Rhia domain 4 Study guides, Class notes & Summaries

RHIA Domain 4 Practice Exam Questions and Answers All Correct The process in which a healthcare entity addresses the provider documentation issues of legibility, completeness, clarity, consistency, and precision is called: a. Query process b. Release of information process c. Coding process d. Case-finding process - Answer-A Healthcare entities should consider a policy in which queries may be appropriate when documentation in the patient record fails to meet one of the following five cri...

RHIA domain 4 Exam with Complete Solutions The coder assigned separate codes for individual tests when a combination code exists. This is an example of which of the following? a. Upcoding b. Complex coding c. Query d. Unbundling - Answer-d. Unbundling Community Hospital implemented a clinical document improvement (CDI) program six months ago. The goal of the program was to improve clinical documentation to support quality of care, data quality, and HIM coding accuracy. Which of the follo...

RHIA DOMAIN 4 EXAM QUESTIONS AND ANSWERS What 3 organizations does CMS recognize for accreditation? - Answer-Joint Commission DNV AOA This certification process is conducted by a state agency, usually the Department of Health and Human Services, on behalf of the Centers for Medicare and Medicaid Services (CMS).Some states and Medicare accept accreditation from specific accreditation organizations as the basis for partial or full licensure. This policy is called _____________ - Answer-deeme...

RHIA Domain 4 2024 Test Questions with Correct Answers What is coordination of benefits? - Answer-In many instances, patients have more than one insurance policy and the determination of which policy is primary and which is secondary is necessary so that there is no duplication in payment of benefits. This process is called coordination of benefits Data-mining efforts of recovery audit contractors (RAC) allow them to deny payments without ever reviewing a health record based on the informati...

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 reaso...

RHIA Domain 4 Exam Questions with Complete Solutions Medicare administrative contractors - Answer-Multistate, regional, contractors responsible for administering both Medicare Part A & Part B claims Quality Improvement organization - Answer-Reviews inpatient hospital claims to prevent improper payment through DRG upcoming (Medicare) Outpatient code editor - Answer-A software program linked to the correct coding initiative that applies a set of logical rules to determine whether various ...

RHIA Domain 4 Practice Test with Complete Solutions A patient is admitted to the hospital with shortness of breath and congestive heart failure. The patient undergoes intubation with mechanical ventilation. The final diagnosis documented by the attending are: Congestive heart failure, mechanical ventilation, and intubation. Which of the following actions should the coder take in this case? - Answer-Query the attending physician as to the reason for the intubation and mechanical ventilation to...

RHIA Domain 4 Test with Compete Solutions Preliminary Step in Strategy Planning - Answer-Conduct an internal environment assessment Graph Analysis - Answer-Can only look at numbers, don't put in analysis for answers Rise in satisfaction after EHR - Answer-Don't assume it's bc of EHR, do more research Negatives of Using Mean - Answer-Influenced by outliers Errors in MPI - Answer-Billing Problems Due Diligence - Answer-Checking references Convenience Sample - Answer-Surveying...

A coder notes that the patient is taking prescribed Haldol. The final diagnoses on the progress notes include diabetes mellitus, acute pharyngitis, and malnutrition. What condition might the coder suspect the patient has that the physician should be queried to confirm? - Answer Mental or behavior problems In conducting a qualitative review, the clinical documentation specialist sees that the nursing staff has documented the patient's skin integrity on admission to support the presence of ...

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 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 Communit...