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RHIA Domain 4 Exam | Questions And Answers Latest {} A+ Graded | 100% Verified
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RHIA Domain 4 Exam | Questions And Answers Latest {} A+ Graded | 100% Verified
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RHIA Domain 4 Exam | Questions And Answers Latest {2024- 2025} A+ Graded | 100%Verified
APC acronym - Ambulatory Patient Classification
APC is used in place of _____ for outpatient prospective systems - DRGs
APG acronym - Ambulatory Patient Groups
Visit based outpatient classification system designed to explain the amount and type of resources used
in the ambulatory setting - APG
Rule requiring Medicare to bundle all outpatient services provided by a hospital to a patient within three
days before admission into the DRG payment for that patient - three day payment window
Payment status indicators are assigned to every ______ code - HCPCS/CPT
an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof
- sentinel event
_____________ was developed based on a federal mandate to Medicare to stop paying for conditions
that hospitals cause or allow to develop during inpatient stays. - POA indicator
Preventable medical error resulting in serious consequences for the patient. - Never events
MS-DRG acronym - Medicare Severity Diagnosis Related Groups
How many major diagnostic categories are there? - 25
Part of Medicare that pays for inpatient care, skilled nursing facility care, skilled home healthcare, and
hospice care - A
, Part of Medicare that pays for physician services, outpatient hospital services, medical equipment, and
other supplies and services - B
Part of Medicare that private health insurance companies contract with CMS to offer Medicare
beneficiaries Medicare Advantage plans that compete with the Original Medicare Plan - C
MMA acronym - Medicare Modernization Act
Part of Medicare that is authorized under the MMA and provides voluntary Medicare prescription drug
plans that are open to people who are eligible for Medicare - D
Difference between Medicare and Medicaid - Medicare is a federal program that provides health
coverage if you are 65 or older or have a severe disability, no matter your income. Medicaid is a state
and federal program that provides health coverage if you have a very low income.
Government contractor that processes claims - fiscal intermediary
Where is CMS headquartered? - Baltimore, Maryland
MACs acronym - Medicare Administrative Contractors
Contractor who handles claims and related functions for Part A and B - MACs
MPFS acronym - Medicare Physician Fee Schedule
Medicare Physician Fee Schedule amounts are ___ percent higher than for nonparticipating providers - 5
Decisions by MACs about the coding and medical necessity of a service - LCD
Policy stating whether and under what circumstances a service is covered - NCD
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