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RHIA Domain 4 Exam | Questions And Answers Latest {} A+ Graded | 100% Verified
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RHIA Domain 4 Exam | Questions And Answers Latest {} A+ Graded | 100% Verified
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RHIA Domain 4 Exam | Questions And Answers Latest {2024- 2025} A+ Graded | 100%Verified
Part of the coding supervisor's responsibility is to review accounts that have not been final billed due to
errors. One of the accounts on the list is a same-day procedure. Upon review, the coding supervisor
notices that the charge code on the bill was hard-coded. The ambulatory procedure coder added the
same CPT code to the abstract. How should this error be corrected?
a. Delete the code from the CDM because it should not be there.
b. Refer the case to the chargemaster coordinator.
c. Force a final bill on the accounts since the duplication will not affect the UB-04.
d. Remove the code from the abstract and counsel the coder regarding CDM hard codes in this service. -
Answer: D
If a service is hard-coded into the charge description master (CDM), it is important that this decision is
communicated to the coding staff. If the decision is not effectively communicated, the result could be
duplicate billing that in turn could result in overpayment to the facility
What are the distinctions between hard and soft coding? - Coding occurs in two ways: hard coding and
soft coding. Hard coding is when codes are assigned by the CDM without human intervention, whereas
soft coding is when codes are manually assigned by a coding specialist.
Exploding charges - The charge description master can provide a method for grouping items that are
frequently reported together. Items that must be reported separately but are used together, such as
interventional radiology imaging and injection procedures, are called exploding charge
Reviewing claims to ensure appropriate coding for deserved payments is one method of:
a. Achieving legitimate optimization
b. Improving documentation
c. Ensuring compliance
d. Using data monitors - Answer: A
, When coders "optimize" the coding process, they attempt to make coding for reimbursement as
accurate as possible. In this way, the healthcare facility can obtain the highest dollar amount justified
within the terms of the government program or the insurance policy involved
In terms of grouping and reimbursement, how are the MS-LTC-DRGs and acute-care MS-DRGs similar?
a. Relative weights
b. Based on principal diagnosis
c. Categorization of low-volume groups into quintiles
d. Classification of short-stay outliers - Answer: B
Under RBRVS, which elements are used to calculate a Medicare payment? - Work
Value
Practice expenses
Which of the following can be a tool for recovery audit contractors' (RAC) preparation because they
outline the hospital's Medicare payment patterns compared to other hospitals in the state?
a. PEPPER
b. HITECH
c. HIPAA
d. MEDPAR - Answer: A
Hospitals should take the opportunity to review old Program for Evaluation Payment Patterns Electronic
Reports (PEPPERs) to identify those claims that could be targeted by the recovery audit contractors
(RACs)
In the HHPPS system, which home healthcare services are consolidated into a single payment to home
health agencies? - Under the home health prospective payment system (HHPPS), CMS has accounted for
nonroutine medical supplies, home health aide visits, medical social services, and nursing and therapy
services (Casto and Forrestal 2015, 235).
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