Professional review guide for the RHIA and RHIT Examination 2011 Edition

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XVII. MOCK EXAMINATION

GULFSIDE HEALTH CARE CENTER
AVERAGE CLINIC WAITING TIME BY TIME BLOCK
DECEMBER 2010
TIME BLOCK PEDIATRICS OBSTETRICS CARDIOLOGY ORTHOPEDICS
8:00-11:00 12 18 10 9
11:01 -2:00 8 10 8 14

2:01 -5:00 10 7 7 12

. Each month, the staff of the clinic with the lowest overall waiting time is awarded a free dessert in the Gulfside Health care Center cafeteria. Take a look at the information listed above. The winner will be selected based on
A demonstrative clinical data.
B. comparative aggregate data.
C. objective individual data.
D. duplicate thematic data.

B

A union campaign is being conducted at your facility. As a department manager, it is appropriate for you to tell employees
A. a strike is inevitable if the union wins.
B. wages will increase if the union is defeated.
C. you need the names of those involved in union activities.
D. you are opposed to the union.

D

You work at All Paper Hospital, a small facility with no computerized health information capacity. There are ongoing problems because many departments collect the same data, creating space problems and issues with data discrepancies. You are frustrated with all this data ________.
A. overload.
B. similarity.
C. transparency.
D. redundancy.

D

Employing the SOAP style of progress notes, choose the "assessment" statement from the following:
A. Patient states low back pain with sciatica is as severe as it was on admission.
B. Patient moving about very cautiously appears to be in pain.
C. Adjust pain medication; begin physical therapy tomorrow.
D. Sciatica unimproved with hot pack therapy.

D Progress note elements written in the acronym "SOAP" style are:
S-subjective; records what the patient states is the problem
O-objective; records what the practitioner identifies through history, physical A-assessment; combines the subjective and objective into a conclusion
P-plan; what approach is going to be taken to resolve the problem
examination,
and diagnostic tests

In preparation for an EHR, you are conducting a total facility inventory of all forms currently used. You must name each form for bar coding and indexing. The unnamed document in front of you includes a checklist for assessing an obstetric patient's lochia, fundus, and perineum. The document type you give to this form is
A. prenatal record.
B. labor record.
C. delivery room record.
D. postpartum record.

D

Based on the MS-DRG report above, what is the case-mix index for this facility?
A. 0.204193
B. 2.965807
C. 11.639
D. 57

B CALCULATION: 169.051 total relative weight = 2.965807 57 total patients seen

The special form or view that plays the central role in planning and providing care at nursing,
psychiatric, and rehabilitation facilities is the
A. interdisciplinary patient care plan.
B. medical history and review of systems.
C. interval summary.
D. problem list.

A The interdisciplinary care plan is the foundation around which patient care is organized.
It contains input from the unique perspective of each discipline involved. It includes an
assessment, statement of goals, identification of specific activities, or strategies to achieve
those goals and periodic assessment of goal attainment.

Four patients were discharged from Crestview Hospital yesterday. A final progress note is an
appropriate discharge summary for
A. Howard, who died within 24 hours after his admission for a second heart attack in 2 weeks.
B. Jackson, who had no comorbidities or complications during this admission for replacement of
a pacemaker battery.
C. Fieldstone, who was admitted just 15 days following a heart attack for the acute onset of chest
pain.
D. Babson, who delivered a healthy 8-pound boy without complications for either mother or
child.

D

Use the information in the tables below to answer the next two questions:
Make Me Better Clinic (MMBC) provides well child visits and childhood immunizations for four insurance companies. Data on the services they provided and the reimbursement they received from the four companies are listed in the two tables below:
Table 1 Well Child Visits
INSURANCE
COMPANY NUMBER OF WELL CHILD
VISITS REIMBURSEMENT FROM
PAYER
Lifecare 259 $31,196.55
Getwell 786 $100,859.52
SureHealth 462 $ 54,631.50
BeHealthy 219 $ 26,991.75

Table 2 Immunizations
INSURANCE COMPANY NUMBER OF IMMUNIZATIONS TOTAL REIMBURSEMENT FROM PAYER
Lifecare 412 2,175.36
Getwell 1,465 9,053.70
SureHealth 609 3,580.92
BeHealthy 417 2,118.36

MMBC receives the best reimbursement for well child visits from
A. Lifecare.
B. Getwell.
C. SureHealth.
D. BeHealthy.

B CALCULATIONS: Reimbursement from payor for one well child visit equals total reimbursement divided by number of visits to the clinic.
INSURANCE COMPANY NUMBER OF WELL CHILD
VISITS REIMBURSEMENT FROM PAYER FOR WELL CHILD VISITS REIMBURSEMENT FROM PAYER FOR ONE
WELL CHILD VISIT (TOTAL REIMBURSEMENT/NUMBER OF VISITS)
Lifecare 259 $31 ,1 96.55 $1 20.45
Getwell 786 $1 00,859.52 $1 28.32
SureHealth 462 $54,631 .50 $1 1 8.25
BeHealthy 21 9 $26,991 .75 $1 23.25

Use the information in the tables below to answer the next two questions:
Make Me Better Clinic (MMBC) provides well child visits and childhood immunizations for four insurance companies. Data on the services they provided and the reimbursement they received from the four companies are listed in the two tables below:
Table 1 Well Child Visits
INSURANCE
COMPANY NUMBER OF WELL CHILD
VISITS REIMBURSEMENT FROM
PAYER
Lifecare 259 $31,196.55
Getwell 786 $100,859.52
SureHealth 462 $ 54,631.50
BeHealthy 219 $ 26,991.75

Table 2 Immunizations
INSURANCE COMPANY NUMBER OF IMMUNIZATIONS TOTAL REIMBURSEMENT FROM PAYER
Lifecare 412 2,175.36
Getwell 1,465 9,053.70
SureHealth 609 3,580.92
BeHealthy 417 2,118.36


Most of the children who are seen at MMBC will have a well child visit and two immunizations. If you factor in the reimbursement for two immunizations with each well child visit, which insurance company benefits MMBC most?
A. Lifecare
B. Getwell
C. SureHealth
D. BeHealthy

B CALCULATIONS:
Reimbursement for one well child visit = total reimbursement divided by number of visits.
Reimbursements for two immunizations = total reimbursement divided by number of immunizations x 2.
Total reimbursement for one average visit = reimbursement for one well child visit + reimbursement for two immunizations.
INSURANCE COMPANY REIMBURSEMENT FOR ONE WELL CHILD VISIT REIMBURSEMENT FOR TWO IMMUNIZATIONS [ (TOTAL REIMBURSEMENT/NUMBER OF IMMUNIZATIONS) × 2] TOTAL REIMBURSEMENT FOR ONE AVERAGE VISIT (REIMBURSEMENT FOR ONE WELL CHILD VISIT + REIMBURSEMENT FOR TWO IMMUNIZATIONS)
Lifecare $1 20.45 $1 0.56 $1 31 .01
Getwell $1 28.32 $1 2.36 $1 40.68
SureHealth $1 1 8.25 $1 1 .76 $1 30.01
BeHealthy $1 23.25 $1 0.1 6 $1 33.41

You are calculating the fee schedule payment amount for physician services covered under
Medicare Part B. You already have the relative value unit figure. The only other information you
need is
A. the facility's case-mix index.
B. a national conversion factor.
C. the facility's base rate.
D. MS-DRG relative weights

B

KEY WEST HOSPITAL FOUR HIGHEST MS-DRGs
MS-DRG A MS-DRG B MS-DRG C MS-DRG D

CMS WEIGHT NUMBER OF PATIENTS WITH MS-DRG A CMS WEIGHT NUMBER OF PATIENTS WITH MS-DRG B CMS WEIGHT NUMBER OF PATIENTS WITH MS-DRG C CMS WEIGHT NUMBER OF PATIENTS WITH MS-DRG D
2.023 323 0.987 489 1.925 402 1.243 386

12. Key West Hospital collected the data displayed above concerning their four highest volume MS-DRGs. Which MS-DRG generated the most revenue for the hospital?
A. MS-DRG A
B. MS-DRG B
C. MS-DRG C
D. MS-DRG D

C CALCULATIONS: MS-DRG A 2.023 × 323 = 653.43
MS-DRG B 0.987 × 489 = 485.65
MS-DRG C 1.925 × 402 = 773.85
MS-DRG D 1.243 × 386 = 479.80

In reviewing a health record for coding purposes, the coder notes that the patient was put on
Keflex post surgery. There is no mention of a postoperative complication in the attending physician's discharge summary. Before querying the doctor, the coder will seek to confirm the infection by reviewing the
A. lab report.
B. nurses' notes.
C. operative report.
D. pathology report.

