand the process in the same way (Carter and Palmer 2016, 513).

r

The manager calculated a unit and time productivity statistic based on employee self-reported data. He used the ________ method to develop this performance standard. a. Benchmarking b. Work distribution analysis c. Work measurement d. Workflow analysis Correct Answer: C Work measurement is based on assessment of internal data collected on actual work performed within the organization and the calculation of time it takes to do the work (Prater 2016, 587).

r

The sum of a hospital's relative DRG weights for a year was 15,192, and the hospital had 10,471 discharges for the year. Given this information, what would be the hospital's case-mix index for that year? a. 0.689 b. 0.689 × 100 c. 1.45 × 100 d. 1.45 Correct Answer: D The weight of each diagnosis-related group (DRG) is multiplied by the number of discharges for that DRG to arrive at the total weight for each DRG—in this situation 15,192. The total weights are summed and divided by the number of total discharges to arrive at the case-mix index for a hospital: 15,192 / 10,471 = 1.45 (Horton 2016b, 401).

r

The three elements of a security program are ensuring data availability, protection, and: a. Suitability b. Integrity c. Flexibility d. Robustness Correct Answer: B Data security embodies three basic concepts: protecting the privacy of data, ensuring the integrity of data, ensuring the availability of data (Rinehart-Thompson 2016c, 254).

r

This type of chart plots all data points as a cell for two given variables of interest and, depending on frequency of observations in each cell, provides color to visualize high or low frequency. a. Barplot b. Scatter plot c. Boxplot d. Heatmap Correct Answer: D A heat map plots all data points as a cell for two given variables or interest, and depending on frequency of observations in each cell, provides color to visualize high or low frequency (Kellogg 2016a, 41).

r

Which of the following are components of AHIMA's principles of information governance? a. Accountability and accessibility b. Integrity and safeguards c. Safeguards and accessibility d. Accountability and integrity Correct Answer: D AHIMA defined the following principles to support proper information governance across an organization: accountability, transparency, integrity, protection, compliance, availability, disposition, and retention (Brinda 2016, 150-151).

r

Which of the following can assist managers with the tasks of monitoring productivity and forecasting budgets? a. Intermediary bulletins b. Mapping errors c. Revenue codes d. Workload statistics Correct Answer: D Workload statistics can assist managers with the tasks of monitoring productivity and provide data regarding resources used, such as equipment, personnel, services, and supplies (Schraffenberger and Kuehn 2011, 223).

r

Which of the following ethical principles is being followed when a health information management professional ensures that patient information is only released to those who have a legal right to access it? a. Autonomy b. Beneficence c. Justice d. Nonmaleficence Correct Answer: B Beneficence would require the HIM professional to ensure that the information is released only to individuals who need it to do something that will benefit the patient (for example, to an insurance company for payment of a claim) (Gordon and Gordon 2016c, 604).

r

Which of the following is a principle of contemporary performance improvement? a. Success must never be celebrated as this does not encourage more success. b. Systems never demonstrate variation. c. Performance improvement works by identifying the individuals responsible for quality problems and reprimanding them. d. Performance improvement relies on the collection and analysis of data to increase knowledge. Correct Answer: D Performance improvement (PI) is based on several fundamental principles, including: the structure of a system determines its performance; all systems demonstrate variation; improvements rely on the collection and analysis of data that increase knowledge; PI requires the commitment and support of top administration; PI works best when leaders and employees know and share the organization's mission, vision, and values (Carter and Palmer 2016, 505).

r

Which of the following should be avoided when designing forms for an electronic document management system (EDMS)? a. Color borders around the edge of a form b. Mnemonic descriptor used for nonbarcode recognition engine c. Quarter-inch border on each side of document without bar code d. Shading of bars or lines that contain text Correct Answer: D The use of colored paper or ink other than black, or shading of text in EDMS should be minimized or eliminated because the color can adversely affect the quality of scanned images (Sayles 2016b, 65).

