AHIMA Quality Improvement 3 — Questions and Answers
Question 1: Which type of health record analysis verifies that all required components and signatures are physically present in the medical record?
- Qualitative analysis
- Quantitative analysis (Correct answer)
- Utilization review
- Prospective review
Correct answer: Quantitative analysis
Quantitative analysis checks for the physical presence of required record components such as history and physical reports, operative notes, and physician signatures.
Question 2: Qualitative analysis of health records primarily evaluates:
- Whether all required report types are physically present in the chart
- The clinical consistency, accuracy, and completeness of documentation content (Correct answer)
- The total number of deficiencies per patient encounter
- The timeliness of record completion after discharge
Correct answer: The clinical consistency, accuracy, and completeness of documentation content
Qualitative analysis goes beyond document presence to assess whether clinical content is consistent, legible, and supports the diagnoses and treatments documented.
Question 3: Under AHIMA coding quality standards, what is the minimum recommended accuracy rate for principal diagnosis assignment?
- 85%
- 90%
- 95% (Correct answer)
- 99%
Correct answer: 95%
AHIMA recommends a minimum coding accuracy rate of 95% for principal diagnosis, secondary diagnoses, and procedures to ensure data integrity and appropriate reimbursement.
Question 4: A focused coding audit is MOST commonly triggered by:
- Completion of annual staff performance evaluations
- Significant variation from expected coding patterns or elevated payer denials (Correct answer)
- New employee onboarding orientation requirements
- Routine monthly productivity reporting
Correct answer: Significant variation from expected coding patterns or elevated payer denials
Focused audits are initiated when data analysis reveals unusual coding patterns, high denial rates, or OIG Work Plan risk areas that warrant targeted review.
Question 5: What is the primary objective of a Clinical Documentation Improvement (CDI) program?
- To reduce the total volume of medical records stored on-site
- To ensure documentation accurately reflects patient severity, complexity, and resource use (Correct answer)
- To accelerate medical record coding turnaround time
- To transition facilities from paper to electronic health records
Correct answer: To ensure documentation accurately reflects patient severity, complexity, and resource use
CDI programs work concurrently with clinicians to clarify ambiguous or incomplete documentation so coded data accurately represents the patient's true clinical picture.
Question 6: Denial management analysis in a health information quality program is BEST used to:
- Generate project timelines and Gantt charts for HIM leadership
- Identify patterns in claim denials linked to coding or documentation deficiencies (Correct answer)
- Measure coder attendance and individual productivity metrics
- Schedule concurrent record reviews during patient admissions
Correct answer: Identify patterns in claim denials linked to coding or documentation deficiencies
Analyzing denial patterns by payer, DRG, or denial reason helps identify systemic coding or documentation issues that can be corrected to improve clean claim rates.
Question 7: Which coding quality activity involves reviewing a statistically valid random sample of discharged records to assess overall coder performance across the department?
- Concurrent prospective review
- Random retrospective coding audit (Correct answer)
- Deficiency analysis
- Case mix monitoring
Correct answer: Random retrospective coding audit
A random retrospective coding audit samples discharged records across coders and payers to evaluate accuracy and identify education needs without targeting a specific issue.
AHIMA Quality Improvement 3
Which type of health record analysis verifies that all required components and signatures are physically present in the medical record?