A

Stan works in an acute care general hospital, Fran works for a skilled nursing facility, Ann is employed at an assisted living facility, and Dan works for a home care provider. Which people are employed in facilities that may seek Joint Commission accreditation?
A. Only Stan and Fran
B. Only Stan and Dan
C. Only Fran and Dan
D. Dan, Stan, and Fran

D

Sunset Beach Clinic allows patients to communicate by e-mail to ask questions regarding their treatment and request appointment changes. E-mails and text messages are
A. considered health care business records and are subject to the same regulations as records created in face-to-face patient encounters.
B. considered proof of patient contact and should be summarized in a progress note in the patient record.
C. generally maintained in a facility's electronic mail system until the next face-to-face patient encounter.
D. not typically maintained or documented as patient encounters.

A

The proposed National Health care Information Network (NHIN) dimensions are graphically depicted in the diagram above. Roman numerals are added to allow for the identification of specific areas. Where would information concerning a patient's health insurance be located on this chart?
A. I
B. II
C. III
D. V

B

The facility's policy for physician's verbal orders in accordance with state law and regulations needs updating. The first area of investigation is the qualifications of those individuals who have been authorized to record verbal orders. For this information you will consult the
A. policy and procedure manual.
B. hospital's Quality Management Plan.
C. data dictionary.
D. hospital bylaws, rules, and regulations.

D

Parker is a type 1 diabetic with hypertension that is currently controlled with medication. Parker was admitted through the ED for an emergency appendectomy. Following surgery, the patient developed an infection at the wound site that was treated with antibiotics. When making decisions about sequencing the codes for this case, the coder should rely on definitions found in the
A. UHDDS.
B. Coding Clinic.
C. CMS Coding Guidelines.
D. Federal Register.

A

Parker is a type 1 diabetic with hypertension that is currently controlled with medication. Parker was admitted through the ED for an emergency appendectomy. Following surgery, the patient developed an infection at the wound site that was treated with antibiotics. Parker's principal diagnosis is the
A. complications of hypertension
B. comorbidity of the wound infection
C. comorbidity of type 1 diabetes
D. acute appendicitis

D

Dr. Reed tried to explain wound care to Mr. Baker prior to discharge, but Baker (who is 104 and moderately senile) just could not seem to understand or remember what the doctor said. Mr.
Baker's daughter was with him, so, Dr. Reed explained Mr. Baker's aftercare to his daughter. Dr.
Reed should document discharge instructions
A. in the discharge summary.
B. on a patient instructions form signed by Dr. Reed and Mr. Baker and filed in Mr. Baker's medical record.
C. in the discharge summary and on a patient instructions form signed by Dr. Reed and Mr. Baker and filed in Baker's medical record.
D. in the discharge summary and on a patient instructions form signed by Dr. Reed and
Mr. Baker's daughter and filed in Mr. Baker's medical record.

D

The physician has documented the final diagnoses as acute myocardial infarction, COPD, CHF, hypertension, atrial fibrillation and status-post cholecystectomy. The following conditions should be reported
401.1 Hypertension, benign
401.9 Hypertension, unspecified
402.91 Hypertension, heart disease, unspecified, with heart failure
410.91 Acute myocardial infarction, unspecified site, initial episode of care
427.31 Atrial fibrillation
428.0 Congestive heart failure, unspecified
496 Chronic obstructive pulmonary disease
V45.79 Acquired absence of gallbladder

A. 410.9, 496, 402.91, 427.31, V45.79
B. 410.91, 496, 428.0, 401.9, 427.31
C. 410.91, 496, 428.0, 401.9, 427.31, V45.79
D. 410.91, 496, 428.0, 401.1, 427.31

B The category V45.7X, acquired absence of organ, is intended to be used for patient care where the absence of an organ affects treatment.

Mary is 6 weeks postmastectomy for carcinoma of the breast. She is admitted for chemotherapy. What is the correct sequencing of the codes?
174.9 Malignant neoplasm of the breast
V10.3 Personal history of malignant neoplasm of breast
V58.11 Encounter for antineoplastic chemotherapy
V67.00 Follow-up exam after surgery

A. V58.11, 174.9
B. V58.11, V10.3
C. V67.00, V58.11
D. V10.3

A The cancer is coded as a current condition as long as the patient is receiving adjunct therapy.

Which of the following is coded as an adverse effect in ICD-9-CM?
A. Tinnitus due to allergic reaction after administration of ear drops
B. Mental retardation due to intracranial abscess
C. Rejection of transplanted kidney
D. Nonfunctioning pacemaker due to defective soldering

A

Which of the following scenarios identifies a pathologic fracture?
A. Greenstick fracture secondary to fall from a bed
B. Compression fracture of the skull after being hit with a baseball bat
C. Vertebral fracture with cord compression following a car accident
D. Compression fracture of the vertebrae as a result of bone metastasis

D

If the same condition is described as both acute and chronic and separate subentries exist in the ICD-9-CM alphabetic index at the same indentation level,
A. they should both be coded, acute sequenced first.
B. they should both be coded, chronic sequenced first.
C. only the acute condition should be coded.
D. only the chronic condition should be coded.

A

Which of the following statements is true?
A. A surgical procedure may include one or more surgical operations.
B. The terms surgical operation and surgical procedure are synonymous.
C. A surgical operation may include one or more surgical procedures.
D. The term surgical procedure is an incorrect term and should not be used.

C A surgical operation is one or more surgical procedures performed at one time for one patient using a common approach or for a common purpose.

Which of the following would be coded as a poisoning?
A. Coumadin intoxication due to a cumulative effect
B. Idiosyncratic reaction to Artane
C. Interaction between Aldomet and a vasodilating agent
D. Reaction between Coumadin and an over-the-counter medication

D

Which of the following diagnoses or procedures would prevent the normal delivery code, 650, from being assigned?
A. Occiput presentation
B. Single liveborn
C. Episiotomy
D. Low forceps

D

Which of the following are considered late effects regardless of time?
A. Congenital defect
B. Nonunion
C. Nonhealing fracture
D. Poisoning

B

Four people were seen in your emergency department yesterday. Which one will be coded as a poisoning?
• Josh was diagnosed with digitalis intoxication.
• Ben had an allergic reaction to a dye administered for a pyelogram.
• Bryan developed syncope after taking Contac pills with a double scotch.
• Matthew had an idiosyncratic reaction between two properly administered prescription drugs.
A. Josh
B. Ben
C. Bryan
D. Matthew

C The condition should be coded as a poisoning when there is an interaction of an over-the-counter drug and alcohol. Answers A, B, and D are adverse effects of a correctly administered prescription drug.

Patient is admitted for elective cholecystectomy for treatment of chronic cholecystitis with
cholelithiasis. Prior to administration of general anesthesia, patient suffers cerebral thrombosis.
Surgery is subsequently canceled. Code and sequence the coding from the following codes.