r

he process that is followed to mitigate and fix issues that arise during a review of systems that contain PHI to reduce vulnerabilities is called: a. Risk analysis b. Risk management c. Results documentation d. Recommendations for controls Correct Answer: B One strategy in protecting the organization's data is to establish a risk management program. Risk management encompasses the identification, evaluation, and control of risks that are inherent in unexpected and inappropriate events (Rinehart-Thompson 2016c, 260).

r

Patient is admitted with prepatellar bursitis following a crushing injury to the left knee as a result of being hit by a car two years ago. What diagnosis codes would be assigned for this patient? M70.40 Prepatellar bursitis, unspecified kneeM70.42Prepatellar bursitis, left kneeS87.02xACrushing injury of left knee, initial encounterS87.02xDCrushing injury of left knee, subsequent encounterS87.02xSCrushing injury of left knee, sequela a. M70.40, S87.02xA b. M70.42, S87.02xS c. M70.42, S87.02xD d. M70.40, S87.02xS

r Correct Answer: B The bursitis was the result of the previous crush injury and should be coded as sequela with the seventh character coded as "S" for sequela. The code for the left knee is also used to identify laterality (Schraffenberger and Palkie 2017, 572).

What factor is medical necessity based on? a. The beneficial effects of a service for the patient's physical needs and quality of life 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 reimbursement available for a given service

right Correct Answer: A Medical necessity is based on the effects of a service for the patient's physical needs and quality of life (Fahrenholz 2013a, 81).

A hospital receives a valid request from a patient for copies of her health records. The HIM clerk who is preparing the records removes copies of the patient's records from another hospital where the patient was previously treated. According to HIPAA regulations, was this action correct? a. No; the records from the previous hospital are considered to be included in the designated record set and should be given to the patient. b. Yes; this is hospital policy for which HIPAA has no control. c. No; the records from the previous hospital are not included in the designated record set but should be released anyway. d. Yes; HIPAA only requires that current records be produced for the patient.

right Correct Answer: A When other healthcare providers provide records, it is done to ensure the continuity of care for the individual. Many covered entities either include the whole file or copies of the file as part of the covered entity's record, with the assumption that the treating physician has used some or all of the records to decide how to treat the patient. Any copies that are included with the records of the individual are, therefore, considered part of the individual's designated record set and should be released (Thomason 2013, 99).

A patient is admitted for the treatment of dehydration secondary to chemotherapy for primary liver cancer. IV fluids were administered to the patient. Which of the following should be sequenced as the principal diagnosis? a. Dehydration b. Chemotherapy c. Liver carcinoma d. Complication of chemotherapy

right Correct Answer: A When the admission or encounter is for management of dehydration due to the malignancy and only the dehydration is being treated, the dehydration is sequenced first, followed by the code(s) for the malignancy (Schraffenberger and Palkie 2017, 140).

The HIM director has put together a group of department employees to develop coding benchmarks for the number and types of charts to be coded per work hour. The group includes seven employees from the analysis, transcription, release of information, and coding sections. No managers are included on the team because the HIM director wants a bottom-up approach to benchmark development. What fundamental team leadership mistake is the HIM director making with composition of the team? a. Insufficient knowledge of team members b. Too many team members c. Unspecific team charge d. Too few team members

right Correct Answer: A Whether selecting a permanent staff team or members of a team for a short-term project, making the right choice is fundamental to the team's success. Putting together a team involves understanding the challenges to be faced and considering all of the perspectives, experience, and knowledge that will be needed. The members of the team should be selected for what they can contribute to the team. Member selection should not be based purely on job title; rather, team members should be selected for the tasks that they actually can perform and the responsibilities they can carry out (Kellogg 2016b, 487).

Which tool is used to display performance data over time? a. Status process control chart b. Run chart c. Benchmark d. Time ladder

right Correct Answer: B A run chart displays data points over a period of time to provide information about performance. The measured points of a process are plotted on a graph at regular time intervals to help team members see whether there are substantial changes in the numbers over time (Carter and Palmer 2016, 509-510).

Which of the following is true regarding the reporting of communicable diseases? a. They must be reported by the patient to the health department. b. The diseases to be reported are established by state law. c. The diseases to be reported are established by HIPAA. d. They are never reported because it would violate the patient's privacy.

right Correct Answer: B All states have a health department with a division that is required to track and record communicable diseases. When a patient is diagnosed with one of the diseases from the health department's communicable disease list, the facility must notify the state public health department (Shaw and Carter 2015, 189).

