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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%
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APC acronym - Ambulatory Patient Classification



APC is used in place of _____ for outpatient prospective systems - DRGs



APG acronym - Ambulatory Patient Groups



Visit based outpatient classification system designed to explain the amount and type of resources used
in the ambulatory setting - APG



Rule requiring Medicare to bundle all outpatient services provided by a hospital to a patient within three
days before admission into the DRG payment for that patient - three day payment window



Payment status indicators are assigned to every ______ code - HCPCS/CPT



an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof
- sentinel event



_____________ was developed based on a federal mandate to Medicare to stop paying for conditions
that hospitals cause or allow to develop during inpatient stays. - POA indicator



Preventable medical error resulting in serious consequences for the patient. - Never events



MS-DRG acronym - Medicare Severity Diagnosis Related Groups



How many major diagnostic categories are there? - 25



Part of Medicare that pays for inpatient care, skilled nursing facility care, skilled home healthcare, and
hospice care - A

, Part of Medicare that pays for physician services, outpatient hospital services, medical equipment, and
other supplies and services - B



Part of Medicare that private health insurance companies contract with CMS to offer Medicare
beneficiaries Medicare Advantage plans that compete with the Original Medicare Plan - C



MMA acronym - Medicare Modernization Act



Part of Medicare that is authorized under the MMA and provides voluntary Medicare prescription drug
plans that are open to people who are eligible for Medicare - D



Difference between Medicare and Medicaid - Medicare is a federal program that provides health
coverage if you are 65 or older or have a severe disability, no matter your income. Medicaid is a state
and federal program that provides health coverage if you have a very low income.



Government contractor that processes claims - fiscal intermediary



Where is CMS headquartered? - Baltimore, Maryland



MACs acronym - Medicare Administrative Contractors



Contractor who handles claims and related functions for Part A and B - MACs



MPFS acronym - Medicare Physician Fee Schedule



Medicare Physician Fee Schedule amounts are ___ percent higher than for nonparticipating providers - 5



Decisions by MACs about the coding and medical necessity of a service - LCD



Policy stating whether and under what circumstances a service is covered - NCD

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