434.00 Cerebral thrombosis without cerebral infarction
574.10 Chronic cholecystitis with cholelithiasis
V64.1 Surgery cancelled, contraindication
997.02 Iatrogenic cerebrovascular infarction or hemorrhage
51.22 Cholecystectomy, total

A. 997.02, 574.10, 51.22
B. 574.10, 434.00, V64.1
C. 997.02, 434.00, V64.1
D. 434.00, V64.1

B

The discharge diagnosis for this inpatient encounter is "rule out myocardial infarction." The coder would assign
A. a code for a myocardial infarction.
B. a code for the patient's symptoms.
C. a code for an impending myocardial infarction.
D. no code for this condition.

A When a diagnosis is preceded by the phrase "rule out" in the inpatient setting, the condition is coded as though it is confirmed.

Staging:
A. refers to the monitoring of incidence and trends associated with a disease.
B. is continued medical surveillance of a case.
C. is a system for documenting the extent or spread of cancer.
D. designates the degree of differentiation of cells.

C Staging is a term used to refer to the progression of cancer. In accessing most types of cancer, a method (staging) is used to determine how far the cancer has progressed. The cancer is described in terms of how large the main tumor is, the degree to which it has invaded urrounding tissue, and the extent to which it has spread to lymph glands or other areas of the body. Staging not only helps to assess outlook but also the most appropriate treatment.

Which of these conditions are always considered "present on admission" (POA)?
A. Congenital conditions
B. E codes
C. Acute conditions
D. Possible, probable, or suspected conditions

A

In your state, it is legal for minors to seek medical treatment for a sexually transmitted disease without parental consent. When this occurs, who would be expected to authorize the release of the medical information documented in this episode of care to the patient's insurers?
A. the patient
B. a court-appointed guardian on behalf of the patient
C. the custodial parent of the patient
D. the patient's doctor on behalf of the patient

A

A patient is admitted through the emergency department. Three days after admission, the physician documents uncontrolled diabetes mellitus. What is the "present on admission" (POA) indicator for uncontrolled diabetes mellitus?
A. "Y"
B. "U"
C. "W"
D. "N"

D Not all of the components of the combination code were POA.
"Y" = yes, present on admission.
"U"= no information in the record.
"W"= clinically undetermined.
"N" = no, not present on admission.

The patient had a thrombectomy, without catheter, of the peroneal artery, by leg incision.
34203 Embolectomy or thrombectomy, with or without catheter; popliteal-tibio-peroneal artery, by leg incision
35226 Repair blood vessel, direct; lower extremity
35302 Thromboendarterectomy, including patch graft if performed; superficial femoral artery
37799 Unlisted procedure, vascular surgery
A. 34203
C. 35302
B. 37799
D. 35226

A

Patient was seen for excision of two interdigital neuroma from the left foot.
28080 Excision, interdigital (Morton) neuroma, single, each
64774 Excision of neuroma; cutaneous nerve, surgically identifiable
64776 Excision of neuroma; digital nerve, one or both, same digit
A. 64774
B. 64776
C. 28080
D. 28080, 28080

D Look up in CPT codebook index under foot, neuroma.

Patient was seen in the Emergency Department with lacerations on the left arm. Two lacerations, one 7 cm and one 9 cm were closed with layered sutures.
12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm
12004 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm
12035 Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm
12045 Layer closure of wounds of neck, hands, feet and/or external genitalia; 12.6 cm to 20.0 cm
A. 12045
B. 12035
C. 12002, 12004
D. 12004

B The sizes of the layered wound repairs of the same body area are added together in order to select the correct CPT code.

Office visit for 43-year-old male, new patient, with no complaints. Patient is applying for life insurance and requests a physical examination. A detailed health and family history was obtained and a basic physical was done. Physician completed life insurance physical form at patient's request. Blood and urine were collected.
99381 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, new patient; infant (age under 1 year)

99386 Initial comprehensive preventive medicine evaluation and management of an individual including a comprehensive history, a comprehensive examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, new patient; 40-64 years

99396 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, established patient; 40-64 years

99450 Basic life and/or disability examination that includes completion of a medical history following a life insurance pro forma
A. 99450
B. 99386
C. 99396
D. 99381

A The codes in this subsection are used to report evaluations for life or disability insurance baseline information.

Patient was seen today for regular hemodialysis. No problems reported, tolerated procedure well.
90935 Hemodialysis procedure with single physician evaluation
90937 Hemodialysis procedure requiring repeated evaluations(s) with or without substantial revision of dialysis prescription
90945 Dialysis procedure other than hemodialysis (e.g., peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies), with single physician evaluation
99354 Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) contact beyond the usual service; first hour (List separately in addition to code for office or other outpatient Evaluation and Management service.)
A. 90937
B. 99354
C.90945
D. 90935

D Dialysis is the main term to be referenced in the CPT manual index.

An established patient was seen by the physician in the office for DTaP vaccine and HiB.
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular injections); one vaccine (single or combination vaccine/toxoid)
90700 Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use
90720 Diphtheria, tetanus toxoids, and whole cell pertussis vaccine and Hemophilus influenza B vaccine (DTP-Hib), for intramuscular use
90721 Diphtheria, tetanus toxoids, and acellular pertussis vaccine and Hemophilus influenza B vaccine (DtaP-Hib), for intramuscular use
90748 Hepatitis B and Hemophilus influenza b vaccine (HepB-Hib), for intramuscular use
99211 Office or other outpatient visit for the evaluation and management of an established patient, which may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.
A. 90721
B. 90720, 90471
C. 90700, 90748, 99211
D. 90471, 90721

D If the immunization is the only service that the patient receives, then two codes are used to report the service. The immunization administration code is first and then the code for the vaccine/toxoid.

A patient with lung cancer and bone metastasis is seen for complex treatment planning by a radiation oncologist.
77263 Therapeutic radiology treatment planning; complex
77290 Therapeutic radiology simulation-aided field setting; complex
77315 Teletherapy, isodose plan (whether hand or computer calculated); complex (mantle or inverted Y, tangential ports, the use of wedges, compensators, complex blocking, rotational beam, or special beam considerations)
77334 Treatment devices, design and construction; complex (irregular blocks, special shields, compensators, wedges, molds, or casts)
A. 77315
B. 77263
C. 77290
D. 77334

B

A 4-year-old had a repair of an incarcerated inguinal hernia. This is the first time this child had been treated for this condition.
49496 Repair initial inguinal hernia full-term infant, under age 6 months, or preterm infant over 50 weeks' post conception age and under 6 months at the time of surgery, with or without hydrocelectomy; incarcerated or strangulated
49501 Repair initial inguinal hernia, age 6 months to under 5 years, with or without hydrocelectomy; incarcerated or strangulated
49521 Repair recurrent inguinal hernia, any age; incarcerated or strangulated
49553 Repair initial femoral hernia, any age; incarcerated or strangulated
A. 49553
C. 49521
B. 49496
D. 49501

D

A quantitative drug assay was performed for a patient to determine digoxin level.
80050 General health panel
80101 Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class
80162 Digoxin (therapeutic drug assay, quantitative examination)
80166 Doxepin (therapeutic drug assay, quantitative examination)
A. 80101
C. 80166
B. 80050
D. 80162

D

Provide the CPT code for anesthesia services for the transvenous insertion of a pacemaker.
00530 Anesthesia for permanent transvenous pacemaker insertion
00560 Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator
33202 Insertion of epicardial electrode(s); open incision
33206 Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial

A. 00560
B. 33202, 00530
C. 00530
D. 33206, 00560

C

The transcriptionists have collected data on the number and types of problems with the dictation equipment. The best tool to display the data they collected is a
A. flowchart.
B. Pareto chart.
C. Gantt chart.
D. PERT chart

B

Based on the information below, what was the net death rate at Seaside Hospital in January?
SEASIDE HOSPITAL SELECTED STATISTICS
JANUARY 2011
Admissions Discharged to Home Discharge Transfers Deaths <48 hours Deaths >48 hours
280 212 28 8 6

A. 2.4%
B. 2.8%
C. 3.8%
D. 5.8%

A Calculation: (6 × 100) = 2.4% (212 + 28 + 6)

The formula used to calculate the percentage of ambulatory care visits made with same day
appointments is
A. number of patients seen with same day appointments for a period × 100 number of patients seen with advance appointments for the same period
B. number of patients seen with advance appointments for a period × 100 number of patients seen with same day appointments for the same period
C. number of patients seen with same day appointments for a period × 100 number of patients seen in the same period
D. number of patients seen with advance appointments for a period × 100 number of patients seen in the same period

C

A HIM Department Budget Report for May shows a payroll budget of $25,000 and an actual payroll expense of $22,345. The percentage of budget variance for the month is
A. $2,655.
B. 11%.
C. $265.
D. 0.9%.

