AHIMA RHIA EXAMS VERIFIED QUESTIONS AND CORRECT
ANSWERS
. A coding supervisor audits coded records to ensure the codes reflect the actual documentation in the
health record. This coding auditing process addresses the data quality element of:
a. Granularity
b. Reliability
c. Timeliness
d. Accuracy
- ANSWERS-Correct Answer: D
The quality of coded clinical data depends on a number of factors, including accuracy. Accuracy is
ensuring that the coded data is free from error and a correct representation of the patient's diagnosis and
procedures (Sharp and Madlock-Brown 2016, 197).
. A researcher mined the Medicare Provider Analysis Review (MEDPAR) file. The analysis revealed trends
in lengths of stay for rural hospitals. What type of investigation was the researcher conducting?
a. Content analysis
b. Effect size review
c. Psychometric assay
d. Secondary analysis
- ANSWERS-Secondary analysis is the analysis of the original work of others. In secondary analysis,
researchers reanalyze original data by combining data sets to answer new questions or by using more
sophisticated statistical techniques. The work of others created the MEDPAR file (Forrestal 2016, 586).
. If a patient has health insurance but pays in full for a healthcare service and asks that the information be
kept private, under HIPAA the covered entity must:
a. Release the information to the health insurance provider
b. Get special patient consent to release the information
,c. Comply with the patient's request and keep the information private
d. Request permission from HHS to release the information
- ANSWERS-Correct Answer: C
The 2013 HIPAA Omnibus Rule finalized regulations give patients the right to request that their PHI not be
disclosed to a health plan if they pay out of pocket in full for the services or items. A provider who accepts
the payment and provides the service is compelled to abide by this request (Rinehart-Thompson 2017d,
220-221).
. The Health Information Services department at Medical Center Hospital has identified problems with its
work processes. Too much time is spent on unimportant tasks, there is duplication of effort, and task
assignment is uneven in quality and volume among employees. The manager has each employee complete
a form identifying the amount of time he or she spends each day on various tasks. What is this tool called?
a. Serial work distribution tool
b. Work distribution chart
c. Check sheet
d. Flow process chart
- ANSWERS-Correct Answer: B
Basic work distribution data can be collected in a work distribution chart, which is initially filled out by each
employee and includes all responsible task content. Task content should come directly from the employee's
current job description. In addition to task content, each employee tracks each task's start time, end time,
and volume or productivity within a typical workweek. The results of a work distribution analysis can lead
a department to redefine the job descriptions of some employees, redesign the office layout, or establish
new or revised procedures for some department functions in order to gain improvements in staff
productivity or service quality (Oachs 2016, 792).
. The process of conducting a thorough review of the internal and external conditions in which a healthcare
entity operates is called:
a. Environmental assessment
b. Operations improvement planning
c. Strategic management
d. Employment assessment
- ANSWERS-Correct Answer: A
Knowledge of the internal and external environment is essential to vision and strategy formulation. An
environmental assessment is defined as a thorough review of the internal and external conditions in which
,an organization operates. This data-intensive process is the continuous process of gathering and analyzing
intelligence about trends that are—or may be—affecting an organization and industry. IBM did not see
the market demands and change in the personal home computing environment quickly enough, so their
competitors were out to market ahead of them (McClernon 2016, 933).
. Who is responsible for the content, quality, and signing of the discharge summary?
a. Attending physician
b. Head nurse
c. Consulting physician
d. Admitting nurse
- ANSWERS-Correct Answer: A
The physician principally responsible for the patient's hospital care generally dictates the discharge
summary. However, a resident, physician assistant, or nurse practitioner who is being supervised by the
attending physician may complete this task. Regardless of who documents it, the attending physician is
responsible for the content and quality of the summary and must date and sign it (Russo 2013a, 284).
1. In developing a coding compliance program, which of the following would not be ordinarily included as
participants in coding compliance education?
a. Current coding personnel
b. Medical staff
c. Newly hired coding personnel
d. Nursing staff
- ANSWERS-Correct Answer: D
In conjunction with the corporate compliance officer, the health information manager should provide
education and training related to the importance of complete and accurate coding, documentation, and
billing on an annual basis. Technical education for all coders should be provided. Documentation education
is also part of compliance education. A focused effort should be made to provide documentation education
to the medical staff. Coding is based primarily on physician documentation, so nursing staff would not be
included in the education process (Hunt 2016, 288).