Two patients' records were filed together by mistake. This is an example of: a. Overlap b. Overlay c. Duplicate d. Purge

right Correct Answer: B Another problem with the question of the quality of the MPI is an overlay, where a patient is erroneously assigned another person's health record number. When this happens, patient information from both patients becomes commingled and care providers may make medical decisions based on erroneous information, increasing the legal risks to the healthcare organization and quality of care risks to the patient as well (Sayles 2016b, 58).

A patient was seen in the emergency department for chest pain. It was suspected that the patient may have gastroesophageal reflux disease (GERD). The final diagnosis was "Rule out GERD." The correct ICD-10-CM diagnosis code is: a. K21.9, Gastro-esophageal reflux disease without esophagitis b. R07.9, Chest pain, unspecified c. R10.11, Right upper quadrant pain d. Z03.89, Encounter for observation for other suspected diseases and conditions ruled out

right Correct Answer: B Because this patient was seen only in the emergency department, he or she would be classified as an outpatient. Diagnoses documented as "probable," "suspected," "questionable," "rule out," or "working diagnosis" or other similar terms in the outpatient setting indicate uncertainty and would not be coded as if existing. Rather, code the condition to the highest degree of certainty for that encounter or visit, such as signs, symptoms, abnormal test results, or other reason for the visit. In this case, unspecified chest pain would be coded (Schraffenberger and Palkie 2017, 102).

When data has been lost in an EHR, which action is taken to remedy this problem? a. Build a firewall b. Data recovery c. Review the audit trail d. Develop data integrity plan

right Correct Answer: B Data recovery is the process of recouping lost data or reconciling conflicting data after the system fails. These data may be from events that occurred while the system was down or from backed-up data (Sayles and Trawick 2014, 213).

A patient had a placenta previa with delivery of twins. The patient had two prior cesarean sections. This was an emergency C-section due to hemorrhage. The appropriate principal diagnosis would be: a. Normal delivery b. Placenta previa c. Twin gestation d. Vaginal hemorrhage

right Correct Answer: B In cases of a cesarean delivery, the selection of the principal diagnosis should be the condition established after study that was responsible for the patient's admission. If the patient was admitted with a condition that resulted in the performance of the cesarean procedure, that condition should be selected as the principal diagnosis. If the reason for the admission or encounter was unrelated to the condition resulting in the cesarean delivery, the condition related to the reason for the admission or encounter should be selected as the principal diagnosis even if a cesarean was performed (Schraffenberger and Palkie 2017, 474-475).

Local coverage determinations (LCD) describe when and under what circumstances which of the following is met: a. MACs b. Medical necessity c. NCDs d. Proper administration of benefits

right Correct Answer: B Local coverage determination (LCD) is used to determine coverage on a Medicare Administrative Contractor-wide, intermediary-wide, or carrier-wide basis (rather than nationwide, as with a NCD). LCDs are educational materials that assist facilities and providers with correct billing and claims processing. Within the LCD is a listing of ICD-10-CM codes that indicate what is covered and what is not covered. For example, a procedure may be covered by Medicare, but is not reimbursed by Medicare because it does not meet medical necessity (Casto and Forrestal 2015, 268).

Which of the following specialized patient assessment tools must be used by Medicare-certified home care providers? a. Minimum data set for long-term care b. Outcomes and Assessment Information Set c. Patient assessment instrument d. Resident assessment protocol

right Correct Answer: B Medicare-certified home healthcare uses a standardized patient assessment instrument called the Outcomes and Assessment Information Set (OASIS-C). OASIS-C items are components of the comprehensive assessment that is the foundation for the plan of care (Giannangelo 2015, 254).