B Calculation: $2,655 × 100 divided by $25,000 = 10.6 = 11%

Your large office practice has decided to try an e-health initiative. They have established a practice Web site and encourage patients to submit questions electronically instead of calling the advice nurse. After an initial surge in interest, very few patients use the service. The Web site is attractive and easy to navigate. Questions submitted via the site are answered by the nursing staff within 2 working days. You suspect few patients use the service because
A. most of your patients are too old to be Internet savvy.
B. the turnaround time is too long to replace the advice nurse.
C. the nurses may be using language that is too technical for patients.
D. most patients just prefer the personal touch they get on the phone

B

Your facility is engaged in a research project concerning patients newly diagnosed with type 2
diabetes. The researchers notice older patients have a longer length of stay than younger patients.
They have seen a
A. positive correlation between age and length of stay.
B. negative correlation between age and length of stay.
C. causal relationship between age and length of stay.
D. homologous relationship between age and length of stay.

A

Johnston City was set upon by a swarm of killer bees. All 5,000 residents are at risk of a bee attack. If 25 residents were attacked by the bees, the incidence of bee attacks
A. is 5 in 1,000.
B. is 5 in 5,000.
C. is 25 in 1,000.
D. cannot be determined at this time.

A

A 335-bed hospital opened a new wing on June 1 of a nonleap year, increasing its bed count to 350 beds. The total bed count days for the year at the hospital was:
A. 122,275.
B. 125,485.
C. 127,750.
D. The answer cannot be calculated with the information provided.

B Calculation: (335 × 151) + (350 × 214) = 125,485

A patient who was admitted to the hospital on January 14 and discharged on March 2 in a nonleap year hasa length of stay of:
A. 45 days.
B. 46 days.
C. 47 days.
D. 48 days.

C Calculation: 31 - 14 + 28 + 2 = 47 days

Release of information has increased its use of part-time prn clerical support in order to respond to increased requests for release of information. The budget variance report will reflect
A. the increase in the cost of part-time clerical support for ROI, but not the increase in revenue from this area.
B. the increase in revenue from increased volume in ROI, but not the increased costs of part-time clerical support.
C. both the increases in revenue and increased costs for clerical support in ROI.
D. neither the increased costs nor increased revenue, as temporary changes are rarely reflected on variance reports.

A

You are heading a research study that includes a patient questionnaire. Five of the questions will be answered using the following scale:
1 Strongly disagree
2 Disagree
3 No opinion
4 Agree
5 Strongly agree

You would like to display the study in your report. If you'd like to include responses to all five questions on one display, you should use a
A. stacked bar graph.
B. pie chart.
C. frequency table.
D. frequency polygon.

C

Your HMO manager has requested a report on the number of patient visits per year for preschool children. Which of the age groupings below will you use for your report?
A. 0-1 year B. < 12 months C. >12 months D. 0-2 years
1-2 years 12-24 months 12-24 months 3-4 years
2-3 years 25-37 months 25-37 months 5 years
3-4 years 38-50 months 38-50 months
4-5 years 51-63 months < 51 months

B

Collins Family Hospital had a bed count of 150 for the first 6 months of the year. On June 1, it added 15 beds when it opened a new wing. If you are given the average length of stay for the year, can you calculate the annual bed turnover rate? How?
A. Yes, using the direct method.
B. Yes, using the indirect method.
C. Yes, using the Joint Commission method.
D. No, there is insufficient data to complete the calculation.

D

In a research study that includes a patient questionnaire, five of the questions will be answered using the following scale:

1 Strongly disagree
2 Disagree
3 No opinion
4 Agree
5 Strongly agree

The data collected using this scale is called
A. cardinal data.
B. ordinal data.
C. nominal data.
D. continuous data.

B

Three people applied for a job: Ted is 84, Fred is 62, and Joe is 38. None of the applicants were offered the job. Given some of the remarks made during the interview, all three men felt they were not hired because they might have been considered too old. They went to an attorney to inquire into filing suit under the Federal Age Discrimination in Employment Act. The attorney said:
A. Ted may have a case, but Fred and Joe are too young to qualify under the Act.
B. Ted and Fred may have a case, but Joe is too young to qualify under the Act.
C. Fred and Joe may have a case, but Ted is too old to qualify under the Act.
D. Fred may have a case, but Joe is too young and Ted is too old to qualify under the Act.

D

The patient's family asked the attending physician to keep the patient in the hospital for a few days more until they could make arrangements for the patient's home care. Because the patient no longer meets criteria for continued stay, if the physician complies with the family's request, this would be considered
A. the best utilization of the hospital's resources.
B. an inappropriate use of hospital resources.
C. a compassionate use of the hospital's resources.
D. appropriate provided it is limited to a few days.

B

The state is considering the closure of the Arcadia Hospital. In reviewing the hospital statistics, which indicator will best help state officials determine whether closure is warranted?
A. daily census
B. percentage of occupancy
C. inpatient service days
D. average length of stay

B

The census taken at midnight on August 1 showed 99 patients remaining in the hospital. On
August 2, four patients were admitted, there was one fetal death, one DOA, and seven patients were discharged. One of these patients was admitted in the morning and remained only 8 hours.
How many inpatient service days were rendered on August 2?
A. 94
B. 95
C. 96
D. 97

D Calculation: Remaining at midnight 8/1 99 Admissions +4 Discharges -7 In and Out Same Day +1 Inpatient Service Days 8/2 97
Fetal Deaths and DOA have no impact on inpatient service days.

You are implementing a quality improvement plan that utilizes the PDSA cycle. If you correctly implement PDSA, which phase of the project will take the most of your time?
A. P
B. D
C. S
D. A

A

A run or line chart would be most useful for collecting data on
A. waiting time in the Pediatrics Clinic.
B. patient satisfaction with the food.
C. delays in scheduling elective surgical procedures.
D. medication errors and their causes

A

Number of Visits and Wait Times in the ER graph see page 549
The ER staff has collected the data on the number of visits and corresponding wait times in the ER. The data is displayed on the chart shown above. Based on this information, what kind of
correlation do you see between the number of visits (Variable X) and the wait times (Variable Y)?
A. A positive correlation between Variable X and Variable Y
B. A negative correlation between Variable X and Variable Y
C. A conjunctive correlation between Variable X and Variable Y
D. A causative correlation between Variable X and Variable Y

A

Fred is recovering nicely, so he asks Dr. Jones if he can go home for the weekend. Dr. Jones approves a two-night leave of absence (LOA). Chances are Fred is a patient in
A. an acute care facility; his LOA will decrease the month's average daily inpatient census.
B. a long-term care facility; his LOA will increase the month's percentage of occupancy.
C. an acute care facility; his LOA will increase the month's total discharge days.
D. a long-term care facility; his LOA will decrease the month's total inpatient service days.

