RHIT 9th Edition Domain 5 Practice Questions and Tips

10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequences.… 1/23 Your work has been saved and submitted Written Oct 17, 2023 11:33 PM - Oct 17, 2023 11:54 PMAttempt 2 of Unlimited Read this page carefully for your next steps. 1. Review your results below. Do not click away from this page until you have printed or saved your results. 2. Save your results. This is your digital documentation for your attempt. 1. Highlight the whole page (all results information) using one of the following methods. Option 1: Click and drag your mouse from the first word on the page and, without unclicking, drag to the bottom of the page ending after the Attempt Score % to highlight the whole page. Option 2: Click and drag your mouse to highlight the first word on the page, unclick, scroll to the bottom of the page, hold down the SHIFT key and click after the Attempt Score % to highlight the whole page. 2. Save the highlighted information with one of the following methods. Option 1 : Print to PDF. Right click inside the highlighted text and select Print from the dropdown menu. Set the destination to PDF. Save the PDF to your preferred location. Option 2 : Print as a hard copy. Right click inside the highlighted text and select Print from the dropdown menu. Set the destination to your preferred printer. Save a copy of your attempt information to your preferred location. NOTE: You will not be able to go back to this results page once you select Done or close the browser tab.

10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequences.… 2/23 Attempt Score 40 / 40 - 100 % Overall Grade (Highest Attempt) 40 / 40 - 100 % Question 1 1 / 1 point When performing a coding audit, a health record technician discovers that an inpatient coding professional is assigning diagnosis and procedure codes specifically for the purpose of obtaining a higher level of reimbursement. The coding professional believes that this practice helps the hospital increase its revenue. Which of the following should be done in this case? Hide question 1 feedback Question 2 1 / 1 point Which of the following justifies the need for an external audit? Hide question 2 feedback Compliment the coding professional for taking initiative in helping the hospital. Report the coding professional to the FBI for coding fraud. Counsel the coding professional and stop the practice immediately. Provide the coding professional with incentive pay for her actions. Ethical coding practices must be followed with appropriate employee counseling and remediation (Foltz and Lankisch 2020, 512–513). It is used to appeal denials. It replaces the need for internal audits. It confirms the validity of the internal audits. It creates a one-time baseline standard. External audits are performed to confirm that a healthcare organization's internal audits are valid. In other words they help to ensure and validate that the internal

10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequences.… 3/23 Question 3 1 / 1 point A(n) _______________ is imposed on providers by the OIG when fraud and abuse is discovered through an investigation. Hide question 3 feedback Question 4 1 / 1 point When a staff member documents in the health record that an incident report was completed about a specific incident, in a legal proceeding how is the confidentiality of the incident report affected? Hide question 4 feedback audits identifying all of the compliance issues (Foltz and Lankisch 2020, 517). Corporate Integrity Agreement OIG Workplan Red Flags Rule Resource Agreement A corporate integrity agreement (CIA) is essentially a compliance program imposed by the government, with substantial government oversight and outside expert involvement in the organization's compliance activities. The OIG negotiates CIAs with healthcare providers and other entities as part of the settlement of federal healthcare program investigations arising under a variety of civil false claims statutes. Providers or entities agree to the obligations, and in exchange, OIG agrees not to seek their exclusion from participation in Medicare, Medicaid, or other federal healthcare programs (Bowman 2017, 460). There is no impact. The person making the entry in the health record may not be called as a witness in trial. The incident report likely becomes discoverable because it is mentioned in a discoverable document. The incident report cannot be discovered even though it is mentioned in a discoverable document.

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10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequences.… 4/23 Question 5 1 / 1 point Which of the following has created ethical issues based on security, interoperability, and record integrity? Hide question 5 feedback Question 6 1 / 1 point Recovery audit contractors (RACs) are required to have a physician medical director on staff. Additionally, RACs are charged with utilizing certified coding professionals for semi-automated and complex record reviews. Which component of the National Recovery Audit Program do these requirements support? Hospitals strive to keep incident reports confidential, and in some states incident reports are protected under statutes protecting quality improvement studies and activities. Incident reports themselves should not be considered a part of the health record. Because the staff member mentioned in the record that an incident report was completed, it will likely be discoverable as the health record is already a discoverable document (Fahrenholz 2017a, 89). Accreditation processes Telemedicine Sensitive data Electronic health record Gaining access to electronic health record systems is a complex challenge in regard to record integrity, information security, linkage of information for continuum of care within different e-health systems, and the development of software for health information management purposes (Hamilton 2020, 674). Ensure accuracy Ensure efficiency and effectiveness Maximize transparency Minimize provider burden

