RHIT Revenue Cycle Management 4

Question 1

Under HIPAA, which transaction standard is used for electronic claim submission from providers to payers?

Accepted Answer

ASC X12 837

Answer

The ASC X12 837 transaction set (837P for professional, 837I for institutional) is the HIPAA-mandated standard for electronic health care claim submission.

Question 2

A provider bills Medicare for a service not medically necessary per LCD criteria. What document should be given to the patient before the service?

Accepted Answer

Advance Beneficiary Notice (ABN)

Answer

An ABN must be issued to Medicare patients before providing a service that Medicare may deny as not medically necessary, allowing the patient to choose whether to receive the service and accept financial responsibility.

Question 3

The term 'upcoding' in the context of revenue cycle compliance refers to:

Accepted Answer

Assigning a higher-level code than documented to increase reimbursement

Answer

Upcoding is a fraudulent billing practice of assigning codes that reflect higher-complexity or more expensive services than were actually documented or performed.

Question 4

Which reimbursement methodology pays a fixed amount per member per month regardless of services utilized?

Accepted Answer

Capitation

Answer

Capitation pays providers a set monthly fee per enrolled patient, transferring financial risk to the provider since payment is independent of services rendered.

Question 5

Which present-on-admission (POA) indicator is assigned when the condition is present at the time of inpatient admission?

Accepted Answer

Y

Answer

POA indicator 'Y' (Yes) is assigned when the condition was present at the time of the inpatient admission.

RHIT - Registered Health Information Technician Practice Test

RHIT - Registered Health Information Technician Practice Test

RHIT Revenue Cycle Management 4