RHIT EXAM NEWEST 2025 ACTUAL EXAM QUESTIONS & DETAILED CORRECT ANSWERS 100 % CORRECT, Exams of Nursing

Download RHIT EXAM NEWEST 2025 ACTUAL EXAM QUESTIONS & DETAILED CORRECT ANSWERS 100 % CORRECT and more Exams Nursing in PDF only on Docsity! RHIT EXAM NEWEST 2024-2025 ACTUAL EXAM QUESTIONS AND DETAILED CORRECT ANSWERS 100 % CORRECT | A+ GRADE Community Hospital is discussing restricting the access that physician have to electronic clinical records. The medical record committee is divided on how to approach this issue. Some committee members maintain that all information should be available, whereas others maintain that HIPAA restricts access. The HIM director is part of the committee. Which of the following should the director advise the committee? Correct Answer The "minimum necessary" concept does not apply to disclosures made for treatment purposes, but the organization must define what physicians need as part of their treatment role A physician takes the medical records of a group of HIV- positive patients out of the hospital to complete research tasks at home. The physician mistakenly leaves the records in a restaurant, where they are read by a newspaper reporter who publishes an article that identifies the patients. The physician can be sued for: Correct Answer Invasion of privacy Mrs. Bolton is an angry patient who resents her physicians "bossing her around." She refuses to take a portion of the medications the nurses bring to her pursuant to physicians orders and is verbally abusive to the patient care assistants. Of the following options, the most appropriate way to document Mrs. Bolton's behavior in the patient medical record is: Correct Answer Non-compliant and hostile towads staff As the corporate director of HIM Services and enterprise privacy officer, you are asked to review a patient's health record in preparation for a legal proceeding for a malpractice case. The lawsuit was brought by the patient 72 days after the procedure. The physician in question has a longstanding history of being lackadaisical with record completion practices. Previous concerns regarding this physician's record maintenance practices had been reported to the facility's Credentialing Committee. Is this information admissible in court? Correct Answer This information could be rejected since the physician dictated the procedure note after the malpractice suit was filed While auditing health records for incomplete documentation, the HIM specialist identifies written progress notes by Dr. Doe that she cannot read. She reports this to the hospital's risk manager. What is the best method to determine the scope of the documentation problem by Dr. Doe? Correct Answer An HIM professional should conduct a more detailed audit of Dr. Doe's patients' records. A Medicate patient had two physician office visits, underwent hospital radiology examinations, clinical laboratory tests, and received take-home surgical resource should be consulted in terms of who may authorize access, use, or disclose the health records of minors? Correct Answer State law because HIPAA defers to state laws on matters related to minors If an HIM department acts in deliberate ignorance or in disregard of official coding guidelines, it may be committing: Correct Answer Fraud What is the general name for Medicare rules affecting healthcare organizations? Correct Answer Conditions of Participation The permanent RAC program was completely implemented in the United States by: Correct Answer January 2010 During user acceptance testing of a new EHR system, physicians are complaining that they have to use multiple log-on screens to access all system modules. For example, they have to use one log-on for CPOE and another log-on to view laboratory results. One physician suggest having a single sign-on that would provide access to all the EHR system components. However, the hospital administrator thinks that one log-on would be a security issue. What information should the HIM director provide? Correct Answer Single sign-on is less frustrating for the end user and can provide better security When all third-party payments have been received and contractual allowances have been written off, the remaining balance is categorized as the patient responsibility. Best practice is to have the patient responsibility amount be less than what percentage of the total balance? Correct Answer 15 Who is responsible for implementing the policies and strategic direction of the hospital or healthcare organization and for building an effective executive management team? Correct Answer Chief Executive Officer Medical school graduates must pass a test before they can obtain a _____ to practice medicine. Correct Answer License Under HIPAA rules, when an individual asks to see his or her own health information, a covered entity: Correct Answer Can deny access to psychotherapy notes. In which of the following situations must a covered entity provide an appeals process for denials to requests from individuals to see their own health information? Correct Answer When a licensed healthcare professional has determined that access to PHI would likely endanger the life or safety of the individual Which of the following statements is true in regard to responding to requests from individuals for access to their PHI? Correct Answer A cost-based fee may be charged for making a copy of the