18
5
Correct18
Wrong5
Unanswered
, 1. In terms of grouping and reimbursement, how are the MS-LTC-DRGs and acute-care MS-DRGs similar?
a. Relative weights
b. Based on principal diagnosis
c. Categorization of low-volume groups into quintiles
d. Classification of short-stay outliers
- ANSWERS-Correct Answer: B
Both the MS-LTC-DRGs and the acute care MS-DRGs are based on the principal diagnosis in terms of
grouping and reimbursement (Casto and Forrestal 2015, 217-218).
1. Patient accounts has submitted a report to the revenue cycle team detailing $100,000 of outpatient
accounts that are failing NCD edits. All attempts to clear the edits have failed. There are no ABNs on file
for these accounts. Based only on this information, the revenue cycle team should:
a. Bill the patients for these accounts
b. Contact the patients to obtain an ABN
c. Write off the accounts to contractual allowances
d. Write off the failed charges to bad debt and bill Medicare for the clean charges
- ANSWERS-Correct Answer: D
The Integrated Outpatient Code Editor (IOCE) is a predefined set of edits created by Medicare to check
outpatient claims for compliance with the Medicare outpatient prospective payment system (OPPS). The
IOCE will review a coded claim for accuracy and send back an edit flag if an error has been detected in
the claim. Most organizations run all their claims through the IOCE prior to sending out to any payer to
look for errors, correct them, and then send out a clean claim. A portion of the NCCI edits are embedded
in the IOCE edits (Schraffenberger and Kuehn 2011, 465).
An NCD sets forth the extent to which Medicare will cover specific services, procedures, or technologies on
a national basis. Medicare contractors are required to follow NCDs. If an NCD does not specifically
exclude/limit an indication or circumstance, or if the item or service is not mentioned at all in an NCD or in
a Medicare manual, it is up to the Medicare contractor to make the coverage decision (see LMRP). Prior to
an NCD taking effect, CMS must first issue a Manual Transmittal, CMS ruling, or Federal Register Notice
giving specific directions to our claims-processing contractors.
10. Using the data in the following graph, we can see changes in this hospital's profile. What concerns
might the hospital's quality council need to address based on these changes in their customer base?
ANSWERS
. A coding supervisor audits coded records to ensure the codes reflect the actual documentation in the
health record. This coding auditing process addresses the data quality element of:
a. Granularity
b. Reliability
c. Timeliness
d. Accuracy
- ANSWERS-Correct Answer: D
The quality of coded clinical data depends on a number of factors, including accuracy. Accuracy is
ensuring that the coded data is free from error and a correct representation of the patient's diagnosis and
procedures (Sharp and Madlock-Brown 2016, 197).
. A researcher mined the Medicare Provider Analysis Review (MEDPAR) file. The analysis revealed trends
in lengths of stay for rural hospitals. What type of investigation was the researcher conducting?
a. Content analysis
b. Effect size review
c. Psychometric assay
d. Secondary analysis
- ANSWERS-Secondary analysis is the analysis of the original work of others. In secondary analysis,
researchers reanalyze original data by combining data sets to answer new questions or by using more
sophisticated statistical techniques. The work of others created the MEDPAR file (Forrestal 2016, 586).
. If a patient has health insurance but pays in full for a healthcare service and asks that the information be
kept private, under HIPAA the covered entity must:
a. Release the information to the health insurance provider
b. Get special patient consent to release the information
,c. Comply with the patient's request and keep the information private
d. Request permission from HHS to release the information
- ANSWERS-Correct Answer: C
The 2013 HIPAA Omnibus Rule finalized regulations give patients the right to request that their PHI not be
disclosed to a health plan if they pay out of pocket in full for the services or items. A provider who accepts
the payment and provides the service is compelled to abide by this request (Rinehart-Thompson 2017d,
220-221).
. The Health Information Services department at Medical Center Hospital has identified problems with its
work processes. Too much time is spent on unimportant tasks, there is duplication of effort, and task
assignment is uneven in quality and volume among employees. The manager has each employee complete
a form identifying the amount of time he or she spends each day on various tasks. What is this tool called?
a. Serial work distribution tool
b. Work distribution chart
c. Check sheet
d. Flow process chart
- ANSWERS-Correct Answer: B
Basic work distribution data can be collected in a work distribution chart, which is initially filled out by each
employee and includes all responsible task content. Task content should come directly from the employee's
current job description. In addition to task content, each employee tracks each task's start time, end time,
and volume or productivity within a typical workweek. The results of a work distribution analysis can lead
a department to redefine the job descriptions of some employees, redesign the office layout, or establish
new or revised procedures for some department functions in order to gain improvements in staff
productivity or service quality (Oachs 2016, 792).