10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequences.… 5/23 Hide question 6 feedback Question 7 1 / 1 point Healthcare abuse relates to practices that may result in: Hide question 7 feedback Question 8 1 / 1 point The deception or misrepresentation by a healthcare provider that may result in a false or fictitious claim for inappropriate payment by Medicare or other insurers for items or services either not rendered or rendered to a lesser extent than described in the claim is: It is imperative that the RACs accurately identify improper payments. RACs must have a physician medical director as well as certified coding professionals on staff. For medical necessity reviews, many RACs use registered nurses or other clinical staff (Casto and White 2021, 205). False representation of fact Failure to disclose a fact Performing medically unnecessary services Knowingly submitting altered claim forms Abuse occurs when a healthcare provider unknowingly or unintentionally submits an inaccurate claim for payment. Abuse generally results from unsound medical, business, or fiscal practices that directly or indirectly result in unnecessary costs to the Medicare program. The performance of medically unnecessary services and submitting them for payment would be an example of healthcare abuse (Casto and White 2021, 200). Healthcare fraud Optimization Upcoding Healthcare abuse

10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequences.… 6/23 Hide question 8 feedback Question 9 1 / 1 point Benefits of a coding compliance plan include: Hide question 9 feedback Question 10 1 / 1 point During an audit of health records, the HIM director finds that transcribed reports are being changed by the author up to a week after initial transcription. To remedy this situation, the HIM director should recommend which of the following? Hide question 10 feedback Healthcare fraud is defined as an intentional misrepresentation that an individual knows to be false or does not believe to be true and makes, knowing that the representation could result in some unauthorized benefit to himself or herself or some other person. An example of fraud is billing for a service that was not furnished (Casto and White 2021, 200). Retention of all coding employees Increase in denials of healthcare services reimbursement based on coding errors Elimination of errors in the health record Correction of coding-related risks Benefits include improved documentation, high standard of coding, reduction in denials, and correction of coding-related risks (Foltz and Lankisch 2020, 518). Immediately stop the practice of changing transcribed reports. Develop a facility policy that defines the acceptable period of time allowed for a transcribed document to remain in draft form. Conduct a verification audit. Alert hospital legal counsel of the practice.

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10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequences.… 7/23 Question 11 1 / 1 point The HIM manager is reviewing the performance metrics for her department and notices that the ROI staff is taking over five days to fulfill a request for PHI. The standard for the ROI staff to complete this task is three days. What metric is the HIM manager monitoring for department compliance? Hide question 11 feedback Question 12 1 / 1 point A coding professional's misrepresentation of the patient's clinical picture through intentional incorrect coding or the omission of diagnosis or procedure codes would be an example of: An example of unethical documentation in healthcare is retrospective documentation—when healthcare providers add documentation after care has been given, possibly for the purpose of increasing reimbursement or avoiding a medical legal action. The HIM professional is responsible for maintaining accurate and complete records and is able to identify the occurrence and either correct the error or indicate that the entry is a late entry into the health record (Hamilton 2020, 670–671). ROI request sources ROI staffing ROI productivity ROI turnaround time The supervisor is responsible for ensuring turnaround times are met. Turnaround time is the time between receipt of request and when the information is sent to the requester (Sayles 2020b, 70). Healthcare fraud Payment optimization Payment reduction Healthcare creativity

