AHIMA AHIMA Certifications RHIA Questions & Answers

• Question 1411:

  A patient is admitted for a diagnostic workup for cachexia. The final diagnosis is malignant neoplasm of lung with metastasis.

  A. Y

  B. N

  C. U

  D. W

  Correct Answer: A

• Question 1412:

  A patient undergoes outpatient surgery. During the recovery period, the patient develops a trial fibrillation and is subsequently admitted to the hospital as an inpatient.

  A. Y

  B. N

  C. U

  D. W

  Correct Answer: A

• Question 1413:

  The centers for Medicare and Medicaid Services (CMS) will make an adjustment to the MSDRG payment the hospital stay. Therefore hospitals are required to report an ____________ indicator for each diagnosis.

  A. sentinel event

  B. payment status

  C. hospital acquired

  D. present on admission

  Correct Answer: D

• Question 1414:

  A HIPPS (Health insurance Prospective Payment System) code is a five-character alphanumeric code. A HIPPS code is used by

  A. ambulatory surgery centers (ASCs).

  B. home health agencies (HHAs).

  C. inpatient rehabilitation facilities (IRFs).

  D. both B and C.

  Correct Answer: D

• Question 1415:

  Targeted states (California, Flordia, and New York) with a large Medicare population were included in a Medicare payment recovery demonstration project. This project's purpose was to determine if the use of ___________ is a cost-effective means of ensuring correct payments are provided under Medicare. These are charged with identifying underpayments and overpayments for claims filed under Medicare Part A and Part B. They recoup overpayments from the providers.

  A. clinical data abstraction centers (CDAC)

  B. quality improvement organizations (QIO)

  C. recovery audit contractors (RAC)

  D. peer review organizations (PRO)

  Correct Answer: C

• Question 1416:

  The Quality Improvement Organizations (QIO) are given hospital-specific data from the Hospital Payment Monitoring Program (HPMP). Hospital data is provided to the QIOs for fourteen target areas on a quarterly basis. This report is called the

  A. Program for Evaluation Payment Patterns Electronic Report (PEPPER).

  B. Payment Error Prevention program (PEP).

  C. Office of Inspector General (OIG) Workplan.

  D. National Correct Coding Initiative (NCCI).

  Correct Answer: A

• Question 1417:

  These services are those performed by a nonphysician practitioner (such as a Physician Assistant) that are an integral yet incidental component of a physician's treatment for illness or injury. A physician must have personally performed an initial visit and must remain actively involved in the continuing care to the patient. Medicare requires direct supervision for these services to be billed.

  A. "technical component" billing.

  B. "assignment" billing.

  C. "incident to" billing.

  D. "assistant" billing.

  Correct Answer: C

• Question 1418:

  The difference between a rejected claim and a denied claim is that

  A. a rejected claim is sent back to the provider; errors may be corrected and the claim resubmitted.

  B. a denied claim is sent back to the provider; errors may be corrected and the claim resubmitted.

  C. a rejected claim may be appealed, but a denied claim may not be appealed.

  D. if a procedure or service is unauthorized, the claim will be rejected, not denied.

  Correct Answer: A

• Question 1419:

  Fee schedules are updated by third party payers

  A. monthly

  B. weekly

  C. annually

  D. semiannually

  Correct Answer: C

• Question 1420:

  Commercial insurance plans usually reimburse health care providers under some type of __________ payment system, whereas the federal Medicare program uses some type of ___________ payment system.

  A. prospective, retrospective

  B. retrospective, concurrent

  C. retrospective, prospective

  D. prospective, concurrent

  Correct Answer: C