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Registered Health Information Administrator (RHIA) Questions 396–400 (page: 81)

Updated On: 9-Feb-2026

When appropriate, under the outpatient PPS, a hospital can use this CPT code in place of, but not in addition to, a code for a medical visit or emergency department service.

  1. CPT Code 99291 (critical care)
  2. CPT Code 99358 (prolonged evaluation and management service)
  3. CPT Code 35001 (direct repair of aneurysm)
  4. CPT Code 50300 (donor nephrectomy)

Answer(s): A



To monitor timely claims processing in a hospital, a summary report of "patient receivables" is generated frequently. Aged receivables can negatively affect a facility's cash flow; therefore, to maintain the facility's fiscal integrity, the HIM manager must routinely analyze this report.

  1. remittance advice
  2. periodic interim payments
  3. DNFB (discharged, no final bill)
  4. chargemaster

Answer(s): C



Assume the patient has already met his or her deductible and that the physician is a nonparticipating Medicare provider, but does accept assignment. The standard fee for the services provided is $120.00. Medicare's PAR fee is $60.00 and Medicare's nonPAR fee is $57.00. How much reimbursement will the physician receives from Medicare?

  1. $120.00
  2. $60.00
  3. $57.00
  4. $45.60

Answer(s): D



The occurrence of an OCE (outpatient code editor) edit can result in one of __________ different dispositions, which help to ensure that the fiscal intermediaries in all parts of the country are following similar claims processing procedures. An example of one of these dispositions is "claim rejection."

  1. 100
  2. 50
  3. 3
  4. 6

Answer(s): D



All of the following statements are true of MS-DRGs, EXCEPT

  1. A patient claim may have multiple MS-DRGs.
  2. The MS-DRG payment received by the hospital may be lower than the actual cost of providing the services.
  3. Special circumstances can result in an outlier payment to the hospital.
  4. There are several types of hospitals that are excluded from the Medicare inpatient PPS.

Answer(s): A



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