10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequences.… 8/23 Hide question 12 feedback Question 13 1 / 1 point The basic functions of healthcare risk management programs are similar for most organizations and should include which of the following? Hide question 13 feedback Question 14 1 / 1 point Which of the following is the statistical method that can be used to give every claim the same chance of being included in an audit? Healthcare fraud is an intended and deliberate deception or misrepresentation by a provider, or by representative of a provider, that results in a false or fictitious claim. These false claims then result in an inappropriate payment by Medicare or other insurers (Foltz and Lankisch 2020, 500). Reporting of claims, initiating an investigation of claims, protecting the primary and secondary health records, negotiating settlements, managing litigations, and using information for claim's resolution in performance management activities Risk acceptance, risk avoidance, risk reduction or minimization, and risk transfer Safety management, security management, claims management, technology management, and facilities management Risk identification and analysis, loss prevention and reduction, and claims management The purpose of the risk management program is to link risk management functions to related processes of quality assessment and PI. The basic functions of healthcare risk management programs are similar for most organizations and include risk identification and analysis, loss prevention and reduction, and claims management (Carter and Palmer 2020, 572). Systematic random sampling Simple random sampling

10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequences.… 9/23 Hide question 14 feedback Question 15 1 / 1 point Which of the following is a fraud and abuse prevention strategy that can be used by providers to protect themselves from fraud and abuse allegations? Hide question 15 feedback Question 16 1 / 1 point The removal of medication from its usual stream of preparation, dispensing, and administration by personnel involved in those steps in order to use or sell the medication in nonhealthcare settings is called: Convenience sampling Stratified random sampling Simple random sampling gives every bill, patient, and so forth the same chance of being chosen (Foltz and Lankisch 2020, 516). Documentation strategies Strategies for noncompliance penalties Strategies developed by the medical staff to enforce compliance Patient readmission strategies A strong clinical documentation integrity (CDI) program is important to fighting fraud and abuse through the focus on quality and accuracy (Foltz and Lankisch 2020, 513). Prescribing Adverse drug reaction Sentinel event Diversion

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10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequence… 10/23 Hide question 16 feedback Question 17 1 / 1 point What resource should the facility compliance officer consult to provide information on new and ongoing reviews or audits each year in programs administered by the Department of Health and Human Services? Hide question 17 feedback Question 18 1 / 1 point The risk manager's principal tool for capturing the facts about potentially compensable events is the: Diversion is the removal of a medication from its usual stream of preparation, dispensing, and administration by personnel involved in those steps in order to use or sell the medication in nonhealthcare settings. An individual might take the medication for personal use, to sell on the street, to sell directly to a user as a dealer, or to sell to others who will redistribute for the diverting individual (Shaw and Carter 2019, 227–228). Regional health information organizations Corporate compliance plans OIG website Federal Register The resource that the facility compliance officer should consult to provide information on ongoing reviews and audits each year in programs administered by the department of Health and Human Services (HHS) is the OIG workplan (Casto and White 2021, 201). Accident report RM report Occurrence report Event report

10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequence… 11/23 Hide question 18 feedback Question 19 1 / 1 point The Department of Health and Human Services has identified that Community Hospital is guilty of fraud. It was determined that the facility tried to comply with standards, but their efforts failed. What category of fraud and abuse prevention does this fall into? Hide question 19 feedback Question 20 1 / 1 point One way for a hospital to demonstrate compliance with OIG guidelines is to: Hide question 20 feedback An occurrence report is a structured data collection tool that risk managers use to gather information about potentially compensable events. Effective occurrence reports carefully structure the collection of data, information, and facts in a relatively simple format (Shaw and Carter 2019, 200). Reasonable cause Reasonable diligence Willful neglect Willful defiance Reasonable diligence is when the healthcare provider has taken reasonable actions to comply with the legislative requirements (Foltz and Lankisch 2020, 506). Designate a privacy officer Continuously monitor PEPPER reports Develop, implement, and monitor written policies and procedures Obtain ABNs for all Medicare registrations

10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequence… 12/23 Question 21 1 / 1 point The HIM improvement team wants to identify the causes of poor documentation compliance in the health record. Which of the following tools would best aid the team in identifying the root cause of the problem? Hide question 21 feedback Question 22 1 / 1 point The HIM department has been receiving complaints about the turnaround time for release of information (ROI) requests. A PI team is created to investigate this issue. What data source would be appropriate to use to investigate this issue further? Over the past several years, the OIG has published several documents to help providers develop internal programs that include elements for ensuring compliance. One of the elements included is written policies and procedures (Foltz and Lankisch 2020, 511). Flowchart Fishbone diagram Pareto chart Scatter diagram A cause-and-effect diagram, also known as a fishbone diagram because of its characteristic fish shape, is an investigation technique that facilitates the identification of the various factors that contribute to a problem. It facilitates root-cause analysis in order to determine the cause of the problem (Carter and Palmer 2020, 565). ROI employee evaluations Survey requestors ROI tracking system ADT system

