RHIT RHIT 2 — Questions and Answers
Question 1: Which coding system is used to report inpatient hospital procedures in the United States?
- CPT
- ICD-10-PCS (Correct answer)
- HCPCS Level II
- SNOMED CT
Correct answer: ICD-10-PCS
ICD-10-PCS is the official coding system for reporting inpatient hospital procedures in the United States.
ICD-10-PCS is a seven-character alphanumeric coding system developed by CMS specifically for inpatient hospital procedures with over 78,000 codes.
Question 2: What is the purpose of the Medicare Severity Diagnosis Related Group (MS-DRG) system?
- To determine physician licensing requirements
- To classify inpatient stays into groups for prospective payment purposes (Correct answer)
- To assign quality scores to nursing homes
- To manage outpatient prescription drug benefits
Correct answer: To classify inpatient stays into groups for prospective payment purposes
The MS-DRG system classifies inpatient hospital stays into clinically similar groups for Medicare's Inpatient Prospective Payment System.
MS-DRGs are the foundation of Medicare's IPPS. Each DRG represents a group of clinically similar cases with similar expected resource use.
Question 3: A patient is admitted for pneumonia and develops a urinary tract infection during the hospital stay. How should the UTI be classified?
- Principal diagnosis
- Comorbidity
- Hospital-acquired condition (Correct answer)
- Admitting diagnosis
Correct answer: Hospital-acquired condition
A condition that develops during the hospital stay and was not present at admission is classified as a hospital-acquired condition (HAC).
Hospital-acquired conditions (HACs) are conditions not present on admission (POA) but develop during the inpatient stay. CMS established the HAC Reduction Program to reduce payments for hospitals with high HAC rates.
Question 4: What is the minimum necessary standard under HIPAA?
- All staff must have access to all patient records
- Covered entities must limit PHI disclosures to the minimum amount needed to accomplish the intended purpose (Correct answer)
- Patients must provide the minimum amount of information at registration
- Hospitals must maintain minimum staffing levels
Correct answer: Covered entities must limit PHI disclosures to the minimum amount needed to accomplish the intended purpose
The HIPAA minimum necessary standard requires covered entities to make reasonable efforts to limit PHI access to only what is needed.
The minimum necessary standard requires implementing policies to limit access based on job function, limit disclosures to needed information, and develop criteria for routine disclosures.
Question 5: What is the function of an encoder in the medical coding process?
- To convert paper records to electronic format
- To provide automated code lookup and validation to assist coders in assigning accurate codes (Correct answer)
- To encrypt patient data for transmission
- To transcribe physician dictation
Correct answer: To provide automated code lookup and validation to assist coders in assigning accurate codes
An encoder is a software tool that assists medical coders by providing automated code lookup, sequencing guidance, and edit checks.
Encoders are essential coding productivity tools that guide coders through the code selection process with built-in edits for Medicare code edits, CCI edits, and DRG grouping.
Question 6: Which of the following is a key component of an effective compliance program in healthcare?
- Eliminating all coding errors
- Conducting regular internal audits, providing staff education, and establishing a reporting mechanism for concerns (Correct answer)
- Avoiding government payer contracts
- Maximizing revenue at all costs
Correct answer: Conducting regular internal audits, providing staff education, and establishing a reporting mechanism for concerns
An effective compliance program includes regular audits, ongoing education, and a mechanism for reporting concerns.
The OIG defines seven elements: written policies, designated compliance officer, training, communication lines, monitoring and auditing, enforcement, and prompt corrective action.
RHIT RHIT 2
Which coding system is used to report inpatient hospital procedures in the United States?