PHI Which of the following is not an automatic contgrol that helps preserve data confidentiality and integrity in an electronic system? Correct Answer Security Awareness programs Within the context of data security, protecting data privacy means defending or safeguarding: Correct Answer Access to information The protection measures and tools for safeguarding information and information systems is a definition of: Correct Answer Data Security To date the HIM department has not charged for copies of records requested by the patient. However, the policy is currently under review for revision. One HIM committee member suggests using the copying fee established by the state. Another committee member thinks that HIPAA will not allow for copying fees. What input should the HIM director provide? Correct Answer Base charges on the cost of labor and supplies for copying and postage if copies are mailed A risk analysis is useful to: Correct Answer Identify security threats Which of the following is required by HIPAA standards? Correct Answer A written contingency plan Which of the following are policies and procedures required by HIPAA that address the management of the following, except: Correct Answer Returned Overpayments Healthcare fraud is all of the following except: Correct Answer Unnecessary Costs to a program Corporate compliance programs became common after adoption of which of the following: Correct Answer Federal Sentencing Guidelines Which of the following is a legal concern regarding the EHR? Correct Answer Ability to subpoena audit trails. The act of granting approval to a healthcare organization based on whether the organization has met a set of voluntary standards is called: Correct Answer Accreditation A group practice has hired an HIT as its chief compliance officer. The current compliance program includes written standards of conduct and policies and procedures that address specific areas of potential fraud. It also has audits in place to monitor compliance. Which of the following should the compliance officer also ensure are in place? Correct Answer A hotline to receive complaints and adoption of procedures to protect whistleblowers from retaliation In developing a coding compliance program, which of the following would not be ordinarily included as participants in coding compliance education? Correct Answer Nursing Staff Which of the following organizations within the federal government is responsible for looking at the issues related to the efficiency and effectiveness of the healthcare delivery system, disease protocols, and guidelines for improved disease outcomes? Correct Answer Agency for Healthcare Research and Quality (AHRQ) Which of the following issues compliance program guidance? Correct Answer HHS Office of Inspector General (OIG) Which of the following is an example of data security? Correct Answer Automatic logoff after inactivity A patient has been discharged prior to an administrative utilization review being conducted. Which of the following should be performed? Correct Answer Retrospective Utilization Review An EHR system can provide better security than a paper record for protected health information system due to: Correct Answer Access controls, audit trails, and authentication systems Community Hospital wants to provide transcription services for transcription of office notes of the private patients of physicians. All of these physicians have medical staff privileges at the hospital. This will provide an essential service to the physicians as well as provide additional revenue for the hospital. In preparing to launch this service, the HIM director is asked whether a business associate agreement is necessary. Which of the following should the hospital HIM director advise to comply with HIPAA regulations? Correct Answer Each physician practice should obtain a business associate agreement with the hospital Which accrediting organization has instituted continuous improvement and sentinel event monitoring and uses tracer methodology during survey visits? Correct Answer The Joint Commission Developing, implementing, and revising the organization's policies is the role of: Correct Answer Middle Managers Position descriptions, policies and procedures, training checklists, and performance standards are all examples of: Correct Answer Staffing Tools This organization has been responsible for accrediting healthcare organizations since the mid 1950's and determines whether the organization is continually monitoring and improving the quality of care they provide. Correct Answer The Joint Commission Which of the following is a written description of an organization's formal position? Correct Answer Policy Which of the following are security safeguards that protect equipment, media, and facilities? Correct Answer Physical Access Controls What does the term access control mean? Correct Answer Identifying which data employees should have a right to use Which of the following is a software program that tracks every access to data in the computer system? Correct Answer Audit Trail All of the following are steps in medical necessity and utilization review, except: Correct Answer Access consideration Which of the following can be used to discover current hot areas of compliance? Correct Answer The OIG workplan In Medicare, the most common forms of fraud and abuse include all of the