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RHIA Domain 4 (Dilhari)
Terms in this set (25)
Query the physician who originated the progress note or other report in question
When documentation in the health record is not clear, the coding professional should:
What is the name of the statement sent after the provider files a claim that details amounts billed by the provider, amounts approved by Medicare, amount Medicare paid, and amount the patient must pay?
MAC, RAC, and QIO
Which of the following lists contains only entities that have roles in the various Medicare Improper Payment Review processes?
Acute respiratory failure in a patient whose lab report findings appear to not support this diagnosis
A physician query may not be appropriate in which of the following instances?
The health plan reimburses Dr. Tan $15 per patient per month. In January, Dr. Tan saw 300 patients so he received $4,500 from the health plan. What method is the health plan using to reimburse Dr. Tan?
Which of the following conditions would be the most likely to fall into the category of notifiable diseases as defined by the National Notifiable Diseases Surveillance System?
Implement a standardized physician query form so that codes can request clarification from physicians about documentation issues.
An internal coding audit at Community Hospital shows that the cause of improper coding is lack of proper physician documentation to support reimbursement at the appropriate level. Coders have found that coding issues result because physician documentation needs clarification. The HIM department staff has met periodically with each clinical specialty to improve communication and provide targeted education, but documentation problems still persist. Which of the following actions would be the most reliable and consistent method to improve communication and documentation?
Which Joint Commission survey methodology involves an evaluation that follows the hospital experiences of current patients?
Submit an adjusted claim to Medicare
After a claim has been filed with Medicare, a healthcare entity had late changes posted to a patient's outpatient account that changed the calculation of the ambulatory payment classification (APC). What is the best practice for this entity to receive the correct reimbursement from Medicare?
It is the year 201X. The federal government is determined to lower the overall payments to physicians. To incur the least administrative work, which of the following elements of the physician payment system would the government reduce?
Remove the code from the abstract and counsel the coder regarding CDM hard codes in this service.
Part of the coding supervisor's responsibility is to review accounts that have not been final billed due to errors. One of the accounts on the list is the same-day procedure. Upon review, the coding supervisor notices that the charge code on the bill was hard-coded. The ambulatory procedure coder added the same CPT code to the abstract. How should this error be corrected?
all query opportunities
A comprehensive retrospective review should be conducted at least once a year
Sue in her role as a patient registration clerk uses a patient's insurance information to see a specialist for cosmetic surgery.
Which of the following is an example of internal medical identity theft?
Admission to deposit in the bank
The accounts receivable collection cycle involves the time from:
Nursing and therapy services, routine and nonroutine medical supplies, home health aide visits
In the HHPPS system, which home healthcare services are consolidated into a single payment to home health agencies?
Review the coding errors and counsel the employee
The lead coder in the HIM department is an acknowledged coding expert and is the go-to person in the healthcare entity for coding guidance. As the HIM director you learn that she is not following proper coding guidelines and her coding practices are not compliant. As the HIM director, the best steps to take would be which of the following?
Counsel the coder to stop the practice immediately
A coding audit shows that an inpatient coder is using multiple codes that describe the individual components of a procedure rather than using a single code that describes all the steps of the procedure performed. Which of the following should be done in this case?
Cases where excellent penmanship created challenges for the coders are identified
An outcome of coding audit reviews may be any of the following except:
Query the physician as to the method used
When the physician does not specify the method used to remove a lesion during an endoscopy, what action should the coder take?
Query the physician to determine if the condition was present on admissino
In conducting a qualitative review, the clinical documentation specialist sees that the nursing staff has documented the patient's skin integrity on admission to support the presence of a stage I pressure ulcer. However, the physician's documentation is unclear as to whether this condition was present on admission. How should the clinical documentation specialist proceed?
Before Central Hospital is permitted to open and provide medical services in a particular state, the healthcare entity must first go through which of the following processes?
The cost of the service is greater than the APC payment by a fixed ratio and exceeds the APC payment plus a threshold amount
In the APC system, a high-cost outlier payment is paid when which of the following occurs?
A polyp was removed from a patient's colon during a colonoscopy procedure. The physician and pathologist document the polyp as probable adenocarcinoma of the colon. Which of the following actions should the coding professional take to code this encounter?
The need for postdischarge queries will be eliminated
Anywhere Hospital is implementing a new clinical documentation improvement (CDI) program. As part of the program, the clinical staff is educated on the components and procedures of the program. Which of the following would not be true about the CDI program?
The health record review process and what other aspect allow for the highest level of quality in clinical documentation?
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