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10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequence… 13/23 Hide question 22 feedback Question 23 1 / 1 point Robin is evaluating the quality of the HIE transmissions between various healthcare organizations and her healthcare organization, ABC Hospital. She is investigating the level of data and content standards' compliance to ensure that the health information transmitted to ABC Hospital is accurate, complete, comprehensive, and uncorrupted. Her job title would be: Hide question 23 feedback Question 24 1 / 1 point What should be done when the HIM department's chart analysis error rate is too high, or its accuracy rate is too low based on policy? The supervisor is responsible for ensuring turnaround times are met. Turnaround time is the time between receipt of the request and when the request is sent to the requester. The ROI system tracks requests for the information (Sayles 2020b, 69–70). Health informaticist Data integrity analyst Certified transfer officer Systems analyst The data integrity analyst is responsible for ensuring the quality of the data in HIM information systems. Data integrity analysts must be able to apply data and content standards to data collection and data storage. They must be able to maintain the information systems, ensure compliance with legal and accreditation requirements, and analyze data (Sayles and Kavanaugh-Burke 2021,116). Re-audit the problem area The problem should be treated as an isolated incident The formula for determining the rate may need to be adjusted

10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequence… 14/23 Hide question 24 feedback Question 25 1 / 1 point City Hospital submitted 175 claims where they unbundled laboratory charges. They were overpaid by $75 on each claim. What is the fine for City Hospital if triple damages are applied? Hide question 25 feedback Question 26 1 / 1 point Which of the following practices is an appropriate coding compliance activity? Corrective action should be taken to meet the department standards Each function should have its own acceptable level of performance and monitoring should be performed to confirm the standards are met. If not, corrective actions should be taken (Sayles 2020b, 79). $40,300 $39,375 $26,250 $13,125 Unbundling is the practice of using multiple codes to bill for the various individual steps in a single procedure rather than using a single code that includes all of the steps of the comprehensive procedure code. In this situation, the penalty is the overpayment of the $75 for all 175 claims overpaid as well as three times the total amount of the overpayment (175 × $75 = $13,125 then; $13,125 × 3 = $39,375) (Foltz and Lankisch 2020, 500). Reviewing all accurately paid claims Developing procedures for identifying coding errors Providing a financial incentive for coding claims improperly Instructing coding professionals to code diagnoses and submit the bill

10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequence… 15/23 Hide question 26 feedback Question 27 1 / 1 point Which of the following situations might result in a compliance audit? Hide question 27 feedback Question 28 1 / 1 point In developing an internal audit review program, which of the following would be risk areas that should be targeted for audit? before all applicable information is documented in the health record Coding compliance activities would not include a financial incentive for coding professionals to commit fraud, to code diagnoses and procedures before documentation is complete, or to spend resources reviewing accurately paid claims. Providing a financial incentive to coding professionals for coding claims improperly would be against any coding compliance plan and would also be a violation of AHIMA's Standards of Ethical Coding. One of the basic elements of a coding compliance program includes developing policies and procedures for identifying coding errors (Foltz and Lankisch 2020, 518–519). Low CMI High CC/MCC capture rate Decreased volume Lower reimbursement The CC capture rate is the number of patients with CCs compared to all of the patients in the population. With the changes in the CC list and the addition of MCCs in the MS-DRG system, facilities are finding that the CC capture rate is much lower than it had been previously, and new benchmarks need to be established for MS-DRGs. The CC capture rate is a valuable tool in measuring the overall severity of patients served by the facility as a whole or by a particular physician or specialty. Assuming that the coding is accurately completed, the rate can help measure the specificity of physician documentation (White 2021, 166). Admission diagnosis and complaints

