RHIA Domain 4 Exam Study Questions with 100% Correct Solutions | Latest Update
1 view 0 purchase
Course
RHIA Domain 4
Institution
RHIA Domain 4
What is the term for the set fee that a policyholder or certificate holder must
periodically pay a health insurance plan in return for healthcare coverage? - Answer
Premium
All of the following occurrences are considered "qualifying life events" except: - Answer
Car accident
All of the followi...
RHIA Domain 4 Exam Study Questions with
100% Correct Solutions | Latest Update
What is the term for the set fee that a policyholder or certificate holder must
periodically pay a health insurance plan in return for healthcare coverage? - Answer
Premium
All of the following occurrences are considered "qualifying life events" except: - Answer
Car accident
All of the following activities are steps in medical necessity and utilization review except:
Initial clinical review
Peer clinical review
Appeal consideration
Administrative review - Answer Administrative review
What is the term that means evaluating, for a healthcare service, the appropriateness of
its setting and its level of service? - Answer Utilization review
Which part of the Medicare program does not include include a premium? - Answer Part
A
The coverage gap, which is a period of expanded cost-sharing, is applicable to which
part of Medicare? - Answer Part D
Which government-sponsored program provides coverage for active-duty service
members of the armed forces (ADSM)? - Answer TRICARE
, Dr. McGee is a primary care physician. Several of Dr. McGee's patients are insured by
Super Payer. Super Payer reimburses Dr. McGee for each service she provides during a
clinic visit. Which reimbursement methodology does Super Payer use to reimburse Dr.
McGee? - Answer Fee schedule
Dayna is analyst at Community Hospital. She is examining inpatient cases for the payer
Super Payer. She notices that all pneumonia cases have the reimbursement amount of
$4,000 and that all CHF cases have a reimbursement rate of $4,200. The reimbursement
is consistent for the entire year. Which reimbursement methodology is Super Payer
using to reimbursement Community Hospital for inpatient admissions? - Answer Case-
rate methodology
CMS uses this reimbursement methodology when they contract with Medicare
Advantage Payers to care for Medicare beneficiaries under Medicare Part C. - Answer
Capitation
CMS uses which reimbursement methodology for inpatient psychiatric facility services
payment system because a specific payment rate is established for each day of the
admission? - Answer Per diem
The MS-DRG classification system is hierarchical. Which of the following is the highest
level in the hierarchy? - Answer Major Diagnostic Categories
In which government publication are the details about the various PPS introduced,
commented on, and finalized? - Answer Federal Register
In MS-DRGs, the case-mix index is a proxy for what? - Answer Consumption of resources
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Examsplug. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $12.49. You're not tied to anything after your purchase.