following, except: Correct Answer Implementing a clinical documentation improvement program The one aspect of managed care that has had the greatest impact on healthcare organizations is: Correct Answer Cost Control The policies and procedures section of a coding compliance plan should include all of the following except: Correct Answer Utilization Review What is the term for an explicit statement that directs clinical decision making? Correct Answer Evidence-based practice guideline Gatekeepers determine the appropriateness of all of the following components, except: Correct Answer Rate of capitation or reimbursement Exceptions to the Federal Anti-Kickback Statute that allow legitimate business arrangements and are not subject to prosecution are: Correct Answer Safe Harbors How often are healthcare facilities required to practice their emergency preparedness plan annually? Correct Answer Twice This private, not-for-profit organization is committed to developing and maintaining practical, customer-focused standards to help organizations measure and improve the quality, value, and outcomes of behavioral health and medical rehabilitation programs. Correct Answer Commission on Accreditation of Rehabilitation Facilities What is it called when accrediting bodies such as The Joint Commission can survey facilities for compliance with the medicare Conditions of Participation for Hospitals instead of the government? Correct Answer Deemed Status Which Joint Commission survey methodology involves an evaluation that follows the hospital experiences of past or current patients? Correct Answer Tracer Methodology Which of the following services is most likely to be considered medically necessary? Correct Answer Standard of care for health condition Case management coordinates an individual's care, especially in complex and high cost cases. Goals of case management include all of the following except: Correct Answer Information Security When a service is not considered medically necessary based on the reason for encounter, the patient should be provided with a(n) ____ indicating that Medicare might not pay and that the patient might be responsible for the entire charge. Correct Answer ABN The number that has been proposed for use as a unique identification number but is controversial because of confidentiality and privacy concerns is the: Correct Answer Social Security Number HIM Professionals have been working with a multidisciplinary committee to identify the best solution that will allow hospital physicians coordinated access to all forms of incoming and outgoing messages including voice, fax, e-mail, and video mail. Currently, physicians have to log in to various systems, using different IDs and passwords to retrieve all their messages, reducing Which of the following is an application that uses standard order sets and other clinical decision support that supports physician order entry into the computer? Correct Answer CPOE Electronic systems used by nurses and physicians to document assessments and findings are called: Correct Answer Electronic point-of-care charting In the relational database shown here, the patient table and the visit table are related by: Correct Answer Patient Number A key element in effective systems implementation is: Correct Answer User training The director of health information services is allowed access to the medical record tracking system when providing the proper log-in and password. Under what access security mechanism is the director allowed access to the system? Correct Answer User-based A special web page that offers secure access to data is a(n): Correct Answer Portal When some computers are used primarily to enter data and others to process data the architecture is called: Correct Answer Client/server The ability to electronically send data from one electronic system to a different electronic system and still retain its meaning is called: Correct Answer Interoperability To effectively transmit healthcare data between a provider and payer, both parties must adhere to which electronic data interchange standard? Correct Answer X12N Who are the primary users of the health record for delivery of healthcare services? Correct Answer Clinical professionals who provide direct patient care The vision of the EHR is that discrete data would be entered by providers into an EHR via: Correct Answer Templates The key for linking data about an individual who is seen in a variety of care settings is: Correct Answer Identity Matching Algorithim Which statement is true concerning CDR and EHR? Correct Answer CDR supports management of data for an EHR The primary user of computerized provider entry is: Correct Answer Physician One of the advantages of an EDMS is that it can: Correct Answer Help manage work tasks Which of the following computer architectures uses a single large computer to process data received from terminals into which data are entered? Correct Answer Mainframe A transition technology used by many hospitals is to increase access to medical record content is: Correct Answer Electronic document management system When a hospital develops its EHR system by selecting one vendor to provide financial and administrative applications and another vendor to supply the clinical applications, this is commonly referred to as a ____ strategy. Correct Answer Dual Core Which of the following