RHIA Domain 4 Test Questions with 100% Correct Solutions | Latest Update
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Course
RHIA Domain 4
Institution
RHIA Domain 4
In the APC system, a high-cost outlier payment is paid when which of the following
occurs?
a. The cost of the service is greater than the APC payment by a fixed ratio and exceeds
the APC payment plus a threshold amount.
b. The LOS is greater than expected.
c. The charges for the services provi...
RHIA Domain 4 Test Questions with 100%
Correct Solutions | Latest Update
. In the APC system, a high-cost outlier payment is paid when which of the following
occurs?
a. The cost of the service is greater than the APC payment by a fixed ratio and exceeds
the APC payment plus a threshold amount.
b. The LOS is greater than expected.
c. The charges for the services provided are greater than the expected payment.
d. The total cost of all the services is greater than the sum of APC payments by a fixed
ratio and exceeds the sum of APC payments plus a threshold amount. - Answer Answer:
A
An outlier payment is paid when the cost of the service is greater than the ambulatory
payment classification (APC) payment by a fixed ratio and exceeds the APC payment
plus a threshold amount (Casto and Forrestal 2015, 175).
What are elements found in a charge description master? - Answer The charge
description master contains elements such as department and item number, item
description, revenue code, HCPCS code, price, and activity status
The accounts receivable collection cycle involves the time from: - Answer Admission to
deposit in the bank
The Medicare programs that encourage patients to review provider bills carefully and to
report any discrepancies to the Secretary of HHS are called:
, Beneficiary incentive programs - Answer Beneficiary incentive programs encourage
Medicare beneficiaries to review their bills for discrepancies. QIO reviews can be
prompted by a Medicare beneficiary through a complaint or a request for appeal, by
federal agencies, or as a routine review of care and billing patterns under the Medicare
program. All of these functions are referred to as "case review"
Using the information provided, if the physician is a non-PAR who accepts assignment,
how much can he or she expect to be reimbursed by Medicare?
Physician's normal charge = $340
Medicare Fee Schedule = $300
Patient has met his deductible - Answer Nonparticipating providers (nonPARs) do not
sign a participation agreement with Medicare but may or may not accept assignment. If
the nonPAR physician elects to accept assignment, he or she is paid 95 percent (5
percent less than participating physicians) of the Medicare fee schedule (MFS). For
example, if the MFS amount is $200, the PAR provider receives $160 (80 percent of
$200), but the nonPAR provider receives only $152 (95 percent of $160). In this case the
physician is nonparticipating so he or she will receive 95 percent of the 80 percent of
the MFS or 80 percent of 300, which is $240; 95 percent of the $240 is $228
A patient is admitted to the hospital with shortness of breath and congestive heart
failure. The patient undergoes intubation with mechanical ventilation. The final
diagnoses documented by the attending physician are: Congestive heart failure,
mechanical ventilation, and intubation. Which of the following actions should the coder
take in this case?
a. Code congestive heart failure, respiratory failure, mechanical ventilation, and
intubation
b. Query the attending physician as to the reason for the intubation and mechanical
ventilation to add as a secondary diagnosis
c. Query the attending physician about the adding the symptom of shortness of breath
as a secondary diagnosis
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