AHIMA AHIMA Certifications RHIA Questions & Answers

• Question 1511:

  The MS-DRG (Medicare Severity--Diagnosis-Related Group) system was designed to pay

  A. multiple groups of reimbursement based on each diagnosis.

  B. only one amount (group) of reimbursement per hospitalization.

  C. multiple group of reimbursement based on the per diem rates.

  D. multiple groups of reimbursement based on the principal diagnosis and the most substantial comorbidity

  Correct Answer: B

• Question 1512:

  How many major diagnostic categories are there in the MS-DRG system?

  A. 29

  B. 20

  C. 19

  D. 25

  Correct Answer: D

• Question 1513:

  The prospective payment system based upon resource utilization groups (RUGs) is used for reimbursement to ________________ for Medicare patients.

  A. freestanding ambulatory surgery centers

  B. hospital-based outpatients

  C. intermediate care facilities

  D. skilled nursing facilities

  Correct Answer: D

• Question 1514:

  The ______________ is a statement sent to the provider to explain payments made by third party payers.

  A. remittance advice.

  B. advance beneficiary notice.

  C. attestation statement.

  D. acknowledgement notice.

  Correct Answer: A

• Question 1515:

  The prospective payment system to hospitals for Medicare hospital s outpatients is called ___ and became effective on _________

  A. APGs, October 1,2000.

  B. RBRVS, January 1,2000.

  C. APCs, August 1,2000.

  D. DRGs, October 1,1983.

  Correct Answer: C

• Question 1516:

  A patient was seen by Dr. Zachary. The charge for the office visit was $125. The Medicare beneficiary had already met his deductible. The Medicare fee schedule amount is $100. Dr. Zachary does not accept assignment. The office manager will apply a practice termed as "balance billing," which means that the patient is

  A. financially liable for the Medicare fee schedule amount.

  B. financially liable for charges in excess of the Medicare fee schedule.

  C. not financially liable for any amount.

  D. is financially liable for the entire charge for the office visit.

  Correct Answer: B

• Question 1517:

  Under the RBRVS, each HCPCS/CPT code contains 3 components, each having assigned relative value units. These 3 components are

  A. geographic index, wage index, and cost of living index.

  B. fee-for-service, per diem payment, and capitation.

  C. conversion factor, CMS weight, and hospital-specific rate.

  D. physician work, practice expense, and malpractice insurance expense.

  Correct Answer: D

• Question 1518:

  ____________ indicates that the claim has been released as a complete for submission to the insurer for payment.

  A. bill drop.

  B. account receivables.

  C. bill hold.

  D. concurrent review.

  Correct Answer: A

• Question 1519:

  All of following items are packaged under the Medicare outpatient prospective payment system, EXCEPT for

  A. recovery room.

  B. supplies.

  C. anesthesia.

  D. medical visits.

  Correct Answer: D

• Question 1520:

  The prospective payment system used to reimburse home health agencies for Medicare patients utilizes data from

  A. MDS (Minimum Data Set).

  B. OASIS (Outcome and Assessment Information Set).

  C. UHDDS (Uniform Hospital Discharge Data Set).

  D. UACDS (Uniform Ambulatory Core Data Set).

  Correct Answer: B