Which of the following is a true statement about the content of the legal health record? a. The legal health record contains only clinical data b. The legal health record may contain metadata c. The legal health record should not include e-mail d. The legal health record should not include diagnostic images

right Correct Answer: B Organizations should develop and maintain an inventory of all documents and data that could comprise the legal health record, considering all locations in the organization (for example, separate departments or servers) where such information could be housed. Organizations should also carefully consider whether to include data such as pop-up reminders, alerts, and metadata. Metadata are data about data and include information that track actions such as when and by whom a document was accessed or changed (Rinehart-Thompson 2016a, 206).

Patient care managers use the data documented in the health record to: a. Determine the extent and effects of occupational hazards b. Evaluate patterns and trends of patient care c. Generate patient bills and third-party payer claims for reimbursement d. Provide direct patient care

right Correct Answer: B Patient care managers are responsible for the overall evaluation of services rendered for their particular area of responsibility. To identify patterns and trends, they take details from individual health records and put all the information together in one place (Sayles 2016b, 54).

HHS has identified a healthcare facility guilty of fraud. HHS saw that the facility tried to comply but their efforts failed. What category does this fall into? a. Reasonable cause b. Reasonable diligence c. Willful neglect d. Abuse

right Correct Answer: B Reasonable diligence is when the healthcare provider has taken reasonable actions to comply with the legislative requirements (Foltz et al. 2016, 451).

In designing an input screen for an EHR, which of the following would be best to capture structured data? a. Speech recognition b. Drop-down menus c. Natural language processing d. Document imaging

right Correct Answer: B Structured data are data that are able to be read and interpreted by a computer. Examples of structured data include check boxes, drop-down boxes, and radio buttons (Brinda 2016, 159-160).

Which of the following is considered the authoritative key in locating a health record? a. Disease index b. Master patient index c. Patient directory d. Patient registry

right Correct Answer: B The master patient index (MPI) is the permanent record of all patients treated at a healthcare facility. It is used by the HIM department to look up patient demographics, dates of care, the patient's health record number, and other information (Sayles 2016b, 56-57).

Joe Patient was admitted to Community Hospital. Two days later, he was transferred to Big Medical Center for further evaluation and treatment. He was discharged to home after three days with a qualified transfer DRG from Big Medical Center. Community Hospital will receive from Medicare: a. The full DRG amount, and Big Medical Center will receive a per diem rate for the three-day stay b. A per diem rate for the two-day stay, and Big Medical Center will receive the full DRG payment c. The full DRG amount, and Big Medical Center will bill Community Hospital a per diem rate for the three-day stay d. No payment; Community Hospital must bill Big Medical Center a per diem rate for the two-day stay

right Correct Answer: B There are two types of transfer cases under the inpatient prospective payment system (IPPS). The first category is a patient transfer between two IPPS hospitals. A type 1 transfer is when a patient is discharged from an acute IPPS hospital (Community Hospital in this case) and is admitted to another acute IPPS hospital (Big Medical Center) on the same day. Payment is altered for the transferring hospital and is based on a per diem rate methodology. The transferring facility receives double the per diem rate for the first day plus the per diem rate for each day thereafter for the patient LOS. The receiving facility receives the full PPS payment rate for the case (Casto and Forrestal 2015, 122).

For research purposes, an advantage of the Healthcare Cost and Utilization Project (HCUP) is that it: a. Contains only Medicare data b. Is used to determine pay for performance c. Contains data on all payer types d. Contains bibliographic listings from medical journals

right Correct Answer: C Healthcare Cost and Utilization Project (HCUP) consists of a set of databases that are unique because they include data on inpatients whose care is paid for by all types of payers, including Medicare, Medicaid, private insurance, self-paying, and uninsured patients. Data elements include demographic information, information on diagnoses and procedures, admission and discharge status, payment sources, total charges, length of stay, and information on the hospital or freestanding ambulatory surgery center (Sharp 2016, 188).

The right of an individual to keep personal health information from being disclosed to anyone is a definition of: a. Confidentiality b. Integrity c. Privacy d. Security

right Correct Answer: C In the context of healthcare, privacy can be defined as the right of individuals to control access to their personal health information (Rinehart-Thompson 2016b, 214).