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10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequence… 16/23 Hide question 28 feedback Question 29 1 / 1 point A hospital receives a valid request from a patient for copies of her health records. The HIM clerk who is preparing the records removes copies of the patient's records from another hospital where the patient was previously treated. According to HIPAA regulations, was this action correct? Hide question 29 feedback Question 30 1 / 1 point Chargemaster description Clinical laboratory results Radiology orders One of the elements of the auditing process is identification of risk areas. Selecting the types of cases to review is also important. Examples of various case selection possibilities include chargemaster description for accuracy (Foltz and Lankisch 2020, 513–514; Casto and White 2021, 144). No; the records from the previous hospital are considered to be included in the designated record set and should be given to the patient. Yes; this is hospital policy for which HIPAA has no control. No; the records from the previous hospital are not included in the designated record set but should be released anyway. Yes; HIPAA only requires that current records be produced for the patient. When other healthcare providers provide records, it is done to ensure the continuity of care for the individual. Many covered entities either include the whole file or copies of the file as part of the covered entity's record, with the assumption that the treating physician has used some or all of the records to decide how to treat the patient. Any copies that are included with the records of the individual are, therefore, considered part of the individual's designated record set and should be released (Thomason 2013, 99).

10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequence… 17/23 In order to provide ongoing compliance education to the coding staff, the coding manager regularly reviews these policies for information regarding reasonable and necessary provisions for a supply, procedure, or service. The policies include a list of codes describing which conditions are a medical necessity and which conditions do not warrant medical necessity. What policies is the coding manager reviewing? Hide question 30 feedback Question 31 1 / 1 point The goal of coding compliance programs is to prevent: Hide question 31 feedback Value-based purchasing Local coverage determinations Clinical documentation integrity Price transparency An LCD policy contains reasonable and necessary provisions regarding a supply, procedure, or service. For example, a list of codes describing which conditions are a medical necessity and which conditions do not warrant medical necessity may be provided in an LCD policy (Casto and White 2021, 216). Accusations of fraud and abuse Delays in claims processing Billing errors Inaccurate code assignments The government and other third-party payers are concerned about potential fraud and abuse in claims processing. Therefore, ensuring that bills and claims are accurate and correctly presented is an important focus of healthcare compliance (Foltz and Lankisch 2020, 518–519).

10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequence… 18/23 Question 32 1 / 1 point Which of the following is the principal goal of a corporate compliance program? Hide question 32 feedback Question 33 1 / 1 point The practice manager at the General Family Practice clinic was reviewing the established patient visit E/M code distribution for the month of May. The physicians' data is presented in the following graph. To determine the accuracy of the visit codes assigned and submitted for patients, the practice manager will need to conduct an audit of patient health records. Which physician's established patient visit code distribution should this practice manager audit as the pattern is concerning? Protect providers from sanctions or fines Increase revenues Improve patient care Limit unnecessary changes to the chargemaster Implementation of an effective corporate compliance program significantly reduces the risk of unlawful or improper conduct, criminal or civil liability, and the risk of a government audit, and also promotes an ethical organizational culture (Bowman 2017, 437). Dr. Carlson

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10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequence… 19/23 Hide question 33 feedback Question 34 1 / 1 point The leader of the coding performance improvement team wants all her team members to clearly understand the coding process. Which of the following would be the best tool for accomplishing this objective? Hide question 34 feedback Dr. Jones Dr. Smith Dr. Gelson Physician practices use data analysis to ensure revenue integrity principles are being met. A big difference between facility E/M coding and physician practice E/M coding is that physicians are not able to use practice-specific criteria to assign E/M codes like facilities. Instead, they must follow strict E/M coding guidelines that are nationally recognized. Therefore, third-party payers often compare providers or group practices to each other to identify areas of variation. These areas of variation could be risk areas for the third-party payer. Payers perform audits to ensure that E/M coding is compliant with established coding guidelines. The concept of a bell-shaped curve for HCPCS codes that are natural levels may also be used when comparing the coding practices of physicians. Dr. Smith's bar graph shows a skew toward the higher level of visits, where the others do not. This could raise a red flag with a payer that the physician is inflating the actual visit work so an audit by the practice manager to assess the accuracy of the visit codes is warranted (Casto and White 2021, 236–237). Scatter diagram Force-field analysis Pareto chart Flowchart When a team examines a process with the intention of making improvements, it must first understand the process thoroughly. Each team member has a unique perspective and significant insight about how a portion of the process works.

