RHIA Domain 4 Exam Questions with Correct Answers
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 reim...
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
Skilled nursing facility services are covered under Medicare Part A. Under this benefit
Medicare beneficiaries are eligible for up to ____ days of SNF-covered services per
benefit period? - Answer-100
, Reimbursement for minor ancillary services associated with a significant procedure are
combined into a single payment for the procedure. This is the definition of _________. -
Answer-Packaging
The methodology used for critical care services, imaging, and mental health services
that results in composite APCs is ______________. - Answer-Bundling
Which of the following software programs is used to execute packaging logic for the
Medicare Hospital Outpatient Payment System? - Answer-The Outpatient Code Editor
(OCE) is an editing system created and maintained by CMS to process outpatient
facility claims. The OCE edits identify incorrect and inappropriate coding of these
claims.
Under the OPPS, outpatient services that are similar both clinically and in use of
resources are assigned to separate groups called ____. - Answer-DRGs
Ambulatory payment classifications (APCs) are a classification system for outpatient
services. APCs are similar to DRGs. Both APCs and DRGs cover only the hospital fees,
and not the professional fees, associated with a hospital outpatient visit or inpatient
stay.
Which of the following modifiers is included in the interrupted services provision under
OPPS? - Answer-73
In Medicare's resource-based relative value scale resource assignment system, to
which type of code has a relative value unit been assigned? - Answer-Healthcare
Common Procedure Coding System
Which element of the relative value unit accounts for the operational costs of delivering
healthcare services, such as rent, wages of technical personnel, and supplies and
equipment? - Answer-Practice expense
Which element of the relative value unit accounts for the physician effort (mental effort
and judgement, technical skill, physical effort, and psychological stress)? - Answer-
Physician work
Which program is an incentive program for physicians and eligible clinicians that links
payment to quality measures and cost-saving goals? - Answer-Quality Payment
Program (QPP)
The Medicare Physician and Other Health Professional Payment system include
payment adjustments for special circumstances. Which special circumstance results in
the MPFS amount to be paid at 150 percent? - Answer-Bilateral procedures
Which of the following is the purpose of a patient financial responsibility agreement? -
Answer-An agreement between a patient and a provider to ensure that the patient
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