AHIMA RHIT (Registered Health Information Technician) — All Questions

A coder is pressured by a supervisor to assign a higher-paying DRG that is not supported by the documentation. Knowingly submitting such a claim to Medicare violates the:

• a.Anti-Kickback Statute only
• b.False Claims Act✓
• c.EMTALA
• d.Stark Law only

Knowingly submitting, or causing the submission of, false or fraudulent claims to a federal program violates the False Claims Act, which also allows whistleblower (qui tam) suits and treble damages. Upcoding for unsupported reimbursement is a classic example. The Anti-Kickback Statute and Stark Law address referral/financial-relationship abuses, and EMTALA addresses emergency treatment obligations — different laws, different conduct.

The primary role of Medicare Recovery Audit Contractors (RACs) is to:

• a.Provide free legal defense to hospitals
• b.Detect and correct improper Medicare payments, including both overpayments and underpayments✓
• c.Set the relative values assigned to CPT codes
• d.Accredit hospitals for participation

RACs review Medicare claims after payment to identify improper payments — recovering overpayments and, less often, flagging underpayments. HIM staff support RAC responses by producing records and tracking appeals. Accreditation is performed by bodies such as the Joint Commission, and code values are set through CMS/AMA processes, not by RACs.

The Office of Inspector General (OIG) framework for an effective corporate compliance program is built around how many core elements?

• a.Three
• b.Five
• c.Seven✓
• d.Ten

The OIG describes seven elements of an effective compliance program: written standards/policies, a designated compliance officer/committee, effective training and education, open lines of communication, internal monitoring and auditing, enforcement through disciplinary guidelines, and prompt response and corrective action. These seven elements are a frequent RHIT exam topic and the backbone of healthcare compliance.