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RHIA and RHIT Exam Preparation Tips

RHIA and RHIT Exam Preparation Tips

Page 22


(PART 3)

RHIT b/w

By Patricia Schnering, RHIA, CCS

(Editor's note: This is the third of a three-part article on preparing for the registered health information administrator [RHIA] and registered health information technician [RHIT] examinations. Here we take a brief look at some of the differences between the exams and provide sample questions for your review.)

Although there are many similarities between the RHIA and RHIT examinations, there are also many significant differences in the level and complexity of knowledge required for the RHIA exam candidate. The differences presented below give only a rudimentary summary in terms of the wording of the competency. Then a sample question for each Domain and Subdomain is given.

Domain II: The RHIA candidate will be expected to analyze clinical data to identify trends in addition to the competencies stated for the RHIT.

Domain IV: There is a significant difference between the level of information systems knowledge required of the RHIA and the RHIT in Domain IV. In addition to the competencies for the RHIT, the RHIA should be able to design data quality controls and edits, enforce confidentiality/security measures in respect to electronic information, and participate in the development of strategic and operational plans for information systems in the facility. The RHIA candidate should also be able to evaluate software packages to determine that they meet the needs of the users. Because virtually all functions in the health information department involve some form of information systems technology, it is better for the RHIT candidate to know more about technology and information systems than simply working with and maintaining current systems.

RHIA Examination Sample Questions
Domain I: Health Care

Subdomain A: Data Structure, Content and Use

1. During a concurrent record review, you notice that Mr. Miller, a Medicare patient, was admitted for disc surgery, but the progress notes indicate that due to some heart irregularities, he may not be a good surgical risk. Because of your knowledge of COP regulations, you expect that soon you will be able to find a/an on his chart.

A) an interval summary

B) a consultation report

C) an advanced directive

D) an interdisciplinary care plan

Subdomain B: Clinical Classification Systems: ICD-9-CM Coding

2. A patient is admitted with pneumonia. Cultures are requested to determine the infecting organism. Which of the following, if present, would alert the coder to ask the physician whether or not this should be coded as gram-negative pneumonia?

A) Colstridium

B) Listeria

C) Staphylococcus

D) Pseudomonas

Subdomain C: Clinical Classification Systems: CPT Coding

3. A physician excises a 3.0 cm malignant lesion of the scalp, which requires full thickness graft from the thigh to the scalp. In CPT, which of the following procedures should be coded?

A) full thickness skin graft to scalp only

B) excision of lesion; full thickness skin graft to scalp

C) excision of lesion; full thickness skin graft to scalp; excision of skin from thigh

D) code 15000 for surgical preparation of recipient site, full thickness skin graft to scalp

Domain II: Health Information

Subdomain A: Healthcare Statistics and Research

4. The collection instrument and the method of data collection have a great impact on the relevance, completeness, accuracy and correctness of the data collected. When choosing the instrument for the research process, the greatest concern is whether the instrument is:

A) valid

B) easy to administer

C) reliable

D) objective

Subdomain B: Clinical Quality Assessment and Performance Improvement

5. A report was sent to the medical staff office that stated there were 75 medication errors in 1999. Which of the following reports is necessary to calculate the percentage of medication errors?

A) total adverse reactions to medications given in error in 1999

B) total number of patients receiving medications in 1999

C) total number of staff who dispense medications in 1999

D) total medications dispensed in 1999

Domain III: Health Care Environment

Subdomain A: Healthcare Delivery Systems

6. According to the following table, the most serious record delinquency problem occurred in which month?

April May June
% incomplete records 70% 68% 79%
% delinquent due to missing discharge summary 55% 43% 61%
% delinquent due to missing H & P 3% 1.4% 0%

A) April

B) May

C) June

D) cannot determine with this data

Subdomain B: Legal Issues

7. A 20-year-old, male employee of PRG Publishing was treated in an acute care hospital for an illness unrelated to work. A representative from the human resources department of the company calls the hospital to request information regarding the employee's diagnosis at this visit. What would be the appropriate course of action?

