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Chapter 5, 6,7,8

Critique this statement: Skilled nursing facilities are no longer paid under a system based on reasonable cost but, rather, through per-diem prospective case-mix-adjusted payment rates.

This is a true statement.

Which of the following classification systems uses resident assessment data to assign residents to one of 44 groups, with each assessment applying to specific days within a resident's stay?


The ambulatory payment classification system is based on the categorization of which services?

Outpatient care

Which classification system is established for the prospective reimbursement of covered home care services to Medicare beneficiaries during a 60-day episode of care?


Which organizations enter into contracts with the CMS to process claims for Parts A & B professional physician services?

Medicare administrative contractors

Which term is used in reference to the transfer of health claims using electronic media?


Which of the following explains Medicare payments and denials?


Which of the following statements best describes the situation for a provider that agrees to accept assignment for Medicare services?

Prohibited from balance billing patients

When did CMS implement the Correct Coding Initiative for physician claims?


Our hospital wants to partner with local physicians so that we can be viewed as a single entity in negotiating managed care contracts. Which of the following model should we develop?


Which of the following plans reimburses patients up to a specified amount?


Catastrophic coverage is categorized as part of which of the following?

Major medical insurance

Which of the following types of care is not covered by Medicare?

Long-term nursing care

Which of the following covers prescribed preventive benefits and is subject to a deductible?

Medicare Part B

Which of the following terms is used for the amount charged for a medical insurance_____policy?


Upon which criterion is Medicaid eligibility-based?


How many benefit periods are covered by hospital insurance during a Medicare beneficiary's lifetime?


What term is used for retrospective reimbursement charges submitted by a provider for each service rendered?


What is the name of the federally funded program that pays the medical bills of the spouses and dependents of persons on active duty in the uniformed services?


What is the name of the program funded by the federal government to provide medical care to people on public assistance?


Some services are covered and paid by Medicare before Medicaid makes payments because Medicaid is considered which of the following?

Payer of last resort

Which of the following groups of healthcare providers contracts with an employer to provide healthcare services?

Health maintenance organization

Which of the following is a nonprofit organization that contracts with physicians, acquires assets, and manages the business side of medical practices?

Medical foundation

Which of the following reimbursement methods pays providers according to charges that are calculated before healthcare______services are rendered?

Prospective payment method

Which of the following apply to radiologist and other procedures that include professional and technical components and are paid as a lump sum to be divided between physician and healthcare facility?

Global payments

Which of the following classifications is used exclusively for classifying cases of malignant disease?


Which of the following is used to report the healthcare supplies, products, and services provided to patients by healthcare professionals?


Which of the following provides the most comprehensive controlled vocabulary for coding the contents of a patient record?


At which level of the classification system are the most specific ICD-9-CM codes found?

Sub-classification level

What are five-digit ICD-9-CM diagnosis codes referred to as?

Sub-classification codes

What are four-digit ICD-9-CM diagnosis codes referred to as?

Subcategory codes

Which of the following ICD-9-CM codes are always alphanumeric?

V codes

Which of the following ICD-9-CM codes classify environmental events and circumstances as the cause of an injury, poisoning, or other adverse effect?

E codes

Which volume of ICD-9-CM contains the tabular and alphabetic lists of procedures?

Volume 3

Which of the following is a standard terminology used to code medical procedures and services?


Which of the following provides a set of codes used for collecting data about substance abuse and mental health disorders?


Which of the following statements does not apply to ICD-9-CM?

It can be used to collect data about nursing care.

Computer software programs that assist in the assignment of codes used with diagnostic and procedural classifications are called:


Nosology can be defined as the branch of medical science that deals with .

Classification systems

Which organization originally published ICD-9?

World Health Organization

Which of the following terms refers to the incidence of disease?


Which of the following terms refers to the incidence of death?


Which of the following is not one of the purposes of ICD-9-CM?

Identification of the supplies, products, and services provided to patients

Which of the following organizations is responsible for updating the diagnosis classification of ICD-9-CM?

National Centers for Health Statistics

Which of the following organizations is responsible for updating the procedure classification of ICD-9-CM?

Centers for Medicare and Medicaid Services

Which volume of ICD-9-CM contains the numerical listing of codes that represent diseases and injuries?

Volume 1

Which volume of ICD-9-CM contains the alphabetic index for the diagnostic codes?

Volume 2

AHIMA has developed Standards of Ethical Coding.


I work at a substance abuse center. What system should I use to code diagnoses?


Which of the following would be an argument for the transition to ICD-10-CM/PCS?

More detail in the code

The services provided by HIM departments in acute care hospitals usually include all the following except

Medical billing

The first point of data collection and the area where the health record number is most commonly assigned in an acute care hospital is the:

Patient registration department

As an HIM professional, you would be directly responsible for tracking the compliance with the Joint Commission's standard for the:

Averaged quarterly medical record delinquency rate

Which of the following tasks would the HIM department not perform in an electronic health record system?


The master patient index:

All of the above

Consider the following sequence of numbers. What filing system is being used if these numbers represent the health record numbers of three records filed together within the filing system?

Terminal digit

Reviewing the health record for missing signatures, missing medical reports and ensuring that all documents belong in the health record is an example of ___ review.


The coding of clinical diagnoses and healthcare procedures and services after the patient is discharged is ____ review.


The release of information function requires the HIM professional to have knowledge of:

Federal and state confidentiality laws

In which of the following systems does an individual receive a unique numerical identifier for each encounter with a healthcare facility?

Serial numbering system

In which of the following systems does an individual receive a unique numerical identifier at the time of first encounter with a healthcare facility and maintain that identifier for all subsequent encounters?

Unit numbering system

A record not completed within the time frame specified in the medical staff rules and regulations is called a:

Delinquent record

Which of the following should be taken into consideration when designing a health record form?

All of the above

Which of the following statements describes alphabetical filing?

File the record alphabetically by the last name, followed by the first name, and then the middle initial.

Which of the following is a micro-graphic method of storing health records in which each document page is placed sequentially on a long roll?

Microfilm roll

Which of the following filing methods is considered the most efficient?

Terminal digit filing

Which of the following indexes is considered to be the authoritative key to locating a health record?

Master patient index

If the vice president of marketing requested information regarding the number of cardiac catheterizations performed in 2010, what index would you consult?

Operations/procedures index

What committee oversees the development and approval of new forms for the health record?

Forms committee

What is the term used to describe the process of checking individual data elements, reports, or files against each other to resolve discrepancies in accuracy of data and information?


Dr. Smith wants to use a lot of free text in his EHR. What should be your response?

Dr. Smith, we recommend that you use little, if any, free text in the EHR.

I am arguing against the use of the copy/paste function in the EHR. Which of the following would be my argument?

I am unable to identify the author.

An HIM student has asked you, the HIM director, why the hybrid record is so challenging. What is your response?

It is because we have to manage both the electronic media as well as the paper.

A functionality of the electronic health record that allows patients access to their protected health information (for example, lab results) is

Patient portal

When a hospital accredited by Joint Commission is considered to be in compliance with Medicare's Conditions of Participation, this is called:

Deemed status

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