AHIMA AHIMA Certifications RHIA Questions & Answers

• Question 1501:

  Based on this patient volume, the MS-DRG which brings in the highest total reimbursement to the hospital is

  A. 470.

  B. 247.

  C. 392.

  D. 871.

  Correct Answer: A

• Question 1502:

  The case-mix index (CMI) for the top 10 MS-DRGs above is

  A. 1.164.

  B. 1.278.

  C. .7823.

  D. 1.097.

  Correct Answer: B

• Question 1503:

  Under ASCs, bilateral procedures are reimbursed at _______ of the payment rate for their group

  A. 50%

  B. 100%

  C. 200%

  D. 150%

  Correct Answer: D

• Question 1504:

  According to the Federal Register, the definition of a "new" patient when assigning a CPT Evaluation and Management (medical visit) code to a Medicare hospital outpatient under the prospective payment system is a patient that has

  A. not seen the physician within the last 3 years.

  B. not seen the physician within the last 5 years.

  C. not already been assigned a medical record number.

  D. never seen the physician before.

  Correct Answer: C

• Question 1505:

  Which of the following best describes the situation of a provider who agrees to accept assignment for Medicare Part B services?

  A. The provider is reimbursed at 15% above the allowed charge.

  B. The provide is paid according to the Medicare physician fee schedule (MPFS) plus 10%.

  C. The provider cannot bill the patients for the balance between the MPFs amount and the total charges.

  D. The provider is a nonparticipating provider.

  Correct Answer: C

• Question 1506:

  Currently, payment to the physician for outpatient surgery performed ona Medicare patient is based upon which prospective payment system?

  A. set of categories.

  B. classification system.

  C. medical nomenclature.

  D. diagnosis listing.

  Correct Answer: C

• Question 1507:

  The ________________ refers to a statement sent to the patient to clarify which services were provided, amount billed, and amount of payments made by the health plan.

  A. Medicare summary notice.

  B. remittance advice.

  C. health care claims transaction.

  D. coordination of benefits.

  Correct Answer: A

• Question 1508:

  Under ASCs, when multiple procedures are performed during the same surgical session, a payment reduction is applied. The procedure in the highest level group is reimbursed at ____ (percent) and all remaining procedures are reimbursed at ____(percent).

  A. 50$, 25%.

  B. 100%, 50%.

  C. 100%, 25%.

  D. 100%, 75%.

  Correct Answer: B

• Question 1509:

  The standard claim from used by hospitals to request reimbursement for inpatient and outpatient procedures performed or services provided is called the

  A. UB-04.

  B. CMS-1500.

  C. CMS-1491.

  D. CMS-1600.

  Correct Answer: A

• Question 1510:

  A computer software program that assigns appropriate MS-DRGs according to the information provided for each episode of care is called a(n)

  A. encoder.

  B. case-mix analyzer.

  C. grouper.

  D. DRG creeper.

  Correct Answer: C