is not true about document imaging? Correct Answer Uses microfilm to store images What type of information system would be used for processing patient admissions, employee time cards, and purchase orders? Correct Answer Transaction processing system The first phase of the SDLC is the ____ phase. Correct Answer Planning What basic components make up every electronic network communications system? Correct Answer Transmitters, receivers, media, and data Which of the following is a technique for graphically depicting the structure of a computer database? Correct Answer Data Model An organization identifies key people in various functional areas to be trained first, and then asks them to subsequently train other users in this same functional area. What is this approach to user training called? Correct Answer Train-the-trainer Which of the following connects computers together in a way that allows for the sharing of information and resources? Correct Answer Network Which of the following is considered a two-factor authentication system? Correct Answer Password and swipe card Which of the following technologies would reduce the risk that information is not accessible during a server crash? Correct Answer Server redundancy A system that enables processing of diagnostic studies results into tables, graphs, or other structure is: Correct Answer Results retrieval and management technology Community Hospital's hardware has been placed on back- order; the network team is having trouble getting the network to function properly. This is an example of: Correct Answer Issues management Audit logs and alert pop-ups are examples of: Correct Answer Metadata Which of the following is a family of standards that aid the exchange of data among hospital systems and physician practices? Correct Answer HL7 The following descriptors about the data element PATIENT_LAST_NAME are included in a data dictionary: definition: legal surname of the patient; field type: numeric: field length: 50; required field: yes; default value: none; input mask: none. Which of the following is true about the definition of this data element? Correct Answer The field type should be changed to Character Systems testing of a new information system should be conducted using: Correct Answer Actual Patient Data Which of the following are used to associate relationships between entities (tables) in a relational database? Correct Answer Foreign Keys Which of the following security controls are built into a computer software program? Correct Answer Application Controls Community Hospital is identifying strategies to minimize the security risks associated with employees leaving their workstations unattended. Which of the following solutions will minimize the security risk of unattended workstations? Correct Answer Implement session termination OASIS data are used to assess the ___ of home health services. Correct Answer Outcome The Deficit Reduction Act of 2005: Correct Answer Made compliance programs mandatory Which of the following statements best defines utilization management? Correct Answer It is a set of processes used to determine the appropriateness of medical services provided during specific episodes of care Which of the following is not a type of utilization review? Correct Answer Peer review Which of the following is not one of the basic functions of the utilization review process? Correct Answer Claims management The Medical Review Committee wants to determine if the hospital is in compliance with Joint Commission standards for medical record delinquency rates. The HIM Director has compiled a report that shows that records are delinquent for an average of 29 days after discharge. Given this information, what can the Committee conclude? Correct Answer Data are insufficient to determine whether the hospital is in compliance PHI? Correct Answer A cost-based fee may be charged for making a copy of the PHI Which of the following is not an automatic contgrol that helps preserve data confidentiality and integrity in an electronic system? Correct Answer Security awareness program Within the context of data security, protecting data privacy means defending or safeguarding: Correct Answer Access to information The protection measures and tools for safeguarding information and information systems is a definition of: Correct Answer Data Security To date the HIM department has not charged for copies of records requested by the patient. However, the policy is currently under review for revision. One HIM committee member suggests using the copying fee established by the state. Another committee member thinks that HIPAA will not allow for copying fees. What input should the HIM director provide? Correct Answer Base charges on the cost of labor and supplies for copying and postage if copies are mailed A risk analysis is useful to: Correct Answer Identify security threats Which of the following is required by HIPAA standards? Correct Answer A written contingency plan Which of the following are policies and procedures required by HIPAA that address the management of computer resources and security? Correct Answer Administrative safeguards What is the biggest threat to the security of healthcare data? Correct Answer Employees To ensure relevancy, an organization's security policies and procedures be reviewed at least: Correct Answer Once a year Which of the