Mixed Deck — All RHIA Topics Flashcards
100 cards from real RHIA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 20 Mixed Deck — All RHIA Topics flashcards as text
What is the primary goal of a health information system implementation project's go-live phase?
Answer: Transition from the old system to the new system in the live production environment
The go-live phase is when the new system transitions from a test/training environment to the live production environment where it handles real patient data and operations.
Which coding system is used exclusively for inpatient hospital procedure coding under HIPAA?
Answer: ICD-10-PCS
ICD-10-PCS (Procedure Coding System) is mandated by HIPAA for reporting inpatient hospital procedures on institutional claims.
Under the Anti-Kickback Statute (AKS), which arrangement is prohibited?
Answer: Offering remuneration to induce referrals of items or services covered by federal health programs
The AKS prohibits knowingly offering, paying, soliciting, or receiving remuneration to induce or reward referrals of items or services reimbursable by federal healthcare programs.
What is the purpose of a Notice of Privacy Practices (NPP) under HIPAA?
Answer: Inform patients of their privacy rights and how their PHI may be used and disclosed
The NPP informs patients of their HIPAA privacy rights and how the covered entity may use and disclose their PHI, and must be provided at first contact.
Ambulatory Payment Classifications (APCs) are used under which Medicare payment system?
Answer: Hospital Outpatient Prospective Payment System (OPPS)
APCs are the basis of payment under the Hospital Outpatient Prospective Payment System (OPPS), grouping outpatient services with similar clinical characteristics and resource use.
In ICD-10-CM, what is the maximum number of characters a code can have?
Answer: 7
ICD-10-CM codes can have up to 7 characters, with the first three characters identifying the category and additional characters providing specificity.
When a patient is admitted as an inpatient following an outpatient procedure that results in a complication, which diagnosis is sequenced as principal?
Answer: The complication that caused the inpatient admission
When an outpatient procedure leads to a complication requiring inpatient admission, the complication is sequenced as the principal diagnosis because it is the condition chiefly responsible for the admission.
What is the primary purpose of the master patient index (MPI) in a healthcare facility?
Answer: Uniquely identify and track each patient across encounters
The MPI serves as the definitive source for uniquely identifying and tracking every patient across all visits and departments within a facility.
You are completing a complete facility inventory of all currently in use forms in preparation for a HER. For bar coding and indexing into a document management system, each form needs a name. The nameless document in front of you describes tissue removed during surgery from a microscopic perspective. You are most likely to submit a document of the following type to this form:
Answer: pathology report
A pathology report is the official document generated by a pathologist after examining tissue or fluid samples (e.g., biopsies, surgical specimens) under a microscope. It details the microscopic findings, provides a diagnosis, and includes other relevant information about the tissue, precisely matching the description of a document describing tissue from a microscopic perspective.
What must a covered entity do when a breach of unsecured PHI affects 500 or more individuals in a state?
Answer: Notify affected individuals, HHS, and prominent media outlets in the affected state within 60 days
For breaches affecting 500 or more individuals in a state, covered entities must notify affected individuals, HHS, and prominent media outlets in that state within 60 days of discovery.
When a HIM professional disseminates medical data that would inevitably lead to genetic prejudice, they are breaking the ethical rule of:
Answer: Nonmaleficence
Nonmaleficence is the ethical principle of 'do no harm.' Disseminating medical data that could lead to genetic prejudice directly harms the patient by potentially causing discrimination or other negative consequences. A HIM professional has an ethical obligation to protect patient information and prevent its misuse, upholding the principle of nonmaleficence.
What is the purpose of a staffing model in HIM department management?
Answer: Determine the number and mix of staff needed to meet workload demands efficiently
A staffing model determines the appropriate number and skill mix of staff required to meet departmental workload demands within productivity and budget parameters.
The Alphabetic Index in ICD-10-CM serves what primary function?
Answer: Directs the coder to the appropriate code or range in the Tabular List
The Alphabetic Index is a starting reference tool used to locate potential codes, but the Tabular List must always be consulted to verify the final code selection.
What is benchmarking in the context of HIM operations?
Answer: Comparing an organization's performance metrics against industry standards or best practices
Benchmarking compares an organization's performance data against external standards, peer organizations, or industry best practices to identify gaps and improvement opportunities.
Under UHDDS guidelines, which diagnosis must be identified as the principal diagnosis for inpatient coding?
Answer: The condition established after study to be chiefly responsible for admission
Per Uniform Hospital Discharge Data Set (UHDDS) guidelines, the principal diagnosis is the condition established after study to be chiefly responsible for causing the admission.
Which HIPAA provision requires covered entities to provide patients with a list of certain disclosures made of their PHI?
Answer: Right to an accounting of disclosures
The right to an accounting of disclosures requires covered entities to provide patients with a list of certain disclosures made outside of TPO purposes upon request.
What is the role of the health information manager in a clinical documentation improvement (CDI) program?
Answer: Educate physicians on documentation to support accurate code assignment
In CDI programs, HIM professionals educate providers on documentation specificity to ensure coded data accurately reflects the patient's clinical condition.
When an exploratory laparotomy is performed then a therapeutic procedure, the coder reports this information in ICD-9-CM.
Answer: Schema mapping
When an exploratory laparotomy is performed followed by a therapeutic procedure, the coder reports this information in ICD-9-CM by assigning codes for both procedures. In the context of health information systems, 'Schema mapping' refers to the process of defining how data elements from one data model (e.g., clinical documentation of procedures) are translated and stored according to another data model (e.g., the database schema used for ICD-9-CM codes). This ensures that the coded information about both procedures is correctly captured and linked within the system.
HCPCS Level II codes are used primarily to report what type of services?
Answer: Supplies, equipment, and non-physician services not in CPT
HCPCS Level II codes supplement CPT to cover supplies, durable medical equipment, ambulance services, and other services not represented in CPT.
In ICD-10-CM, the 7th character 'A' for fracture codes indicates the encounter is:
Answer: Initial encounter for active treatment of the fracture
The 7th character 'A' designates an initial encounter, used while the patient is receiving active treatment for the fracture, regardless of whether the provider is seeing the patient for the first time.