A) request that the human resources

office send an authorization for release of information that is signed and dated by the patient

B) require parental consent

C) release the information as the employer is paying the patient's bill

D) call the patient to obtain verbal permission to release the information

Subdomain C: Healthcare Information Requirements and Standards

8. After reviewing the following case study, which of the following ratios would you recommend?

Case Study: You are helping the nursing department to write indicators, to determine appropriate formulae for ratios and to determine data collection time frames. One important aspect of care is the documentation of education of patients. More specifically, the nursing department would like to assess its documentation of education on colostomy care for patients with new colostomies.

A) number of records with documentation of colostomy-care teaching total number of patients on surgery unit

B)number of records with documentation of teaching total number of discharges

C) number of records with documentation of colostomy-care teaching total number of patients with new colostomy

D) number of records reviewed with documentation of colostomy-care teaching total number of records reviewed

Domain IV: Information Technology and Systems

Subdomain A: Information Technology

9. To transfer confidential patient information across the Internet in a multi-facility system, a technique can be used that transforms the original data into unintelligible code that can be re-recreated by an authorized user. This method is known as:

A) erecting a firewall

B) data encryption

C) validity processing

D) packet switching

Subdomain B: Health Information Systems

10. Plans for a manual backup system for locating patient records in the event the computer system is not operating would include:

A) converting from terminal digit filing to alphabetic filing

B) issuing all patients WORM smart cards indicating their medical record number

C) using the same number for the patient account number and medical record number

D) using an MPI card system or maintaining a paper/microfilm copy of an alphabetic MPI listing

Domain V: Organization and Management

Subdomain A: Human Resources Management

11. You are responsible for orientation, training, continuing education and departmental training. You are preparing a training program for specific functional areas of the department (i.e. coding, transcription, etc.). Which of the following is the primary factor to consider in developing an effective training program?

A) the credentials of the employees

B) the cost of training the employees

C) the number of employees to be trained

D) the objectives of each functional area

Subdomain B: Health Information Services Management

12. In deciding to purchase or lease a new dictation system, an HIM director calculates the payback period and rate of return on investment. The hospital's required payback period is three years with a required rate of return of 20 percent. If the equipment costs $32,000 and generates $8,000 per year in savings, what would the payback period for this equipment be?

A) 2 years

B) 3 years

C) 4 years

D) 5 years

RHIT Examination Sample Questions

Domain I: Health Care Data Subdomain

Subdomain A: Data Structure, Content and Use

1. A health record abstractor who needed to locate the microscopic description of tissue excised during surgery would be most likely to find this information within the:

A) recovery room record

B) pathology report

C) operative report

D) discharge summary

Subdomain B: Clinical Classification Systems: ICD-9-CM Coding

2. Admission for treatment of acute cholecystitis with cholelithiasis. This 30-year-old patient has AIDS but is asymptomatic. The procedures performed were an exploratory laparotomy and cholecystectomy.

A) 042; 176.3; 540.9; 47.09; 54.11

B) 540.9; 176.9; V08; 47.09

C) 540.9; 042.0; 176.9; 54.11; 47.09

D) 574.00; 042; 51.22

Subdomain C: Clinical Classification Systems: CPT Coding

3. Dr. Jones conducted an initial nursing facility assessment on his patient Julie Clark, at the nursing home. His assessment included obtaining a detailed history, a comprehensive review and a moderate medical decision.

A) 99302

B) 99313

C) 99214

D) 99233

Domain II: Health Information Analysis

4. Twelve new cases of a certain disease occurred during the month of August. If 4,000 persons were at risk during August, then the

A) prevalence was 3 per 1,000 persons

B) prevalence was 6 per 1,000 persons

C) incidence was 3 per 1,000 persons

D) incidence was 6 per 1,000 persons

Domain III: Health Care Environment

Subdomain A: Health Care Delivery Systems

5. Mandatory reporting requirements for vital statistics generally:

A) do not require authorization by the patient

B) require authorization by the physician

C) require authorization by the payer

D) do not apply to health care facilities

Subdomain B: Legal Issues

6. The following are four statements regarding release of medical record information. Which statement is the BEST example of a policy?