following is not true of good electronic forms design? Correct Answer Use radio buttons to select multiple items from a set of options What committee usually oversees the development and approval of new forms for the health record? Correct Answer Use radio buttons to select multiple items from a set of options The process of determining whether the medical care provided to a specific patient is necessary according to preestablished objective screening criteria is: Correct Answer Utilization Review Placing locks on computer room doors is considered what type of security control? Correct Answer Physical control Which of the following is recommended for design of forms for an EDMS? Correct Answer 24 lb. paper for double- sided forms The HIM Supervisor suspects that a departmental employee is accessing the EHR for personal reasons but has no specific data to support this suspicion. In this case, what should the supervisor do? Correct Answer Ask the security officer for audit trail data to confirm or disprove the suspicion. Coding policies should include which of the following elements? Correct Answer AHIMA Standards of Ethical Coding The Medicare Integrity Program was established as part of Title II of HIPAA to battle fraud and abuse and is charged with which of the following responsibilities? Correct Answer Payment determinations and audit of cost reports An individual designated as an inpatient coder may have access to an electronic medical record to code the record. Under what access security mechanism is the coder allowed access to the system? Correct Answer Role- based A secretary in the Nursing Office was recently hospitalized with ketoacidosis. She comes to the health information management department and requests to review her health record. Of the options here, what is the best course Which of the following can be used to discover current hot areas of compliance? Correct Answer The OIG Workplan In Medicare, the most common forms of fraud and abuse include all of the following, except: Correct Answer Implementing a clinical documentation improvement program The one aspect of managed care that has had the greatest impact on healthcare organizations is: Correct Answer Cost control The policies and procedures section of a coding compliance plan should include all of the following except: Correct Answer Utilization Review The policies and procedures section of a coding compliance plan should include all of the following except: Correct Answer Evidence-based practice guideline Gatekeepers determine the appropriateness of all of the following components, except: Correct Answer Rate of capitation or reimbursement Exceptions to the Federal Anti-Kickback Statute that allow legitimate business arrangements and are not subject to prosecution are: Correct Answer Safe Harbors How often are healthcare facilities required to practice their emergency preparedness plan annually? Correct Answer Twice This private, not-for-profit organization is committed to developing and maintaining practical, customer-focused standards to help organizations measure and improve the quality, value, and outcomes of behavioral health and medical rehabilitation programs. Correct Answer Commission on Accreditation of Rehabilitation Facilities What is it called when accrediting bodies such as The Joint Commission can survey facilities for compliance with the medicare Conditions of Participation for Hospitals instead of the government? Correct Answer Deemed Status An HIM department is researching various options for scanning the hospital's health records. The department director would like to achieve efficiencies through scanning such as performing coding and cancer registry functions remotely. Given these considerations, which of the following would be the best scanning process? Correct Answer Scanning all documents at the time of patient discharge In conducting a qualitative analysis to ensure that documentation in the health record supports the diagnosis of the patient, what documentation would a coder look for to substantiate the diagnosis of aspiration pneumonia? Correct Answer Patient has history of inhaled food, liquid, or oil Which of the following is an organization's planned response to protect its information in the case of a natural disaster? Correct Answer Business continuity plan Which of the following is not a responsibility of a healthcare organization's quality management department? Correct Answer Conducting medical peer review to identify patters of care Which of the following has the ultimate responsibility for ensuring quality in a healthcare facility? Correct Answer Board of Directors The process that involves ongoing surveillance and prevention of infections so as to ensure the quality and safety of healthcare for patients and employees is known as: Correct Answer Infection Control Every healthcare organization's risk management plan should include the following components except: Correct Answer Peer Review Hospital A discharges 10,000 patients per year. Hospital B is located in the same town and discharges 5,000 patients per year. At Hospital B's medical staff committee meeting, a physician reports that he is concerned about the quality of care at Hospital B because the hospital has double the number of deaths per year than Hospital A. The HIM hour. The transcription unit supports 80 physicians at a cost of 