AHIMA RHIT Practice Exam-5 2025/2026

Arbitration - ANS-A healthcare facility uses this *proceeding to avoid court action.*
Health care operations - ANS-When *in-house counsel* is conducting the defense of a
malpractice claim, an authorization is not required because review of the record would
be covered under:
*Privacy* - ANS-*The right of an individual to have freedom from observation or
intrusion into their private affairs and rights to maintain control over certain personal
health information.*
Confidentiality - ANS-The responsibility to *use,* *disclose,* or *release of information*
related to *private matters.*
Ethical problems of ROI - ANS-*Violation of the need-to-know principle*, misuse of
blanket authorizations, and violations of privacy that occur because of secondary
release of information are what type of issue?
*Protected Health Information* - ANS-*Individually identifiable *health information that is
transmitted by electronic medium, or in any other form or medium.
*Confidentiality* - ANS-The *privacy of personal health* information
Case Resource Consumption - ANS-Under a prospective payment system, payment for
healthcare is *predetermined* by:
Actual Cost - ANS-Prior to the implementation of Hospital Outpatient Prospective
Payment System, Medicare reimbursement was *originally* based on:
Diagnosis Related Group (DRG) - ANS-Case Mix Index (CMI) is often calculated on:
Revenue Code - ANS-A four-digit number used for Medicare Billing
Diagnostic codes - ANS-Third party payers will deny payment for services that are
considered unreasonable and unnecessary based on:
*Center for Medicare and Medicaid Services 1500 (CMS) 1500* - ANS-The claim form
that Physicians use for Medicare Part B reimbursement.
*Resource-Based Relative Value Scale (RBRVS)* - ANS-Medicare uses the
methodology for physician reimbursement.