Understanding Healthcare Coding, Reimbursement, Statistics,

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break, so be sure that you have seen the entire question and all the answers before choosing an answer.

1. Which of the following is calculated by the sum of the values divided by the frequency?

A. Measure

B. Median

C. Mode

D. Mean

2. A patient’s record was assigned code J0135. What type of code was used?

A. CPT-4




3. _______ are not actually health insurance plans, but act as entitlements.

A. Managed care plans

B. Preferred provider organizations

C. Government-funded health plans

D. Integrated delivery networks

4. Which of the following initiatives was created by the Joint Commission to measure performance for the

accreditation process and quality improvement?





5. When patients sign a form allowing an insurance plan to pay the physician directly, this process is known


A. coinsurance.

B. adjudication.

C. explanation of benefits.

D. assignment of benefits.

6. A federal employee who gets hurt on the job may be covered by



C. Medicaid.


7. Which of the following acts as an intermediary between a health plan and a provider?



C. Prospective payment system

D. Clearinghouse

8. A patient’s account was assigned code 90806 for psychotherapy. What type of coding was being





D. CPT-4

9. Systems produced by the same company and share a database are known as

A. integrated.

B. interfaced.

C. decision support.

D. administrative.

10. Which of the following is an example of an administrative system?

A. Case management

B. Continuing education

C. Payroll

D. Patient scheduling

11. _______ is a part of Medicare funded through payroll taxes while a person is working.

A. Medicare D

B. Medicare A

C. Medicare C

D. Medicare B

12. Dr. Brown’s office just received $792 from a patient’s insurance. This payment is referred to as the

A. copay.

B. adjustment.

C. deductible.

D. remittance .

13. Employers use information from _______ to select the best plan coverage for their employees.




D. HL7

14. Which of the following plans was created as a way to give patients more options?





15. Which of the following DRG factors reflects the average relative costliness of medical cases versus

those cases in Medicare?





16. Which of the following codes was created to meet the needs of codes that aren’t addressed under any

other coding system?


B. CPT-4



17. Which system produces data and reports used mainly for decision and risk analysis?

A. Financial

B. Scheduling

C. Quality management

D. Administrative

18. Which of the following doesn’t need the additional plan to cover the gaps in insurance?

A. Medicare C

B. Medicare D

C. Medicare B

D. Medicare A

19. This coverage is approved by Medicare, but run by private companies.

A. Medicare C

B. Medicare D

C. Medicare A

End of exam

D. Medicare B

20. HIPAA requires that individual patient information used for other things besides TPO have the patient’s

personal information removed. This process is known as _______ data.

A. indexing

B. de-identifying

C. aggregating

D. coding


Understanding the Fundamentals of Managing Health Records an

  1. Your hospital is transitioning from paper-based records to electronic health records. Right now, part of

The record is paper, and some of it has been transitioned to electronic formats. AHIMA refers to this as a(n)

_______ Health record.

  1. source-oriented
  2. integrated
  3. problem-oriented
  4. hybrid
  5. Which of the following is required by the Joint Commission for ambulatory charts?
  6. Discharge summary
  7. Medication list
  8. Consent to treat
  9. Problem list
  10. You’re reviewing patient information in which resolution is a big factor. What system are you most likely

to be using?

  1. Pharmacy
  2. Biomedical
  3. Radiology
  4. Dictation/transcription
  5. Which of the following is an example of a secondary record?
  6. Demographic data
  7. Lab results
  8. SOAP note
  9. Billing claim
  10. In reverse chronological order, the _______ patient record is the most common record used.
  11. problem-oriented
  12. integrated
  13. hybrid
  14. source-oriented
  15. Admission and discharge notes are examples of
  16. demographic data.
  17. primary records.
  18. secondary records.
  19. claims.
  20. Which of the following is required by CMS?
  21. DEEDS
  22. UCDS
  23. OASIS
  24. NCDB
  25. You sit on the electronic health record committee that has decided to get systems that work best for each

department. This method is known as the _______ approach.

  1. best-of-breed
  2. integrated systems
  3. LOINC
  4. hanging protocol
  5. Which of the following requires that the criteria of message integrity, nonrepudiation, and user

authentication be used?

  1. Flow sheets
  2. Nomenclature
  3. EHR forms
  4. Electronic signatures
  5. Which of the following is an example of a secondary record?
  6. Dental record
  7. Ambulatory care record
  8. MPI
  9. Physician order
  10. Which of the following is required by the CMS?
  11. Refusal of treatment
  12. Advanced directive
  13. Medicare patient rights statement
  14. HIPAA consent
  15. Which of the following is used for planning care in an SNF?
  16. Data sets
  17. SOAP
  18. Case management
  19. RAI
  20. The nurse indicates that the patient in Room 302 is DNR. Where would you look to confirm this?
  21. Patient rights statement
  22. Advance directives
  23. Disclosure records
  24. Assignment of benefits
  25. The admission clerk misspells a patient’s name and therefore can’t find him in the system, so a new

number gets assigned and a chart created. This problem is a common downfall of

  1. electronic records.
  2. common names.
  3. paper records.
  4. unit numbering.
  5. Which of the following is considered a public health record?
  6. Medical history
  7. Organ donor
  8. Referral consult
  9. Death record
  10. Which of the following does AHIMA recommend keeping permanently?
  11. Death registry
  12. Mammography
  13. Children’s records
  14. Pathology reports
  15. You’re filing a patient’s paper record with the number 462-99-00. Your department is probably using

which filing system?