15 cents per line. What should be the first step that the supervisor takes to establish benchmarks for the transcription division? Correct Answer Clearly define what is to be studied and accomplished by instituting benchmarks A record that fails quantitative analysis is missing the quality criterion of: Correct Answer Completeness A report that lists the ICD-9-CM codes associated with each physician in a healthcare facility can be used to assess the quality of the physician's services before he or she is: Correct Answer Recommended for staff reappointment When all required data elements are included in the health record, the quality characteristic for ____ is met. Correct Answer Data comprehensiveness The sixth scope of work for quality improvement organizations (QIOs) introduced which of the following? Correct Answer Payment error Prevention Program The following table compares Community Hospital's pneumonia length of stay (observed LOS) to the pneumonia LOS of similar hospitals (expected LOS). Given this data, where might Community Hospital want to focus attention on its pneumonia LOS? Correct Answer Family Practice After an outpatient review, individual audit results by coder should become part of the: Correct Answer Individual employee's performance evaluation The following data has been collected about the HIM department's coding productivity as part of the organization's total quality improvement program. Which of the following is the best assessment of this data? Correct Answer Full-time coders are more productive than part- time coders The following data has been collected about the HIM department's coding productivity as part of the organization's total quality improvement program. Which of the following is the best assessment of this data? Correct Answer Full-time coders are more productive than part- time coders The primary goal of the Hospital Standardization Program established in 1918 by the American College of Surgeons was to: Correct Answer Establish minimum quality standards for hospitals A quantitative tool that provides an indication of an organization's performance in relation to a specified process or outcome is a(n): Correct Answer Performance measure A standard of performance or best practice for a particular process or outcome is called a(n): Correct Answer Benchmark This type of performance measure focuses on a process that leads to a certain coutcome, meaning that a scientific or experimental basis exists for believing that the process, when executed well, will increase the probability of achieving a desired outcome. Correct Answer Process Measure Which of the following is not a step in quality improvement decision-making? Correct Answer Determination of the quickest solution The principal process by which organizations optimize the continuum of care for their patients is: Correct Answer Case management When the patient's physician contacts a healthcare organization to schedule an episode of care service, the healthcare organization begins which step in the case management process? Correct Answer Preadmission care planning The National Patient Safety Goals (NPSGs) have effectively mandated all healthcare organizations to examine care processes that have a potential for error that can cause injury to patients. Which of the following processes are included in the NPSGs? Correct Answer Check patient medicines, prevent infection, and identify patients correctly organizations in accordance with state and federal laws, regulations, and guidelines is called: Correct Answer Standards of care An HIM director reviews the departmental scanning productivity reports for the past three months and sees that productivity is below that of the national average. Which of the following actions should the director take? Correct Answer Investigate whether there are factors contributing to the low productivity that are not reflected in the national benchmarks Through the establishment of the National Practitioner Data Bank (NPDB), the federal government became involved in malpractice issues and what other type of issue? Correct Answer Quality of care All of the following are Joint Commission core measure criteria sets except: Correct Answer Diabetes mellitus During training, the employee should be: Correct Answer Evaluated to make sure work is error free A coding supervisor who makes up the weekly work schedule would engage in what type of planning? Correct Answer Operational Performance standards are used to: Correct Answer Communicate performance expectations A supervisor wants to determine whether the release of information staff are working at optimal output. Which of the following would be most useful to determine this? Correct Answer Set productivity standards for the area and review results on a regular basis I reviewed the patient's record of Mr. Brown and found there was no H&P on the record at seven hours past this patient's admission time. This would be an example of: Correct Answer Quantitative analysis I reviewed the health record of Sally Williams and found the physician stated on her post-op note, "examined after surgery." This would be an example of: Correct Answer Qualitative Analysis Attorneys for healthcare organizations use the health record to: Correct Answer Protect the legal interests of the facility and its healthcare providers Under HIPAA, which of the following is