. The process of conducting a thorough review of the internal and external conditions in which a healthcare
entity operates is called:
a. Environmental assessment
b. Operations improvement planning
c. Strategic management
d. Employment assessment
- ANSWERS-Correct Answer: A
Knowledge of the internal and external environment is essential to vision and strategy formulation. An
environmental assessment is defined as a thorough review of the internal and external conditions in which
,an organization operates. This data-intensive process is the continuous process of gathering and analyzing
intelligence about trends that are—or may be—affecting an organization and industry. IBM did not see
the market demands and change in the personal home computing environment quickly enough, so their
competitors were out to market ahead of them (McClernon 2016, 933).
. Who is responsible for the content, quality, and signing of the discharge summary?
a. Attending physician
b. Head nurse
c. Consulting physician
d. Admitting nurse
- ANSWERS-Correct Answer: A
The physician principally responsible for the patient's hospital care generally dictates the discharge
summary. However, a resident, physician assistant, or nurse practitioner who is being supervised by the
attending physician may complete this task. Regardless of who documents it, the attending physician is
responsible for the content and quality of the summary and must date and sign it (Russo 2013a, 284).
1. In developing a coding compliance program, which of the following would not be ordinarily included as
participants in coding compliance education?
a. Current coding personnel
b. Medical staff
c. Newly hired coding personnel
d. Nursing staff
- ANSWERS-Correct Answer: D
In conjunction with the corporate compliance officer, the health information manager should provide
education and training related to the importance of complete and accurate coding, documentation, and
billing on an annual basis. Technical education for all coders should be provided. Documentation education
is also part of compliance education. A focused effort should be made to provide documentation education
to the medical staff. Coding is based primarily on physician documentation, so nursing staff would not be
included in the education process (Hunt 2016, 288).
18
5
Correct18
Wrong5
Unanswered
, 1. In terms of grouping and reimbursement, how are the MS-LTC-DRGs and acute-care MS-DRGs similar?
a. Relative weights
b. Based on principal diagnosis
c. Categorization of low-volume groups into quintiles
d. Classification of short-stay outliers
- ANSWERS-Correct Answer: B
Both the MS-LTC-DRGs and the acute care MS-DRGs are based on the principal diagnosis in terms of
grouping and reimbursement (Casto and Forrestal 2015, 217-218).
1. Patient accounts has submitted a report to the revenue cycle team detailing $100,000 of outpatient
accounts that are failing NCD edits. All attempts to clear the edits have failed. There are no ABNs on file
for these accounts. Based only on this information, the revenue cycle team should:
a. Bill the patients for these accounts
b. Contact the patients to obtain an ABN
c. Write off the accounts to contractual allowances
d. Write off the failed charges to bad debt and bill Medicare for the clean charges
- ANSWERS-Correct Answer: D
The Integrated Outpatient Code Editor (IOCE) is a predefined set of edits created by Medicare to check
outpatient claims for compliance with the Medicare outpatient prospective payment system (OPPS). The
IOCE will review a coded claim for accuracy and send back an edit flag if an error has been detected in
the claim. Most organizations run all their claims through the IOCE prior to sending out to any payer to
look for errors, correct them, and then send out a clean claim. A portion of the NCCI edits are embedded
in the IOCE edits (Schraffenberger and Kuehn 2011, 465).
An NCD sets forth the extent to which Medicare will cover specific services, procedures, or technologies on
a national basis. Medicare contractors are required to follow NCDs. If an NCD does not specifically
exclude/limit an indication or circumstance, or if the item or service is not mentioned at all in an NCD or in
a Medicare manual, it is up to the Medicare contractor to make the coverage decision (see LMRP). Prior to
an NCD taking effect, CMS must first issue a Manual Transmittal, CMS ruling, or Federal Register Notice
giving specific directions to our claims-processing contractors.
10. Using the data in the following graph, we can see changes in this hospital's profile. What concerns
might the hospital's quality council need to address based on these changes in their customer base?