D

Community Hospital reported an average LOS in December of 3.7 days with a standard deviation of 23. This information indicates that
A. there was a small variation in the LOS at Community Hospital.
B. there was a large variation in the LOS at Community Hospital.
C. most of the patients at Community Hospital stay 3 to 4 days.
D. patients stay longer at Community than at most hospitals.

B

Four HIT students are working on a LOS project at their clinical site. To describe the variability of the data, Smithson suggests using range because it is the most exact. Donaldson wants to use the mean because it is easy to calculate. Franklin recommends variance because it is the most popular measure of variability. Howell proposes the use of standard deviation because it is the most easily understood. Who made the best suggestion?
A. Smithson
B. Donaldson
C. Franklin
D. Howell

D

Sun City reported 12 cases of chronic heart disease in a population of 8,000 in 2004. In 2008, Sun City reported there were still 12 cases of chronic heart disease, but its population had decreased to 6,000. This represents an increase in the
A. prevalence of chronic heart disease in Sun City.
B. incidence of chronic heart disease in Sun City.
C. reliability of reporting chronic heart disease in Sun City.
D. occurrence of chronic heart disease in Sun City.

A

Community Hospital Administration decided to change the number of adult and children beds from 300 to 375 effective July 1. The total number of inpatient service days for adults and children for the year was 111,963. What was the percentage of occupancy rate for adults and children for the entire year?
A. 0.9%
B. 45.4%
C. 90.8%
D. 91.0%

C Calculation: (111,963 × 100) = 90.8% (300 × 181) + (375 × 184)

When checking the census data at South Beach Women's Center, you see that just yesterday, there were four sets of triplets, five sets of twins and eight single births. Yesterday, South Beach
Women's Center had
A. 17 deliveries.
B. 25 deliveries.
C. 30 deliveries.
D. 39 deliveries.

A Multiple births are still considered one delivery for statistical purposes.

In preparing the retention schedule for health records, the most concrete guidance in determining when records may be destroyed will be
A. the average readmission rate for the facility.
B. the available options for inactive records.
C. the statute of limitations in your state.
D. Joint Commission and AOA standards regarding minimum retention periods.

C

The Credentialing Committee reviewed Dr. Hernandez's application for renewal of his medical staff privileges. They noted that Dr. Hernandez had a high incidence of nosocomial infections after hip replacement surgery. The committee recommended renewal of Dr. Hernandez's general medical staff privileges, but suspended his permission to perform hip replacement surgery until he completed an AMA-approved course on infection control and successfully demonstrated improved technique to the department chair.

The Credentialing Committee discovered the problems with Dr. Hernandez's hip replacements by
A. sampling and reviewing Dr. Hernandez's patient records.
B. reviewing Dr. Hernandez's quality profile.
C. querying the National Physician Data Bank.
D. interviewing the Chief of Surgery.

B

You are starting your new job as the sole HIM professional at a small psychiatric practice. The practice uses DSM for billing purposes. You find this "theoretically" reasonable because DSM
A. is a widely used and accepted classification system.
B. codes are also valid ICD-9-CM codes.
C. codes are also valid CPT codes.
D. is the industry standard for psychiatric billing systems.

B

As the Information Security Officer at your facility, you have been asked to provide examples of the physical safeguards used to manage data security measures throughout the organization. Which of the following would you provide?
A. Audit controls
B. Entity authentication
C. Chain-of-trust partner agreements
D. Workstation use and location

D

The MS-DRG weight in a particular case is 2.0671 and the hospital's payment rate is $3,027. How much would the hospital receive as reimbursement in this case?
A. $3,027.00
B. $5,094.10
C. $6,257.11
D. $ 960.00

C Calculation: $3,027 × 2.0671 = $6,257.11

A patient's husband slipped and fell in your HIM reception area and now he is suing the facility. You have to prepare detailed written answers to a long list of questions and send them to your hospital attorney. You will spend the afternoon working on
A. affidavits.
B. allocutions.
C. interrogatories.
D. depositions

C

TYPE OF MATERIAL NUMBER SCANNED NUMBER INDEXING ERRORS
CONSULTATION REPORTS 2,879 431
LAB SLIPS 15,242 458
CORRESPONDENCE 1,426 114
OTHER 6,271 313

If you want to begin with the type of material that has the highest error rate, you will start by working on problems with
A. consultation reports.
B. lab slips.
C. correspondence.
D. other.

A Calculation: (431 × 100)/2,879=14.97% (458 × 100)/15,242=3% (114 × 00)/1,426=8% (313 × 100)/6,271=5% The highest percentage of error is in consultation reports.

TYPE OF MATERIAL NUMBER SCANNED NUMBER INDEXING ERRORS
CONSULTATION REPORTS 2,879 431
LAB SLIPS 15,242 458
CORRESPONDENCE 1,426 114
OTHER 6,271 313


Referring again to the data collected on scanning errors, if you want to work on the type of material with the highest volume, you will work on problems with
A. consultation reports.
B. lab slips.
C. correspondence.
D. other.

B The highest volume (number) of errors is in lab slips.

You are providing an educational session to new hires at your hospital. You tell the new employees that hospital records may be used as evidence in court even though hearsay laws bar the use of most evidence that does not represent personal knowledge of the witness. That's because the hospital record
A. is written rather than spoken.
B. was kept in the regular course of business.
C. has not been tampered with in any way.
D. is accurate and complete.

B

Which of the following responsibilities would you expect to find on the job description of a facility's Information Security Officer, but NOT on the job description of Chief Privacy Officer?
A. Cooperate with the Office of Civil Rights in compliance investigations
B. Conduct audit trails to monitor inappropriate access to system information
C. Oversee the patient's right to inspect, amend, and restrict access to protected health information
D. Monitor the facility's business associate agreements

B

Sally is a HIM professional with many years of experience. Unlike some of her colleagues, Sally loves the challenge of adapting to change. She is happy that HIPAA empowers the Secretary of DHHS to adopt standards for electronically maintained health information. Sally hopes the standardization under HIPAA will make it easier to design safeguards for electronic data, to protect against unauthorized access,
A. to make and use copies of the data, and to guard against unauthorized data integration.
B. to protect electronic records from corruption, and to prosecute hackers under federal law.
C. to prevent the corruption of electronically stored data, and to protect the integrity of the
information itself.
D. to submit revisions of claims as they are denied, and to track third-party payers.

C

An 11-year-old female is brought to the emergency room with a compound, comminuted fracture of the right tibia and fibula. Her mother was very seriously injured in the same accident and is unconscious. What should be done?
A. Nothing until consent can be obtained from the nearest relative.
B. The mother can be treated under implied consent, but not the child.
C. The hospital should quickly seek a court-appointed guardian for the child.
D. Both patients can be treated under implied consent.

D

A pharmacist at your facility was caught running a drug ring. The pharmacist filled orders of valuable medications with cheap outdated ones purchased on the Internet, and then sold the good drugs for profit. Patients have been injured and the lawsuits are starting. Unfortunately, your facility is going to be held responsible for the pharmacist's negligent acts under the doctrine of:
A. adjudicus res.
B. res ipsa loquitur.
C. respondeat superior.
D. stare decisis.

C

A clerk brings you a question about a request for information. The patient was treated for meningitis at age 3 (15 years ago). The patient is now 18. The patient's attorney is requesting information on the admission. You tell the clerk the information is:
A. no longer available because your facility retains information for 10 years after the last patient visit
B. available, but the attorney will have to obtain a court order before you will release it.
C. available, but the patient's parents will have to sign a consent for you to release it.
D. available, and the patient may sign consent to release the information in the record.

D

A patient has written to request a copy of his own record. When the clerk checked the record, it was noted that the patient was last admitted to the psychiatric unit of the facility. You advise the clerk to:
A. comply with the request immediately.
B. contact the patient's attending physician before complying.
C. ignore the request and advise you if it is repeated.
D. ask the patient to send the required fee prior to the release.