not named as a covered entity? Correct Answer Outsourced transcription company The HIPAA Privacy Rule: Correct Answer Sets a minimum (floor) of privacy requirements Which of the following is not an element that makes information "PHI" under the HIPAA Privacy Rule? Correct Answer Contained within a personnel file Which of the following is not an element that makes information "PHI" under the HIPAA Privacy Rule? Correct Answer Contained within a personnel file Which of the following is not an identifier under the Privacy Rule? Correct Answer Age 75 Central City Clinic has requested that Ghent Hospital send its hospital records from Susan Hall's most recent admission to the clinic for her follow-up appointment. Which of the following statements is true? Correct Answer The Privacy Rule's minimum necessary requirement does not apply Susan is completing her required high school community service hours by serving as a volunteer at the local hospital. Relative to the hospital, she is a(n): Correct Answer Workforce member Lane Hospital has a contact with Ready-Clean, a local company, to come into the hospital to pick up all of the facility's linen for off-site laundering, Ready-Clean is: Correct Answer Not a business associate because it does not use or disclose individually identifiable health information Jeremy Lykins was required to undergo a physical exam prior to becoming employed by San Fernando Hospital. Jeremy's medical information is: Correct Answer Not protected by the Privacy Rule because it is part of a personnel record To be in compliance with HIPAA regulations, a hospital would make its membership in a RHIO known to its patients through which of the following? Correct Answer Notice of Privacy Practices Law enacted by a legislative body is a(n): Correct Answer Statute What is the legal term used to describe the physical and electronic protection of health information? Correct Answer Security The "custodian of health records" refers to the individual within an organization who is responsible for the following action(s),except: Correct Answer Testifies regarding the care of the patient Who owns the health record? Correct Answer Provider who generated the record The process of releasing health record documentation originally created by a different provder is called: Correct Answer Redisclosure Which of the following is not true of notices of privacy practices? Correct Answer Must contain content that may not be changed Which document directs an individual to bring originals or copies of records to court? Correct Answer Subpoena duces tecum To comply with HIPAA, under usual circumstances, a covered entity must act on a patient's request to review or copy his or health information within __ days Correct Answer 30 This HIPAA Privacy Rule requires that covered entities must limit use, access, and disclosure of PHI to only the amount needed to accomplish the intended purpose. What concept is this an example of? Correct Answer Minimum Necessary Which of the following statements is false? Correct Answer An authorization does not have to be obtained for uses and disclosures for treatment, payment, and operation The legal term used to describe when a patient has the right to maintain control over certain personal information is referred to as: Correct Answer Privacy What is the legal term used to define the protection of health information in a patient-provider relationship? Correct Answer Confidentiality Which of the following statements is not true about a business associate agreement? Correct Answer It allows the business associate to maintain PHI indefinitely Under HIPAA regulations, how many days does a covered entity have to respond to an individual's request for access to his or her PHI is stored off-site? Correct Answer 60 days The security officer is responsible for: Correct Answer Advising administration on information security Which of the following is an example of a business associate? Correct Answer Contract coder What type of health record policy dictates how long individual health records must remain available for authorized use? Correct Answer Retention policies If a patient wants to amend his or her health record, the covered entity may require the individual to: Correct Answer Make an amendment request in writing and provide a rationale for the amendment Which of the following statements about the directory of patients maintained by a covered entity is true? Correct Answer Individuals must be given an opportunity to restrict or deny permission to place information about them in the directory According to HIPAA, what does the abbreviation PHI stand for? Correct Answer Protected health information Which of the following is not true about the Notice of Privacy Practices? Correct Answer Must include at least two examples of how information is used for both treatment and operations Which of the following would a health record technician use to perform the billing function for a physician's office? Correct Answer Screen 837P or CMS 1500 When a provider accepts assignment, this means that the: Correct Answer Provider accepts as payment in full the allowed charge from the fee schedule The coordination of benefits transaction (COB) is important so that: Correct Answer There is no duplication of benefits paid Community Hospital has launched a clinical documentation improvement (CDI) initiative. Currently, clinical documentation does not always adequately reflect the severity of illness of the patient or support optimal HIM coding accuracy. Given this situation, which of the following would be the best action to validate that the new program is achieving its goals? Correct Answer Conduct a retrospective review of all query opportunities for the year Which of the following is made up of claims data from Medicare claims submitted by acute-care hospitals and skilled nursing facilities? Correct Answer MEDPAR The collection of information on healthcare fraud and abuse was mandated by HIPAA and resulted in the development of: Correct Answer Healthcare Integrity and Protection Data Bank What is the name of the federally funded program that pays the medical bills of the spouces and dependents of persons on active duty in the uniformed services? Correct Answer TRICARE Mr. Jones is a 67-year-old patient who only has Medicare's Part A insurance. Given the information here, if Mr. Jones used 36 lifetime reserve days, how many does the patient have left to be used at a later date? Correct Answer 24 days Under outpatient prospective payment system, Medicare decides how much a hospital or a community health center will be reimbursed for each service rendered. Depending on the service, the patient pays either a coninsurance amount (20%) or a fixed copayment amount, whichever is less. Mr. Smith who has paid his deductible for the year, was charged $85 for a minor procedure performed in the hospital outpatient department. The fixed copayment amount for this type of procedure, adjusted for wages in the geographic area, is $15. What would Mr. Smith need to pay in this case? Correct Answer $15 The number of days Medicare will cover SNF inpatient care per benefit period is limited to which of the following? Correct Answer 100 Which of the following types of care is not covered by Medicare? Correct Answer Long-term nursing care Active armed services members and their qualified family members are covered by which of the following healthcare programs? Correct Answer TRICARE What is the name of the program funded by the federal government to provide medical care to people on low incomes or with limited financial resources? Correct Answer Medicaid Some services are covered and paid by Medicare before Medicaid makes payments because Medicaid is considered which of the following? Correct Answer Payer of last resort Which of the following groups of healthcare providers contracts with a self-insured employer to provide healthcare services? Correct Answer Preferred provider organization Which of the following reimbursement methods pays providers according to charges that are calculated before healthcare services are rendered? Correct Answer Prospective payment method Which of the following apply to radiological and other procedures that include professional and technical components and are paid as a lump sum to be divided between physician and healthcare facility? Correct Answer Global payments The unique number that identifies each service or supply in the CDM and links each item to a particular department is known as the: Correct Answer Charge code All of the following are required elements of a charge description master except: Correct Answer Date of service The codes used in a charge description master are: Correct Answer HCPCS Levels I and II The codes used in a charge description master are: Correct Answer HCPCS Levels I and II The facility's Medicare case-mix index has dropped, although other statistical measures appear constant. The CFO suspects coding errors. What type of coding quality review should be performed? Correct Answer Focused audit The most recent coding audit has revealed a tendency to miss secondary diagnoses that would have increased reimbursement for the case. Which of the following strategies will help to identify and correct these cases in the short term? Correct Answer Focused reviews on lower weighted MS-DRGs from triples and pairs There should be four primary percentages that should be calculated and tracked to assess clinical documentation improvement (CDI) programs. These include all of the following except: Correct Answer Record agreement rate CDI staff should revisit cases: Correct Answer Every 24 to 48 hours The federal legislation that focused on healthcare fraud and abuse issues, especially as they relate to penalties, was the: Correct Answer Balanced Budget Act of 1997 Which of the following services would be included in the 72-hour payment window and included in the inpatient MS-DRG payment to an acute-care hospital? Correct Answer Diagnostic laboratory testing The phrase "bad debt" refers to accounts that include money owed by the patient and are: Correct Answer Determined by the facility to be uncollectible The best practice for a system hold for all charges to be entered into the billing system and all coding to be completed is: Correct Answer 4 days post-discharge or visit The "discharged, not final billed" report (also known as "discharged, no final bill" or "accounts not selected for billing") includes what type of accounts? Correct Answer Accounts that have been discharged and have not been billed for a variety of reasons 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: Correct Answer Write off the failed charges to bad debt and bill Medicare for the clean charges