Mixed Deck — All RHIT Topics Flashcards
100 cards from real RHIT 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 RHIT Topics flashcards as text
In ICD-10-CM, what is the significance of a 7th character 'A' in injury codes?
Answer: Initial encounter — active treatment phase
The 7th character 'A' denotes the initial encounter when the patient is receiving active treatment for the injury.
An HIM professional sends a fax containing PHI to the wrong recipient. Under HIPAA, this is considered:
Answer: A potential breach requiring a risk assessment
A misdirected fax is an impermissible disclosure that triggers the four-factor risk assessment to determine if it constitutes a reportable breach.
What is the primary purpose of the Uniform Hospital Discharge Data Set (UHDDS) in inpatient coding?
Answer: To define standardized data elements and their definitions for inpatient hospital reporting
The UHDDS establishes minimum common data elements—including the definition of principal diagnosis, other diagnoses, and procedures—that must be reported consistently for inpatient hospital discharges.
A release of information specialist receives a request for records from a patient's attorney. Which document is essential before releasing records in a non-litigation context?
Answer: A valid written HIPAA-compliant authorization signed by the patient
Without a court order or subpoena, a valid patient authorization is required to release records to an attorney.
A healthcare organization is implementing a master patient index (MPI) cleanup project. Which of the following is the MOST critical outcome of a well-maintained MPI?
Answer: Accurate linkage of all records to the correct patient
The primary function of the MPI is to uniquely identify each patient and correctly link all their encounters to a single identity. Errors in the MPI lead to fragmented or misassigned records, creating significant patient safety and data integrity risks.
Which data quality characteristic ensures that a data element has a value whenever it is required and is not left blank?
Answer: Completeness
Completeness ensures that all required data fields contain values and that no required information is missing.
What does the abbreviation PHI stand for in the context of HIPAA regulations?
Answer: Protected Health Information
PHI stands for Protected Health Information, which includes any individually identifiable health information transmitted or maintained in any form.
Which technique helps identify relationships and patterns in health data that may indicate data quality problems?
Answer: Data profiling
Data profiling analyzes the structure, content, and relationships within a dataset to detect anomalies and quality issues.
What is the purpose of a deficiency analysis in health information management?
Answer: To identify incomplete records requiring physician completion
Deficiency analysis identifies missing or incomplete components of the health record that require provider completion to meet standards.
A hospital conducts a Failure Mode and Effects Analysis (FMEA) before implementing a new medication administration process. This is an example of:
Answer: Proactive risk assessment
FMEA is a proactive tool used to identify potential failure points and their consequences before a process is implemented, allowing teams to prevent problems before they occur.
What is the purpose of the Present on Admission (POA) indicator in inpatient coding?
Answer: To identify whether a condition was present at the time of the patient's admission
The POA indicator identifies whether a diagnosis was present at the time of inpatient admission.
What is encryption and why is it important for ePHI?
Answer: Converting data into an unreadable coded format that can only be decoded with the proper key
Encryption transforms readable data into an unreadable format using an algorithm and key.
A claim is denied with reason code CO-4. This means:
Answer: The procedure code is inconsistent with the modifier
CO-4 denial indicates the procedure code is inconsistent with the modifier used, requiring the coder to review and correct the modifier or procedure code combination.
What rights do patients have regarding restrictions on PHI use under HIPAA?
Answer: Patients can request restrictions, and providers must agree when patients pay out-of-pocket in full
Patients can request restrictions, and providers must agree to restrict disclosures to health plans when the patient pays in full out-of-pocket.
Which ambulatory payment classification (APC) system is used to reimburse Medicare outpatient hospital services?
Answer: Outpatient Prospective Payment System (OPPS)
OPPS groups outpatient services into APCs and pays a predetermined rate per APC, used by Medicare for hospital outpatient reimbursement.
A claim submitted without errors that meets all payer requirements on its first submission is called a:
Answer: Clean claim
A clean claim contains all required data elements, no errors, and is accepted for adjudication without additional information requests.
How soon after a claim denial from an insurance like Blue Cross/Blue Shield must an internal appeal be filed?
Answer: 180
If an insurer, such as Blue Cross/Blue Shield, rejects a claim, the insurance company must file an internal appeal within 180 days following the rejection. For services to be provided in the future, the insurance provider must finish the appeals process and make a determination within 30 days, and for services previously rendered, within 60 days. The claimant has 60 days following notification of the denial to obtain an external review by a third party if the insurer continues to decline the claim.
Which of the following is an example of a compliant physician query format?
Answer: A query presenting multiple clinically supported options including 'other' and 'undetermined'
Compliant queries are non-leading, present multiple supported options, and include clinical indicators to guide physician response.
What is the minimum necessary standard under HIPAA?
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.
What is the correct sequencing when a patient is admitted for chemotherapy?
Answer: The chemotherapy encounter code (Z51.11) is the principal diagnosis, followed by the neoplasm code
When admitted solely for chemotherapy, the Z code is the principal diagnosis with the neoplasm as secondary.