RHIA Domain 4 Test Questions with 100% Correct Solutions | Latest Update
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Course
RHIA Domain 4
Institution
RHIA Domain 4
Medicare Prescription Drug Plan: covers the cost of prescription drugs. Deductibles,
cost, and coverage vary; the beneficiary pays a monthly premium, a deductible, and part
of the cost of the drug. - Answer Medicare Part D
__________ is a joint program of the federal and state government that pr...
RHIA Domain 4 Test Questions with 100%
Correct Solutions | Latest Update
Medicare Prescription Drug Plan: covers the cost of prescription drugs. Deductibles,
cost, and coverage vary; the beneficiary pays a monthly premium, a deductible, and part
of the cost of the drug. - Answer Medicare Part D
__________ is a joint program of the federal and state government that provides health
care for individuals who receive welfare, low-income pregnant women, and poor
children. Each state determines qualification criteria, such as income levels, but the
state must comply with federal guidelines. Secondary to individual state involvement,
reimbursement for services also varies among the states. In some areas, joining
managed care plans are encouraged. - Answer Medicaid
________is healthcare coverage for active and retired military personnel and their
dependents. Originally known as the Civilian Health and Medical Program for the
Uniformed Services (CHAMPUS). - Answer Tricare
________is managed by individual state insurance laws. Medical expenses, lost income,
and lost professional skills are considerations for coverage. Work-related illnesses and
death benefits for survivors are also included. - Answer Worker's compensation
______uses cost-based relative weights that demonstrate increased clinical complexity
and greater variations in the relative weights. This system includes both comorbidities &
complications (CCs) and major comorbidities & compliations (MCCs) that impact the MS-
DRG assignment. - Answer MS_DRG's
Status N: Items and services packaged into APC rates
Status T: Significant procedure, multiple reduction applies
Status X: Ancillary Service
,Are used for OPPS________ - Answer APC's
Y Diagnosis present at time of admission
N Diagnosis not present at time of admission
U Insufficient documentation to identify if present on admission
W Clinically undetermined
1 Exempt from POA reporting
Are use to report: - Answer present on admission
A prepaid fixed amount paid to the provider regardless of whether healthcare services
were utilized is ________. - Answer capitation
The type of healthcare option which requires voluntary enrollment by the subscriber is
a(n) ________. - Answer HMO
In low-income areas, a patient may pay for healthcare services depending on their
ability to pay for services. This is known as ________. - Answer sliding scale
The Medicare medical insurance that requires voluntary enrollment and a monthly
premium to assist in payment for physician services is ________. - Answer Medcare Part
B
The managed care organizations in which physicians can provide services to both MCO
subscribers and non-MCO subscribers is the ________. - Answer IPA
, ______________may be voluntary; however, it gives the healthcare organization
credibility within the industry. Accreditation is often regarded as a key benchmark for
comparing and measuring quality of patient care. - Answer Accreditation
Accreditation for managed care organizations is______ - Answer National Committee
for Quality Assurance (NCQA)
an accreditation organization who has accreditation standards for a number of
healthcare settings including hospitals. - Answer The Joint Commission (TJC)
accreditation organization who focuses only on hospitals. - Answer Det Norske Veritas
(DNV)
Accreditation organization for rehab facilities - Answer Commission on Accreditation of
Rehabilitation Facilities (CARF)
For a healthcare organization to participate in and receive reimbursement from federal
payers such as Medicare or Medicaid programs, the organization must demonstrate
compliance with the Conditions of Participation (CoP) by receiving a _______ status. -
Answer deemed
organization who accredits osteopathic hospitals - Answer American Osteopathic
Association (AOA) Hospital Accreditation Program
What 3 organizations does CMS recognize for accreditation? - Answer Joint Commission
DNV
AOA
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