B

Your HIS Department receives an authorization for Sara May's medical history to be sent to her attorney, but the expiration date noted on the authorization has passed. What action is appropriate according to HIPAA privacy rules?
A. Do not honor because the authorization is invalid.
B. Contact the patient to get permission to respond.
C. Contact the attending physician for permission to respond.
D. Honor the authorization since the patient obviously approves of the release.

A

The hospital's strategic plan calls for having the entire health record content recorded in discrete form within the next 10 years. Which system will the HIM Director most likely recommend in the early stages of the project as a transition strategy?
A. Electronic document management system
B. Clinical data repository system
C. CPOE system
D. Speech recognition system

A Many hospitals use the EDMS as a transition strategy to support their EHR effort.

As the Information Security Officer at your facility, you have been asked to provide examples of technical security safeguards adopted as a result of HIPAA legislation. Which of the following would you provide?
A. Audit controls
B. Evidence of security awareness training
C. Surge protectors
D. Workstation use and location

A

See page 556 for graph After your coders helped you rank the reasons for coding errors in the order of their importance, you then plotted the results on the chart above. The results of your work surprise you because
A. you expected the coders to put more emphasis on time pressure.
B. you thought limited training was the primary reason for the errors.
C. the rankings show surprising disagreement on the issue.
D. the results appear to violate the Pareto principle.

D

Joanie Howell presents to Dr. Franklin requesting rhinoplasty. Because Howell is covered by
Medicare, Dr. Franklin must provide Howell with
A. a Notice of Exclusion, because rhinoplasty is not a Medicare covered service.
B. an Advance Beneficiary Notice, because rhinoplasty is not a Medicare covered service.
C. a Notice of Exclusion, because Howell's rhinoplasty may not be medically necessary.
D. an Advance Beneficiary Notice, because Howell's rhinoplasty may not be medically
necessary.

D

A 19-year-old former patient faxes a request to your facility requesting the release of his medical records of all episodes of care to the Army. The release of information clerk should
A. send the records as requested.
B. inform the young man that specific reports must be identified in his request.
C. send a letter informing him that faxed requests are not accepted.
D. deny the request.

A

A 16-year-old male was treated at your facility for a closed head injury. The patient's 18-year-old wife accompanied him to the hospital and signed the consent for admission and treatment because of the patient's incapacity at the time. The patient has requested that copies of his medical records be sent to his attorney. Who should sign the authorization to release the records?
A. The patient
B. Either of the patient's parents
C. The patient's parent or legal guardian
D. The patient's wife

A

When a patient is admitted because of a primary neoplasm with metastasis and treatment is directed toward the secondary neoplasm only,
A. code only the primary neoplasm as the principal diagnosis.
B. the primary neoplasm is coded as the principal diagnosis and the secondary neoplasm is coded as an additional diagnosis.
C. the secondary diagnosis is coded as the principal diagnosis, and the primary neoplasm is coded as an additional diagnosis.
D. code only the secondary neoplasm as the principal diagnosis.

C

During her hospitalization for her third delivery, Calee had a sterilization procedure performed. When the record is coded, the V code for sterilization, V25.2, is
A. not used.
B. used and sequenced as the principal diagnosis.
C. used and sequenced as a secondary diagnosis.
D. the only code used.

C

A transcription unit has been asked to tally the number of times they have to leave sections of a report blank for various reasons (poor dictation technique, background noise, etc.). The quality improvement tool most likely to help collect this data would be
A. force field analysis.
B. decision matrix.
C. flowchart.
D. check sheet.

D

Your facility is part of a community health information network and you belong to a committee charged with the responsibility of encouraging the uniform collection and reporting of data. Among your recommendations is the adoption of a common
A. data set.
B. forms design.
C. record format.
D. data quality monitoring system.

A

The Chief of Staff, Chief of Medicine, President of the Governing Body, and most departmental managers have already completed CQI training. Unfortunately, the hospital administrator has not been to training, refuses to get involved with CQI, and refuses to let the administrative departmental staff get training.
A. This level of involvement is enough to meet Joint Commission standards.
B. The Joint Commission only expects involvement from clinical staff.
C. This will not do because it violates Joint Commission standards and CQI philosophy.
D. If you can talk him into training his staff, you can let him skip the training.

C It is the responsibility of organizational leaders to participate in the QI process.

RECORD COMPLETION INFORMATION FOR DECEMBER 2010
INCOMPLETE RECORDS DELINQUENT RECORDS AVERAGE MONTHLY DISCHARGES AVERAGE MONTHLY OPERATIVE PROCEDURES DELINQUENT OPERATIVE REPORTS
604 304 845 526 14

101. Use the information provided in the table above to calculate the delinquent rate. The delinquent rate
A. cannot be determined.
B. is 36%.
C. is 50%.
D. is 71%.

B Calculation: (304 × 100)/845 = 36%

The percentage of records delinquent due to the absence of an operative report
A. is 1.7%.
B. is 2.7%.
C. is 4.6%.
D. cannot be determined from the information given.

C Calculation: (14 × 100)/526 = 2.66% or 2.7%

The purpose of the Correct Coding Initiative is to
A. increase fines and penalties for bundling services into comprehensive CPT codes.
B. restrict Medicare reimbursement to hospitals for ancillary services.
C. teach coders how to unbundle codes.
D. detect and prevent payment for improperly coded services.

D

Access to radiologic images has been improved through the use of which of the following?
A. LOINC
B. PACS
C. EDMS
D. CPOE

B Picture archiving and communication systems provide a means to store and rapidly access
digitized file images.

The difference between an Institutional Review Board (IRB) and a hospital's Ethics Committee is that:
A. the IRB focuses on patient care only, and the Ethics Committee addresses both patient care and business practices.
B. the Ethics Committee reviews ethics complaints, and the IRB focuses on developing policies and procedures.
C. the IRB deals with the ethical treatment of human research subjects, and the Ethics Committee covers a wide range of issues.
D. the IRB is made up entirely of patient care providers, and the Ethics Committee is multidisciplinary.

C

A common goal of the Office of the National Coordinator for Health Information Technology, RHIOs, and a national infrastructure for information is:
A. translating images into a digital format.
B. sharing information among providers.
C. transferring health information within a hospital system.
D. promoting telemedicine.

B Health information exchange is a term used to refer to a "plan in which health information is shared among providers."

You are considering the classification of two patients discharged from your hospital yesterday. Both patients had a length of stay that was increased due to comorbidities and/or complications described below:
• Fred's hospitalization for gallbladder surgery was extended because Fred is a brittle diabetic.
True to form, Fred's blood glucose dropped to alarming levels and his hospital stay was extended until it was back under control.
• Ted is also a diabetic, but his sugar is typically well controlled. After Ted's surgery, the physician prescribed a broad-spectrum antibiotic prophylactically. Ted had a severe reaction to the medication and had to spend an additional night in the hospital.
The best way to describe these two cases would be to say that
A. both Fred and Ted have concomitant chronic comorbidities; Fred also had a nosocomial complication.
B. both Fred and Ted have concomitant chronic comorbidities; Ted also had an iatrogenic complication.
C. Fred had a concomitant chronic comorbidity; Ted had a concomitant complication.
D. Fred had a concomitant chronic complication; Ted had a concomitant comorbidity.

B

. Your facility would like to improve physician documentation in order to allow improved coding. As coding supervisor, you have found it very effective to provide the physicians with
A. a copy of the facility coding guidelines, along with written information on improved documentation.
B. the UHDDS and information on where each data element is collected and/or verified in your
facility.
C. regular in-service presentations on documentation, including its importance and tips for improvement.
D. feedback on specific instances when improved documentation would improve coding.