A patient was admitted to the hospital with symptoms of a stroke and secondary diagnoses of COPD and hypertension. The patient was subsequently discharged from the hospital with a principal diagnosis of cerebral vascular accident and secondary diagnoses of catheter-associated urinary tract infection, COPD, and hypertension. Which of the following diagnoses would be reported as POA? a. Catheter-associated urinary tract infection, COPD, Hypertension b. Cerebral vascular accident, COPD, Catheter-associated urinary tract infection c. Cerebral vascular accident, COPD, Hypertension d. Hypertension, Catheter-associated urinary tract infection, Cerebral vascular accident

right Correct Answer: C Present on admission (POA) is defined as present at the time the order for inpatient admission occurs. Conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered present on admission. This patient was not admitted with a catheter-associated urinary infection and so that condition cannot be coded as POA. The patient was admitted with symptoms of a stroke and diagnoses of COPD and hypertension. The CVA was documented after admission, but the symptoms of the stroke were POA, so this condition would be coded as POA (Schraffenberger and Palkie 2017, 85).

An inpatient, acute-care coder must follow official ICD-10-CM and ICD-10-PCS coding guidelines established by the: a. American Health Information Management Association b. American Medical Association c. Centers for Medicare and Medicaid Services d. Cooperating Parties

right Correct Answer: D Coding professionals shall adhere to the ICD coding conventions, official coding guidelines approved by the Cooperating Parties and any other official coding rules and guidelines established for use with mandated standard code sets (Casto and Forrestal 2015, 30-31).

The HIM manager is conducting a study in which she is comparing the current year's diagnosis codes to the proposed new codes for the next fiscal year and documenting variations in order to assess the impact on the organization. This process creates a: a. Data chargemaster report b. Data dictionary c. Database management system d. Data map

right Correct Answer: D Data mapping is a process that allows for connections between two systems. For example, mapping two different coding systems to show the equivalent codes allows for data initially captured for one purpose to be translated and used for another purpose (Brinda 2016, 148).

In CPT, if a patient has two lacerations of the arm that are repaired with simple closures, which of the following would apply for correct coding? a. Two CPT codes, one for each laceration b. One CPT code for the largest laceration c. One CPT code for the most complex closure d. One CPT code, adding the lengths of the lacerations together

right Correct Answer: D The length of multiple laceration repairs located in the same classification are added together and one code is assigned (Smith 2017, 70).

Standardizing medical terminology to avoid differences in naming various health conditions and procedures (such as the synonyms bunionectomy, McBride procedure, and repair of hallux valgus) is one purpose of: a. Content and structure standards b. Security standard c. Transaction standards d. Vocabulary standards

right Correct Answer: D Vocabulary standards are a list or collection of clinical words or phrases with their meanings; also the set of words used by an individual or group within a particular subject field, such as to provide consistent descriptions of medical terms for an individual's condition in the health record (Russo 2013b, 317; Fahrenholz and Russo 2013, 715).

64. From the information provided, how many APCs would this patient have?Billing NumberStatus IndicatorCPT/HCPCSAPC998323V99285-250612998323T255000044998323X720500261998323S721280283998323S704500283 a. 1 b. 4 c. 5 d. Unable to determine Correct Answer: C Each HCPCS code is assigned to one and only one ambulatory payment classification (APC). The APC assignment for a procedure or services does not change based on the patient's medical condition or the severity of illness. There may be an unlimited number of APCs per encounter for a single patient. The number of APC assignments is based on the number of reimbursable procedures or services provided for that patient. In this instance, the patient has five APCs (Casto and Forrestal 2015, 173).

see pic

Assign codes for the following scenario: A 35-year-old male is admitted with esophageal reflux. An esophagoscopy and closed esophageal biopsy were performed. K20.9Esophagitis, unspecifiedK21.0Gastro-esophageal reflux disease with esophagitisK21.9Gastro-esophageal reflux disease without esophagitis

see pic

City Hospital's Revenue Cycle Management team has established the following benchmarks: (1) The value of discharged not final billed cases should not exceed two days of average daily revenue, and (2) AR days are not to exceed 60 days. The net average daily revenue is $1,000,000. The following data indicate that City Hospital's DNFB cases met its benchmarks:

see pic