AHIMA AHIMA Certifications RHIA Questions & Answers

• Question 1451:

  The following coding system(s) /are utilized in the MS-DRG prospective payment methodology for assignment and proper reimbursement.

  A. HCPCS/CPT codes

  B. ICD-9-CM codes

  C. both HCPCS/CPT codes and ICD-9-CM codes

  D. none of the above

  Correct Answer: B

• Question 1452:

  Accounts Receivable (A/R) refers to

  A. cases that have not yet been paid.

  B. the amount the hospital was paid.

  C. cases that have been paid.

  D. denials that have been returned to the hospital.

  Correct Answer: A

• Question 1453:

  This document is published by the Office of Inspector General (OIG) every year. It details the OIG's focus for Medicare fraud and abuse for that year. It gives health care providers an indication of general and specific areas that are targeted for review. It can be found on the Internet on CMS' Web Site.

  A. The OIG's Evaluation and Management Documentation Guidelines

  B. The OIG's Model Compliance Plan

  C. The Federal Register

  D. The OIG's Workplan

  Correct Answer: D

• Question 1454:

  When billing for the admitting physician for a patient that is admitted to the hospital as an inpatient, one must use a CPT Evaluation and Management code based upon the level of care provided. These are the codes to be selected from for initial hospital care.99221 Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components.

  a detailed or comprehensive history a detailed or comprehensive examination and -medical decision making that is straightforward or of low complexity. 99222 Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components. a comprehensive history a comprehensive examination and -medical decision making of moderate complexity 99223 Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components. a comprehensive history a comprehensive examination and -medical decision making of high complexity The following statement is true.

  A. This code can be used only once per hospitalization.

  B. This code can be used by the admitting physician or consulting physician.

  C. This code can be used for patients admitted to observation status.

  D. This code can be used by the hospital to bill for facility services.

  Correct Answer: A

• Question 1455:

  In the managed care industry, there are specific reimbursement concepts, such as "capitation." All of the following statements are true in regard to the concept of "capitation," EXCEPT

  A. each service is paid based upon the actual charges.

  B. the volume of services and their expense does not affect reimbursement.

  C. capitation means paying a fixed amount per member per month.

  D. captions involves a group of physicians or an individual physician.

  Correct Answer: A

• Question 1456:

  This is a ten digit, intelligence-free, numeric identifier designed to replaced all previous provider legacy numbers. This number identifies the physician universally to all payers. This number is issued to all HIPAA-covered entities. It is mandatory on the CMS1500 and UB-04 claim forms.

  A. National Practitioner Databank (NPD)

  B. Universal Physician Number (UPN)

  C. Master Patient Index (MPI)

  D. National Provider Identifier (NPI)

  Correct Answer: D

• Question 1457:

  Under APCs, payment status indicator "C" means

  A. ancillary services.

  B. inpatient only service.

  C. multiple procedure reduction applies.

  D. multiple procedure reduction does not apply.

  Correct Answer: B

• Question 1458:

  Under APCs, payment status indicator "S" means

  A. ancillary services.

  B. medical visits.

  C. multiple procedure reduction applies.

  D. multiple procedure reduction does not apply.

  Correct Answer: D

• Question 1459:

  Under APCs, payment status indicator "T" means

  A. ancillary services.

  B. medical visits.

  C. multiple procedure reduction applies.

  D. multiple procedure reduction does not apply.

  Correct Answer: C

• Question 1460:

  Under APCs, payment status indicator "V" means

  A. ancillary services.

  B. medical visits.

  C. inpatient procedure.

  D. multiple procedure reduction does not apply.

  Correct Answer: B