RHIT DOMAIN 5 EXAM REVIEW QUESTIONS WITH
VERIFIED ANSWERS NEW MODIFIED LATEST
UPDATE WITH RATIONALES
Which of the following groups are included in the feedback loop between
denials, management, and clinical documentation improvement (CDI) program
staff?
a. Compliance
b. Office of the Inspector General
c. Center for Medicare and Medicaid Services
d. Payers --CORRECT ANSWER--a
The clinical documentation improvement (CDI) manager should coordinate a
feedback loop with functional managers that involved reporting data from the
department to CDI and then from CDI back to the department. The three areas
for CDI best practices include operationalizing feedback loops with denials
management, compliance, and HIM (Hess 2015, 242).
Every healthcare organization's risk management plan should include the
following components except:
a. Loss prevention and reduction
b. Safety and security management
c. Peer review
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,d. Claims management --CORRECT ANSWER--c
Risk management programs have three functions: risk identification and
analysis, loss prevention and reduction, and claims management (Carter and
Palmer 2016, 522).
A pharmacist who submits Medicaid claims for reimbursement on brand name
drugs when less expensive generic drugs were actually dispensed has committed
the crime of:
a. Criminal negligence
b. Fraud
c. Perjury
d. Products' liability --CORRECT ANSWER--b
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. This situation would fall under category 2 (Foltz et al. 2016,
448).
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
room records without a written authorization from the patient. Was this action
in compliance?
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,a. No; the records are needed for continued care of the patient, so no
authorization is required
b. Yes; the release of all records requires written authorization from the patient
c. No; permission of the ER physician was not obtained
d. Yes; one covered entity cannot request the records from another covered
entity --CORRECT ANSWER--a
Treatment, payment, and operations (TPO) is an important concept because the
Privacy Rule provides a number of exceptions for PHI that is being 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 2016b, 223).
The overutilization or inappropriate utilization of services and misuse of
resources, typically not a criminal or intentional act is called which of the
following?
a. Fraud
b. Abuse
c. Waste
d. Audit --CORRECT ANSWER--c
Waste is the overutilization or inappropriate utilization of services and misuse
of resources, and typically is not a criminal or intentional act. Waste includes
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, practice like over prescribing and ordering tests inappropriately (Foltz et al.
2016, 448).
Examples of high-risk billing practices that create compliance risks for
healthcare organizations include all except which of the following?
a. Altered claim forms
b. Returned overpayments
c. Duplicate billings
d. Unbundled procedures --CORRECT ANSWER--b
Fraudulent billing practices represent a major compliance risk for healthcare
organizations. High-risk billing practices include: billing for noncovered
services, altered claim forms, duplicate billing, misrepresentation of facts on a
claim form, failing to return overpayments, unbundling, billing for medically
unnecessary services, overcoding and upcoding, billing for items or services not
rendered, and false cost reports (Bowman 2017, 440-441, 466).
A notice that suspends the process or destruction of paper or electronic records
is called:
a. Subpoena
b. Consent form
c. Rule
d. Legal hold --CORRECT ANSWER--d
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VERIFIED ANSWERS NEW MODIFIED LATEST
UPDATE WITH RATIONALES
Which of the following groups are included in the feedback loop between
denials, management, and clinical documentation improvement (CDI) program
staff?
a. Compliance
b. Office of the Inspector General
c. Center for Medicare and Medicaid Services
d. Payers --CORRECT ANSWER--a
The clinical documentation improvement (CDI) manager should coordinate a
feedback loop with functional managers that involved reporting data from the
department to CDI and then from CDI back to the department. The three areas
for CDI best practices include operationalizing feedback loops with denials
management, compliance, and HIM (Hess 2015, 242).
Every healthcare organization's risk management plan should include the
following components except:
a. Loss prevention and reduction
b. Safety and security management
c. Peer review
Page | 1
,d. Claims management --CORRECT ANSWER--c
Risk management programs have three functions: risk identification and
analysis, loss prevention and reduction, and claims management (Carter and
Palmer 2016, 522).
A pharmacist who submits Medicaid claims for reimbursement on brand name
drugs when less expensive generic drugs were actually dispensed has committed
the crime of:
a. Criminal negligence
b. Fraud
c. Perjury
d. Products' liability --CORRECT ANSWER--b
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. This situation would fall under category 2 (Foltz et al. 2016,
448).
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
room records without a written authorization from the patient. Was this action
in compliance?
Page | 2
,a. No; the records are needed for continued care of the patient, so no
authorization is required
b. Yes; the release of all records requires written authorization from the patient
c. No; permission of the ER physician was not obtained
d. Yes; one covered entity cannot request the records from another covered
entity --CORRECT ANSWER--a
Treatment, payment, and operations (TPO) is an important concept because the
Privacy Rule provides a number of exceptions for PHI that is being 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 2016b, 223).
The overutilization or inappropriate utilization of services and misuse of
resources, typically not a criminal or intentional act is called which of the
following?
a. Fraud
b. Abuse
c. Waste
d. Audit --CORRECT ANSWER--c
Waste is the overutilization or inappropriate utilization of services and misuse
of resources, and typically is not a criminal or intentional act. Waste includes
Page | 3
, practice like over prescribing and ordering tests inappropriately (Foltz et al.
2016, 448).
Examples of high-risk billing practices that create compliance risks for
healthcare organizations include all except which of the following?
a. Altered claim forms
b. Returned overpayments
c. Duplicate billings
d. Unbundled procedures --CORRECT ANSWER--b
Fraudulent billing practices represent a major compliance risk for healthcare
organizations. High-risk billing practices include: billing for noncovered
services, altered claim forms, duplicate billing, misrepresentation of facts on a
claim form, failing to return overpayments, unbundling, billing for medically
unnecessary services, overcoding and upcoding, billing for items or services not
rendered, and false cost reports (Bowman 2017, 440-441, 466).
A notice that suspends the process or destruction of paper or electronic records
is called:
a. Subpoena
b. Consent form
c. Rule
d. Legal hold --CORRECT ANSWER--d
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