  1. Alphanumeric
  2. Straight numeric
  3. Family numbering
  4. Serial-unit
  5. Which of the following is often used to meet Joint Commission compliance?
  6. Unit numbering
  7. Serial-unit numbering
  8. Serial numbering
  9. Family numbering
  10. The downfall of this numbering system is that there may be multiple records for one patient.
  11. Family numbering
  12. Unit numbering

End of exam

  1. Serial-unit numbering
  2. Serial numbering
  3. You’re looking at a patient’s paper record in which all the physician notes are grouped together in one

section, the lab results are grouped together in another section, and the nursing notes are organized in yet

another section. Which type of record are you most likely viewing?

  1. Hybrid
  2. Integrated
  3. Source-oriented
  4. Problem-oriented





As part of the requirements of this course, you must complete a project. The project is designed to train your mind to think in ways that may serve you well in your professional life. When you complete the project, you’ll submit it for grading.

For your research project, you’ll use a computer word proces- sor to complete the following Critical Thinking Exercises from your textbook:

Health Information Technology and Management

  • Richard Gartee


  • print font, size 12. Use a standard document format with
  • 1-inch margins. (Do not use any fancy or cursive fonts.)
  • Include the following information at the top of your
  • paper:
  • Name and complete mailing address
  • Student number
  • Research Project
  • 56
  • Course title and number (Department Management,
  • HIT 209)
  • Research project number (40931800)
  • Read the assignment carefully and answer each question.
  • Be specific. Limit your submission to the questions
  • asked and issues mentioned.
  • Proofread your work carefully. Check for correct spelling,
  • grammar, punctuation, and capitalization.
  • Grading Criteria
  • Your project will be evaluated according to the following
  • Content
  • 80 percent
  • Written communication
  • 10 percent
  • Format
  • 10 percent
  • Here’s a brief explanation of each of these.
  • Content
  • The student
  • Provides clear answers to the assigned questions
  • Addresses the questions in complete sentences, not just
  • simple yes or no statements
  • Stays focused on the assigned issues
  • Writes in his or her own words and uses quotation
  • marks to indicate direct quotations
  • Written Communication
  • The student
  • Answers each question
  • Uses correct grammar, spelling, punctuation, and sentence
  • first, however, on the other hand, and so on, conse-
  • quently, since, next, and when)
  • Makes sure the paper contains no typographical errors



  • Chapter 1, page 21: Critical Thinking Exercises 1 and 2
  1. Which department discussed in this chapter is located in an inpatient hospital, but is considered an outpatient facility?
  2. If a patient seen in this department is sent home but is admitted as an inpatient in there days or less how does that affect the hospital’s billing?


  • Chapter 2, page 41: Critical Thinking Exercise 1
  1. Although you are just being introduced to the health information profession, thing about the several different allied health professional occupation that were described in this chapter. Which of them piqued interest the most and why?


  • Chapter 3, page 72: Critical Thinking Exercises 1, 2, and 3
  1. You have a job in the HIM department. A friend of your works for a lawyer. She comes to your facility to pick up copies of records for one of her boss’s clients. She has forgotten to bring the client’s authorization form. She is in a hurry and doesn’t have time to go back her office. You have known her for many years and are good friends. Do you give her the records without the authorization from?
  2. If you decide to give your friend the records, what are the implications for your employer?
  3. Is there a way to help your friend get the records without requiring her to drive back to her office?
  • Chapter 5, page 126: Critical Thinking Exercise 1
  1. CMS takes the position that ‘’ if it isn’t documented, is wasn’t done.’’ What does this mean and why would it matter to CMS?
  • Chapter 8, page 204: Critical Thinking Exercises 1 and 2
  1. Using figure 8-3 determine the sounndex code for your surname.
  2. Many medical errors occur when patients are given medications. How do the ‘’ five rights’’ prevent these errors? How does a CPOE system contribute to patient safety?
  • Chapter 9, page 235: Critical Thinking Exercise 1
  1. Several reimbursement methodologies were describe in this chapter. What incentive would a provider have to participate in each reimbursement type?
  • Chapter 10, page 259: Critical Thinking Exercises 1 and 2
  1. Locate the questions in Box 10 of the CMC-1500 insurance form show in figure 10-5. Why would a health plan want this information on its claim form?
  2. What are some of the advantage of electronic media claims over paper claims?
  • Chapter 11, page 282: Critical Thinking Exercises 1 and 2
  1. Ask 10 people their height. Make a list and arrange it in order by height.
  2. Find the mean, median, and mode on your list from Exercise 1. Does list contain outliers (such as children or basketball players) that are much shorter or taller than most of the others on the list?
  • Chapter 12, page 299: Critical Thinking Exercises 1, 2, 3, 4, and 5
  1. Is this a PCE?
  2. What steps should be taken immediately?
  3. What Structures and processes in the facility should be examined?
  4. What improvements should be made to prevent such accidents in the future?
  5. What changes should be made to limit liability for similar events in the future?