AHIMA RHIT (Registered Health Information Technician) — All Questions

Under the Medicare Inpatient Prospective Payment System (IPPS), the payment for an inpatient stay is primarily determined by:

• a.The MS-DRG derived from the principal diagnosis, secondary diagnoses (CC/MCC), and procedures✓
• b.The number of days the patient stayed, billed per diem
• c.The chargemaster total of all itemized services
• d.The physician's professional fee schedule

IPPS pays a predetermined amount based on the MS-DRG, which is assigned from the principal diagnosis, the presence of complications/comorbidities (CC) or major CC (MCC), and significant procedures. Because payment is fixed per DRG regardless of actual charges, accurate coding and complete documentation directly drive appropriate reimbursement. Per-diem and charge-based methods apply to other payment systems, not inpatient IPPS.

A clinical documentation integrity (CDI) specialist needs clarification because the record shows clinical signs of a condition that is not clearly documented. A compliant physician query should:

• a.Present the relevant clinical indicators and remain non-leading✓
• b.Suggest the specific diagnosis that yields the highest payment
• c.Instruct the physician to document sepsis to raise the DRG
• d.Be sent only when it will increase the reimbursement

A compliant query is non-leading: it states the clinical indicators found in the record (labs, vitals, treatments) and asks the provider to clarify, without suggesting a specific answer or being driven by reimbursement. Leading queries or queries generated only when they raise revenue violate AHIMA/ACDIS query-practice standards and can constitute fraud. The goal is accurate documentation, not a higher DRG.

The hospital's chargemaster (charge description master, CDM) links each billable service to its:

• a.CPT/HCPCS code, revenue code, and charge amount✓
• b.Patient insurance premium and deductible
• c.ICD-10-CM principal diagnosis only
• d.Admitting physician's NPI schedule

The chargemaster is the master file that connects each chargeable item or service to its CPT/HCPCS code, revenue code, department, description, and price. Errors in the CDM propagate to every claim, so it must be maintained and audited regularly. Diagnoses (ICD-10-CM) are assigned by coders based on documentation, not stored in the chargemaster.

A Medicare outpatient service is likely to be denied as not medically necessary. Before providing it, the facility should have the patient sign a(n):

• a.Advance Beneficiary Notice of Noncoverage (ABN)✓
• b.Authorization to release information
• c.Notice of Privacy Practices
• d.General consent to treat

An Advance Beneficiary Notice (ABN) informs a Medicare beneficiary in advance that a service may not be covered and that they may be financially responsible, giving them the choice to proceed and pay. Without a valid ABN, the provider generally cannot bill the patient for a denied non-covered service. The other documents serve privacy and consent purposes, not financial-liability notice.