D

A piece of objective data collected upon initial assessment of the patient is the
A. review of systems.
B. history of present illness.
C. chief complaint.
D. vital signs.

D

The use of computer key signatures requires the same administrative controls as
A. rubber stamp signatures.
B. computer passwords.
C. signatures made by interns and residents.
D. use of faxed signatures.

A

A number of key elements for your facility's computerized patient record are still input by clerical staff from handwritten data entry sheets. You are concerned about the transfer of data. If the vital signs stored in the database are not what were originally recorded, the impact on patient care could be severe. You are concerned about the
A. stability of the data.
C. legitimacy of the data.
B. validity of the data.
D. reliability of the data.

B

ORYX is a program that was developed by
A. CMS to track Medicare costs.
B. Joint Commission to link patient outcomes to accreditation.
C. NIH to track communicable diseases.
D. AMA to allow for rapid CPT updates.

. B

In preparation for conversion to a computerized patient record, a committee at your facility is defining each of the data elements in a patient record to determine which elements should be required and to set parameters for each element. The committee is working on the data
A. edits.
B. reasonableness.
C. dictionary.
D. feasibility.

C

An effective means of protecting the security of computerized health information would be to
A. require all facility employees to change their passwords at least once a month.
B. write detailed procedures for the entry of data into the computerized information system.
C. install a system that would require fingerprint scanning and recognition for data access.
D. develop clear policies on data security that are supported by the top management of the facility.

D

In reviewing the policies on release of information in respect to the privacy rules, you note that it is still acceptable to allow release of protected health information without patient permission to
A. the patient's spouse.
B. a health care provider interested in the case.
C. the quality assurance committee for review purposes.
D. a third-party payer with a direct interest in the case.

C

Your facility has a team that has been working to develop a strong performance improvement model, and they have come up with the model shown above. The team asks if you see anything missing from the model. You tell them they
A. are missing a step requiring regular employee input into the process.
B. are missing a step requiring reporting to the board of directors.
C. are missing a step requiring ongoing monitoring and reassessment.
D. aren't missing any steps; the model is a good one.

C

Part of your job description is to educate physicians regarding proper documentation policies and standards. You are the
A. Information Security Manager.
B. Clinical Data Specialist.
C. Health Information Manager.
D. Risk Manager.

C

Your hospital has purchased a number of outpatient facilities. You have been assigned to chair an interdisciplinary committee that will write record retention policies for the new corporation. You begin by telling the committee their primary consideration when making retention decisions must be
A. space considerations.
B. statutory requirements.
C. provider preferences.
D. professional standards.

B

A major drug company wants to promote a fundraiser targeting patients with congestive heart failure. The drug company representative has requested a list of patients treated at your facility.
As privacy and security officer, you tell them that
A. they just need to send a written request for the list.
B. a prior authorization is required before any PHI can be released.
C. you will need to confer with the medical director.
D. if the fundraising was conducted by a business associate without authorization, and the funds were to benefit your facility (the covered entity), that you could disclose the information.

B

Your facility is storing scanned records for long-term storage on optical disk. The Risk Management Committee's Disaster Task Force has recommended that copies of the disks be stored at a facility across town. The administrator is concerned that records may be altered on the disks stored off-site. You tell the administrator
A. this is a legitimate concern; it should be addressed in the contract written with the storage facility.
B. this is not a concern because WORM technology makes it impossible to alter the documents.
C. this is a legitimate concern; perhaps the committee should consider storing duplicates in two locations in this facility.
D. this is not a concern; there is really no need to make and store duplicate disks as they are difficult to damage.

B

Your Pharmacy and Therapeutics Committee has asked you to find out more about a computerized order entry system that calculates drug dosages based on patient parameters (weight, age, etc.) and even suggests the best drug given the patient's diagnosis and current treatment. The committee is asking for information on a(n)
A. application system.
B. expert system.
C. ordering system.
D. practice parameters system.

B

A portion of a deficiency slip is reproduced below. This patient was discharged yesterday. Your greatest concern regarding deficiencies on this record would be the missing:
Physician: Hunter, J. T.
Missing Signatures Missing Reports
X History Diagnoses/Procedure
Physical History
Consultative Report Physical
X Operative Report Consultation Report
Discharge Summary X Operative Report
X-ray Report Discharge Summary
Other X-Ray Report
Others


A. signature on the physical exam.
B. signature on the discharge summary.
C. diagnoses and procedures.
D. operative report.

D

In the past, Joint Commission standards have focused on promoting the use of a facility approved abbreviation list to be used by hospital care providers. With the advent of the Commission's national patient safety goals, the focus has shifted to the
A. prohibited use of any abbreviations.
B. flagrant use of specialty-specific abbreviations.
C. use of prohibited or "dangerous" abbreviations.
D. use of abbreviations used in the final diagnoses.

C The Joint Commission requires hospitals to prohibit abbreviations that have caused
confusion or problems in their handwritten form. (Example: "U" for unit, which can be mistaken for "0" (zero) or "4". Spelling out "unit" is preferred.

Annual costs for the only Release of Information Clerk at Jacksonville Beach Healthcare Center (salary and benefits) are $36,429. The monthly cost for the copier used solely for ROI is $89 (supplies and repairs). It costs the department $0.95 on average for ROI mailings (envelopes and postage). There were 687 requests filled for ROI last month. The cost per request for release of information last month was
A. $4.42.
B. $4.55.
C. $4.63.
D. $5.50.

D CALCULATIONS:
• $36,429 annual labor costs/12 = $3,035.75 cost per month
• $3,035.75 + $89 copier cost = $3,124.75 monthly costs/687
• ROI last month = 4.548 or $4.55 unit cost (not counting mailing)
• $4.55 + 0.95 average mailing cost = $5.50 per ROI

The decision makers in the HIM department have decided to use the decision analysis matrix method to select coding software. Use of this method will help ensure
A. all alternatives/vendors are evaluated subjectively.
B. the personalities of individual vendors will not influence the decision.
C. consistent criteria are used to evaluate the alternatives/vendors.
D. the level of software support will be considered in the decision.

C

Many of the departments in your facility create and modify forms often. A major key to forms control in this setting is
A. consistent formatting of each page of each form.
B. capturing every data item required by UHDDS.
C. giving each form or view an identifiable name, number, and revision date.
D. providing instructions when necessary for appropriate data fields.

C

Record # Patient Last Name Date of Birth Date of Service
32-15-65 Smith 02/3/76 3/20/2010
02-45-77 Cook 09/12/86 10/21/2010
10-88-48 Baker 01/23/24 11/14/2010

Which means of data modeling is illustrated in the table shown above?
A. Entity-relationship model C. Data management model
B. Object-oriented model D. Relational data model

D

Record # Patient Last Name Date of Birth Date of Service
32-15-65 Smith 02/3/76 3/20/2010
02-45-77 Cook 09/12/86 10/21/2010
10-88-48 Baker 01/23/24 11/14/2010


Which of the following is the unique identifier in the database illustrated in the table for question 127?
A. Record number C. Date of birth
B. Patient's last name D. Date of service

A

As the HIM Director at the Pediatric Clinic, you have just contracted with a firm that will scan your retired paper records to disk. You tell the administrator you would like to have retired records currently on microfilm scanned to disk, too. The administrator would like to keep those records on roll film to save the cost of the extra scanning. You tell the administrator you do not recommend this because:
A. roll microfilm is an outdated medium that is no longer accepted in most courts.
B. agencies with more than four rolls of microfilm must store them in fire-safe cabinets.
C. keeping the old film will require maintaining an old reader-printer for access.
D. roll microfilm is such an old technology that the clinic should be ashamed to use it.

