AHIMA CCA: HEALTHCARE CODING AND BILLING EXAM
2025 |160 QUESTIONS WITH ACCURATE ANSWERS
1. Describe the implications of a business associate agreement on the
handling of PHI by a business associate.
A business associate agreement permits the business associate to
disclose PHI to anyone without consent.
A business associate agreement ensures that the business
associate handles PHI in compliance with HIPAA regulations and
only for the purposes specified in the contract.
A business associate agreement allows the business associate to
use PHI freely without restrictions.
A business associate agreement eliminates the need for the
covered entity to monitor PHI usage.
2. What are some examples of add-on payments that hospitals can receive
under Medicare?
Additional payments may be made for locum tenens, increased
emergency room services, stays over the average length of stay,
and cost outlier cases.
Additional payments may be made for increased emergency
room services, critical access hospitals, increased labor costs, and
cost outlier cases.
Additional payments may be made to disproportionate share
hospitals for indirect medical education, new technologies, and
cost outlier cases.
Additional payments may be made to critical access hospitals, for
higher-than-normal volumes, unexpected hospital emergencies,
and cost outlier cases.
,3. What is the term used for the reimbursement model that rewards
healthcare providers for improving clinical outcomes?
Payer of last resort
Patient referrals
Performance evaluations
Pay for performance and quality
4. If a healthcare organization implements a pay for performance model,
what changes might they make to their electronic health record system
to align with this incentive?
They might focus solely on billing codes without considering
quality metrics.
They might reduce the number of fields in the electronic health
record to simplify data entry.
They might eliminate documentation requirements to save time for
providers.
They might integrate quality metrics tracking and reporting
features into the electronic health record system.
5. As mandated by the HIPAA Privacy Rule, how many days does an office
have to comply with a patient's written request for a copy of his or her
clinical record?
30 days
90 days
10 days
3 days
120 days
,6. In a scenario where a healthcare facility implements an EHR system, what
impact would you expect on their coding practices?
No significant change in coding practices since EHRs are
unrelated to coding.
A complete overhaul of existing coding systems without any
training.
Decreased reliance on technology and more manual coding
processes.
Increased efficiency and accuracy in coding due to computer-
assisted coding.
7. If a patient is diagnosed with a benign cyst of the breast, which coding
category should the coder avoid using based on the guidelines
provided?
D24
D22.5
N60.2
N60.-
8. Which coding initiative is specifically mentioned as a source of denials for
outpatient claims?
OCE (outpatient code editor)
National and local policies
OCE (outpatient claims editor)
NCCI (National Correct Coding Initiative)
9. If a patient requests their medical records and the HIM clerk only
provides records from the current hospital, what potential consequences
could arise from this action under HIPAA?
, The patient would have to pay a fine for requesting too many
records.
The hospital would be praised for following HIPAA regulations
correctly.
The HIM clerk would receive a commendation for efficient record
management.
The hospital could face legal penalties for not providing the
complete designated record set.
10. Which section of a patient's medical record includes information about
their past use of drugs, alcohol, and tobacco?
Social history
Past medical history
Systems review
History of present illness
11. Interpret the relationship between relative weight and patient severity in
healthcare billing.
Higher relative weight means lower reimbursement for healthcare
facilities.
Relative weight has no impact on payment rates or patient
severity.
A lower relative weight suggests that patients are more severely
ill.
A higher relative weight typically indicates a more complex or
severe case, leading to higher payment rates.
12. If a healthcare organization fails to comply with laws regarding health
information disclosure, what could be a potential consequence?
Improved coding accuracy
2025 |160 QUESTIONS WITH ACCURATE ANSWERS
1. Describe the implications of a business associate agreement on the
handling of PHI by a business associate.
A business associate agreement permits the business associate to
disclose PHI to anyone without consent.
A business associate agreement ensures that the business
associate handles PHI in compliance with HIPAA regulations and
only for the purposes specified in the contract.
A business associate agreement allows the business associate to
use PHI freely without restrictions.
A business associate agreement eliminates the need for the
covered entity to monitor PHI usage.
2. What are some examples of add-on payments that hospitals can receive
under Medicare?
Additional payments may be made for locum tenens, increased
emergency room services, stays over the average length of stay,
and cost outlier cases.
Additional payments may be made for increased emergency
room services, critical access hospitals, increased labor costs, and
cost outlier cases.
Additional payments may be made to disproportionate share
hospitals for indirect medical education, new technologies, and
cost outlier cases.
Additional payments may be made to critical access hospitals, for
higher-than-normal volumes, unexpected hospital emergencies,
and cost outlier cases.
,3. What is the term used for the reimbursement model that rewards
healthcare providers for improving clinical outcomes?
Payer of last resort
Patient referrals
Performance evaluations
Pay for performance and quality
4. If a healthcare organization implements a pay for performance model,
what changes might they make to their electronic health record system
to align with this incentive?
They might focus solely on billing codes without considering
quality metrics.
They might reduce the number of fields in the electronic health
record to simplify data entry.
They might eliminate documentation requirements to save time for
providers.
They might integrate quality metrics tracking and reporting
features into the electronic health record system.
5. As mandated by the HIPAA Privacy Rule, how many days does an office
have to comply with a patient's written request for a copy of his or her
clinical record?
30 days
90 days
10 days
3 days
120 days
,6. In a scenario where a healthcare facility implements an EHR system, what
impact would you expect on their coding practices?
No significant change in coding practices since EHRs are
unrelated to coding.
A complete overhaul of existing coding systems without any
training.
Decreased reliance on technology and more manual coding
processes.
Increased efficiency and accuracy in coding due to computer-
assisted coding.
7. If a patient is diagnosed with a benign cyst of the breast, which coding
category should the coder avoid using based on the guidelines
provided?
D24
D22.5
N60.2
N60.-
8. Which coding initiative is specifically mentioned as a source of denials for
outpatient claims?
OCE (outpatient code editor)
National and local policies
OCE (outpatient claims editor)
NCCI (National Correct Coding Initiative)
9. If a patient requests their medical records and the HIM clerk only
provides records from the current hospital, what potential consequences
could arise from this action under HIPAA?
, The patient would have to pay a fine for requesting too many
records.
The hospital would be praised for following HIPAA regulations
correctly.
The HIM clerk would receive a commendation for efficient record
management.
The hospital could face legal penalties for not providing the
complete designated record set.
10. Which section of a patient's medical record includes information about
their past use of drugs, alcohol, and tobacco?
Social history
Past medical history
Systems review
History of present illness
11. Interpret the relationship between relative weight and patient severity in
healthcare billing.
Higher relative weight means lower reimbursement for healthcare
facilities.
Relative weight has no impact on payment rates or patient
severity.
A lower relative weight suggests that patients are more severely
ill.
A higher relative weight typically indicates a more complex or
severe case, leading to higher payment rates.
12. If a healthcare organization fails to comply with laws regarding health
information disclosure, what could be a potential consequence?
Improved coding accuracy