A) Medical record information may be released to another local hospital without patient authorization provided it can be ascertained that the patient is currently hospitalized at the requesting hospital and the records are needed for the continuity of care.

B) The authorization presented by an insurance agent for the purposes of reviewing a chart is to be signed and dated by the viewer and stapled to the inside back of the chart folder.

C) Receipts for prepayment of medical record information are enclosed when the information is sent.

D) Correspondence, social service notes and incident reports are removed from the chart folder before it is presented to an insurance representative for review.

Subdomain C: Health Care Information Requirements and Standards

7. The medical record committee at your hospital does a very thorough job of reviewing documentation for clinical pertinence. At least quarterly, HIM personnel, physician reviewers and members of the nursing staff meet to review 5 percent of the facility's health records. During a typical meeting, you might find this committee reviewing an operative report to determine: the presence or absence of such items as preoperative and postoperative diagnosis, description of findings and specimens removed.

A) whether a postoperative infection occurred.

B) the quality of patient care as defined by indicator monitor, the severity of illness and/or intensity of service indicated at an acute level of care.

C) the severity of illness and/or intensity of service indicated at an acute level of care.

Domain IV: Information Technology and Systems

Subdomain A: Information Technology

8. As supervisor of the cancer registry, you report the registry's annual caseload to administration. The most efficient way to retrieve this information would be to use

A) patient abstracts

B) patient index

C) accession register

D) follow-up files

Subdomain B: Health Information Systems

9. What would be the proper course of action if the following patient is mistakenly assigned a new unit medical record number when a previous number for this patient already exists?

* Admitted 12/13/99 as Randall Jones - assigned 99-98-50

* Admitted 11/01/98 as Randy Jones - assigned 98-14-00

* Admitted 01/27/88 as R.B. Jones - assigned 67-55-43

A) void all old numbers and file all admissions under 99-98-50

B) void all new numbers assigned and file all admissions under 67-55-43

C) void all previous numbers and assign a pseudonumber

D) file all admissions under 98-14-00 and delete the new number

Domain V: Organization and Supervision

10. The results of a quality improvement study indicated that an informed consent was not obtained for 25 percent of the surgical procedures performed. The director of the HIM department has been asked to assist in addressing this problem. The director has decided to begin corrective action by providing an in-service. The most important participants that should attend this in-service are:

A) nurses and unit clerks

B) medical record and quality improvement personnel

C) physicians and residents

D) administrators


Schnering, P., et al. Professional Review Guide for the RHIA and RHIT Examinations, 2000 Edition, PRG Publishing, 2000.

Patricia Schnering is president of PRG Publishing Inc., St. Petersburg, FL, and is an adjunct instructor at St. Petersburg Junior College.

Domain I: The Task Statements for Domain I are the same for RHIA and RHIT. The RHIA exam will have 20 coding questions, whereas the RHIT exam will have 30.

Domain III: Competencies are stated the same in Subdomain A. In Subdomain B, Task Statements 1-3 are the same. RHIT Task Statement 4 requires the RHIT to maintain and enforce patient health record confidentiality requirements. The competency is expanded for the RHIA to include development of confidentiality and privacy policies and procedures for the department and assist in facility wide development of confidentiality policies. In addition to the tasks for the RHIT in Subdomain C, the RHIA should be able to develop and demonstrate HIM service compliance with appropriate regulations and accreditation standards.

Domain V: This domain is very different for the RHIA and RHIT. The RHIT has 15 questions in Domain V, whereas the RHIA has 50 questions. The RHIT is charged with supervisory duties and monitoring resources for area of responsibility. Domain V for the RHIA encompasses the complete range of leadership, human resources and management functions for the department, as well as functioning as a member of the facility management team. It would serve the RHIT better to have a deeper knowledge than supervisory skills about management and human resource functions.


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