RHIT Exam Practice Questions Domain 5

RHIT Exam Practice Questions Domain 5

The evaluation of coders is recommended at least quarterly for the purpose

of measurement and assurance of:

• Speed
• Data quality and integrity
• Accuracy
• Effective relationships with physicians and facility personnel

(Ans- Data quality and integrity

Coders should be evaluated at least quarterly, with appropriate training needs identified, facilitated, and reassessed over time. Only through this continuous process of evaluation can data quality and integrity be accurately measured and ensured.

Which of the following is a legal concern regarding the EHR?

• Ability to subpoena audit trails
• Template design
• ANSI standards
• Data sets

(Ans- Ability to subpoena audit trails

There are a number of legal issues facing the electronic health record (EHR). State laws vary as to what is and is not acceptable in a court of law regarding EHRs. Healthcare providers frequently receive subpoenas requesting the production of the health record. The subpoenas may require the production of audit trails.

Healthcare fraud is all except which of the following?

• Damage to another party that reasonably relied on misrepresentation
• False representation of fact 1 / 4

• Failure to disclose a material fact
• Unnecessary costs to a program

(Ans- Unnecessary costs to a program

Healthcare fraud is the intentional deception or misrepresentation that an individual knows (or should know) to be false, or does not believe to be true, and makes, knowing the deception could result in some unauthorized benefit to himself or some other person(s). Unnecessary costs to a program, in and of itself, would not be healthcare fraud, there would need to be some intentional deception for it to be considered fraud.

Corporate compliance programs became common after adoption of which of the following?

• False Claims Act.
• Federal Sentencing Guidelines
• Office of the Inspector General for HHS
• Federal Physician Self-Referral Statute

(Ans- Federal Sentencing Guidelines

The U.S. Federal Sentencing Guidelines outline seven steps as the hallmark of an effective program to prevent and detect violations of law.These seven steps were the basis for the OIG's recommendations regarding the fundamental elements of an effective compliance program.

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?

• A bonus program for coders who code charts with higher paying MS-

DRGs

• A hotline to receive complaints and adoption of procedures to protect

whistleblowers from retaliation 2 / 4

• Procedures to adequately identify individuals who make complaints so

that appropriate follow-up can be conducted

• A corporate compliance committee that reports directly to CFO

(Ans- A hotline to receive complaints and adoption of procedures to protect whistleblowers from retaliation

The OIG has outlined seven elements as the minimum necessary for a comprehensive compliance program. One of the seven elements is the maintenance of a process, such as a hotline, to receive complaints and the adoption of procedures to protect the anonymity of complaints and to protect whistleblowers from retaliation.

Examples of high-risk billing practices that create compliance risks for healthcare organizations include all EXCEPT which of the following?

• Altered claim forms
• Returned overpayments
• Duplicate billings
• Unbundled procedures

(Ans- Returned overpayments

Fraudulent billing practices represent a major compliance risk for

healthcare organizations. High-risk billing practices include: billing for

noncovered services, altered claim forms, duplicate billing, misrepresentation of facts on a claim form, failing to return overpayments, unbundling, billing for medically unnecessary services, overcoding and upcoding, billing for items or services not rendered, and false cost reports.

Which of the following issues compliance program guidance?

A. AHIMA

B. CMS

• Federal Register
• HHS Office of Inspector General

(Ans- HHS Office of Inspector General 3 / 4

From February 1998 until the present, the Office of Inspector General (OIG) continues to issue compliance program guidance for various types of healthcare organizations. The OIG website (www.oig.hhs.gov) posts the documents that most healthcare organizations need to develop fraud and abuse compliance plans.

In developing a coding compliance program, which of the following would NOT be ordinarily included as participants in coding compliance education?

• Current coding personnel
• Medical staff
• Newly hired coding personnel
• Nursing staff

(Ans- Nursing staff

In conjunction with the corporate compliance officer, the health information manager should provide education and training related to the importance of complete and accurate coding, documentation, and billing on an annual basis. Technical education for all coders should be provided.Documentation education is also part of compliance education. A focused effort should be made to provide documentation education to the medical staff.

Which type of identity theft occurs when a patient uses another person's name and insurance information to receive healthcare benefits?

• Medical
• Financial
• Criminal
• Health

(Ans- Medical

Medical identity theft occurs when a patient uses another person's name and insurance information to receive healthcare benefits. Most often this is

• / 4