C

Which patient numbering system(s) always assign(s) the next new number in the system to link a new or readmitted patient to his or her health history?
A. Unit numbering system
B. Both unit and serial numbering systems
C. Both serial and serial-unit numbering systems
D. Terminal digit numbering system

C

A supervisor reviews a job to determine the required content, skills, knowledge, abilities, and responsibilities for the position. The tasks are grouped and lines of responsibility and authority are defined. The supervisor is writing a job
A. description.
B. analysis.
C. process.
D. detail.

A

The emergency department staff has complained that the clerical staff in your department is
delaying stat reports. You decide to meet with your staff and develop a cause and effect diagram
to determine possible reasons for the delay. You have explained the issue to your staff and have
set up a blank cause and effect diagram. The next step is to
A. discuss the importance of prompt delivery of stat reports.
B. determine whether there are internal conflicts in the area.
C. brainstorm possible reasons for delays in delivering the reports.
D. design a new system that will support prompt report delivery.

C

As your meeting with the clerical staff on the stat report continues, one clerk suggests a possible reason for the delays is a lack of training concerning the nature of stat reports. On the cause and effect diagram, this would most appropriately be listed under
A. personnel.
B. equipment.
C. materials.
D. methods

A

Record # Patient Last Name Date of Birth Date of Service
32-15-65 Smith 02/3/76 3/20/2010
02-45-77 Cook 09/12/86 10/21/2010
10-88-48 Baker 01/23/24 11/14/2010


Which of the following is the unique identifier in the database illustrated in the table
A. Record number
B. Patient's last name
C. Date of birth
D. Date of service

D

The performance standard for coders is 28-33 workload units per day. Workload units are calculated as follows:
Inpatient record = 1 workload unit
Outpatient surgical procedure records = 0.75 workload units
Outpatient observation/emergency records = 0.50 workload units

One week's productivity information is shown in the table above. What percentage of the coders is meeting the productivity standards?
A. 100%
B. 75%
C. 50%
D. 25%

A employee # 425: 120 + (35 × 0.75)+(16 × 0.5) = 154.25
154.25/5 = 30.85 average work units per day
employee # 426: 48+(89 × 0.75)+(95 × 0.5) = 162.25
162.25/5 = 32.45 average work units per day
employee # 427: 80+(92 × 0.75)+(4 × 0.5) = 151
151/5 = 30.2 average work units per day
employee # 428: 65+(109 × 0.75)+(16 × 0.5) = 154.75
154.75 = 30.95 average work units per day

The coding supervisor tends to deal with issues as they come up, prioritizing only when problems are pressing or appear to be important to upper management. This crisis manager is particularly weak in which management function?
A. Planning
B. Organizing
C. Controlling
D. Budgeting

A

As a new HIM manager, you recognize that employee development is a necessary investment for the long-term survival and growth of the organization. Your goal is to design and implement a staff development program for your employees, so one of your first steps is to
A. implement training programs that emphasize teamwork.
B. establish a budget for all hospital employee training.
C. survey the HIM employees to assess their need for new skills or knowledge.
D. establish HIPAA training programs hospital-wide.

C

Now that the EHR has been fully implemented, you are ready to move old records to basement storage. You are ordering shelving for those old paper files. You have 18,000 records. The files average is three files per filing inch. The shelf units you have selected have six shelves that will hold 34 inches per shelf. You will have to plan for a 20% expansion rate to accommodate miscellaneous paper records over the next 10 years. How many shelving units should you order?
A. 30
B. 31
C. 35
D. 36

D Calculation: (You can only purchase whole shelf units.)
34 × 3 = 102 records per shelf
102 × 6 = 612 records per filing unit
18,000 × .20 = 3,600 records for projected expansion
18,000 + 3,600 = 21,600 total records
21,600/612 = 35.29 = 36 total filing units needed

Postage charges in the Health Information Department have increased during the last quarter. The department director has seen metered envelopes in the mail bin that do not appear to be those used for departmental business. The best course of action for the director would be to:
A. remove the postage meter from the department.
B. keep a watchful eye on the meter and who uses it.
C. issue employee warnings at the next departmental meeting.
D. assign responsibility for the postage meter to one employee.

D

A clerk's work performance has diminished dramatically during the past 2 weeks. The supervisor initiates a discussion with the clerk, during which the clerk reveals that he recently accepted that he has an alcohol addiction. The clerk states an intention to quit drinking completely. The supervisor should
A. terminate the clerk if it can be proved alcohol was used on the job.
B. suspend the clerk if alcohol has diminished the clerk's job performance.
C. give the clerk a leave of absence until these problems can be resolved.
D. refer the clerk to the facility's Employee Assistance Program.

D

Everyone in the Health Information Department has been working overtime to complete a major record conversion. The supervisor will have to plan for overtime pay for all personnel who are not
A. hourly employees.
B. salaried exempt employees.
C. salaried nonexempt employees.
D. temporary employees.

B

If a time standard is determined from sample observations to be 2.50 minutes per record for coding emergency room records, what is the daily standard for the number of records coded when a 15% fatigue factor is allowed? The coder works 7.5 hours per day.
A. 153 records per day
B. 180 records per day
C. 192 records per day
D. 200 records per day

A Calculation: 7.5 hours × 60 minutes per hour = 450 minutes per day
450 × 15% = 67.5 450 - 67.5 = 382.5 382.5/2.5 = 153

The correspondence section of your department receives an average of 50 requests per day for release of information. It takes an average of 30 minutes to fulfill each request. Using 6.5 productive hours per day as your standard, calculate the staffing needs for the correspondence section.
A. 3.8 FTE
B. 2.5 FTE
C. 3 FTE
D. 4 FTE

A Calculation: 50 × 30 = 1,500 1,500/60 = 25 25/6.5 = 3.8

Your hospital takes advantage of the 8/80 exemption for health care facilities. Assuming that no employee worked more than 8 hours in a day, which of the employees listed in the table below will be paid overtime this pay period?
EMPLOYEE NUMBER SCHEDULED HOURS PER WEEK ACTUAL HOURS THIS WEEK ACTUAL HOURS LAST WEEK
101 40 42 40
102 40 38 42
103 30 40 40
104 20 22 24
105 40 40 48

A. Employees 101 and 105
B. Employees 101, 102, and 105
C. Employees 101, 104, and 105
D. Employees 101, 103, 104, and 105

A Although employees 103 and 104 worked more hours than scheduled, they still did not work overtime using the 8/80 rules.

. During the work sampling of a file clerk's activity, it is noted that the employee is speaking on the telephone during 76 of 300 observations. How much of the employee's time is spent on the phone if the employee works 7 hours a day?
A. 1.77 hours
B. 3.28%
C. 3.94 hours
D. 9.2%

A Calculation: 76/300 = 0.253 0.253 × 7 hours = 1.77 hours

You are conducting an educational session on benchmarking. You tell your audience that the key to benchmarking is to use the comparison to
A. implement your QI process.
B. make recommendations for improvement.
C. improve your department's processes.
D. compare your department with another.

C Benchmarking involves comparing your department to other departments or organizations known to be excellent in one or more areas. The success of benchmarking involves finding out how the other department functions and then incorporating their ideas into your department.

In conducting an educational session for your staff about implementing a benchmarking program, you tell your staff that when an organization uses benchmarking, it is important to compare your facility's outcomes to
A. nationally known facilities.
B. larger facilities.
C. facilities within your corporation.
D. facilities with superior performance.

D

See chart page 572

You supervise five clerical employees who will be moving when a new wing of your facility is
completed. When you meet with the architect to plan their space, you will ask for
A. 200 square feet of space for your clerical staff.
B. 250 square feet of space for your clerical staff.
C. 300 square feet of space for your clerical staff.
D. 350 square feet of space for your clerical staff.

C Generally, allow 60 sq. ft. per employee.

How long will it take to complete the project described below?
A. 12 days
B. 17 days
C. 20 days
D. 29 days

C

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