10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequence… 20/23 Question 35 1 / 1 point A provider's office calls to retrieve emergency room records for a patient's follow-up appointment. The HIM professional refused to release the emergency department records without a written authorization from the patient. Was this action in compliance? Hide question 35 feedback Question 36 1 / 1 point The leaders of a healthcare organization are expected to select an organization-wide performance improvement approach and to clearly define how all levels of the organization will monitor and address improvement issues. The Joint Commission requires ongoing data collection that might require improvement for which of the following areas? Flowcharts help all the team members understand the process in the same way (Carter and Palmer 2020, 563). No; the records are needed for continued care of the patient, so no authorization is required. Yes; the release of all records requires written authorization from the patient. No; permission of the ER physician was not obtained. Yes; one covered entity cannot request the records from another covered entity. Treatment, payment, and operations (TPO) is an important concept because the Privacy Rule provides a number of exceptions for PHI used or disclosed for TPO purposes. Treatment means providing, coordinating, or managing healthcare or healthcare-related services by one or more healthcare providers (Rinehart- Thompson 2020b, 253). Operative and other invasive procedures, medication management, and blood and blood product use

10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequence… 21/23 Hide question 36 feedback Question 37 1 / 1 point Which of the following describes incomplete records that are not completed by the physician within the time frame specified in the healthcare facility's policies? Hide question 37 feedback Question 38 1 / 1 point A decreasing CMI is indicative of which trend? Blood and blood product use, medication management, and appointment to the board of directors Medication management, marketing strategy, and blood use Operative and other invasive procedures, appointments to the board of directors, and restraint and seclusion use Appointments to the Board of Directors is important information, but the Joint Commission requires detailed information on the responsibilities and actions of the Board, not necessarily its composition. The Joint Commission requires healthcare organizations to collect data on each of these areas: medication management, blood and blood product use, restraint and seclusion use, behavior management and treatment, operative and other invasive procedures, and resuscitation and its outcomes (Shaw and Carter 2019, 304, 313). Suspended records Delinquent records Loose records Default records Physicians and other practitioners are notified when they have incomplete health records requiring their attention. If a health record remains incomplete for a specified number of days, as defined in the medical staff rules and regulations, the record is considered to be a delinquent record (Sayles 2020b, 77).

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10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequence… 22/23 Hide question 38 feedback Question 39 1 / 1 point Which of the following statements regarding appeal of denials is true? Hide question 39 feedback Question 40 1 / 1 point A pharmacist who submits Medicaid claims for reimbursement on brand name drugs when less expensive generic drugs were dispensed has committed the crime of: Increasing patient resource intensity Increasing proportion of surgical patients Decreasing payment per case Decreasing cost of living A hospital's case-mix index (CMI) represents the average MS-DRG relative weight for a particular hospital. The CMI allows administration to measure the hospital's performance based on MS-DRG cases. By analyzing a facility's CMI a manager is able to compare the CMI against other similar facilities in the area, or the year-to- year changes of the facility in its CMI. A decreasing CMI would indicate that the facility would be receiving decreased payment per case (Gordon, M. L. 2020, 493– 494). All types of appeals are addressed in the same way. A medical necessity appeal letter should be written by the physician. An appeal letter should be written solely by the chief compliance officer. An appeal letter should be written on all denials The author of the appeal letter should be appropriate for the type of the denial. For example, the physician would address medical necessity (Foltz and Lankisch 2020, 517). Criminal negligence

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10/17/23, 8:54 PM RHIT 9th Edition Practice Questions: Domain 5 https://myahima.brightspace.com/d2l/le/enhancedSequenceViewer/9898?url=https%3A%2F%2F609fcc4e-9df5-4fbf-a2d2-19d07606f074.sequence… 23/23 Hide question 40 feedback Fraud Perjury Products' liability Fraud in healthcare is defined as a deliberate false representation of fact, a failure to disclose a fact that is material (relevant) to a healthcare transaction, damage to another party that reasonably relies on the misrepresentation, or failure to disclose (Foltz and Lankisch 2020, 500).

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RHIT 9th Edition Practice Questions_ Domain 5#

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