CHDA DOMAIN 1 (BUSINESS NEEDS

ASSESSMENT) 2024

In order to ensure a successful implementation of electronic health records, the organization must
identify and define strategic planning roles. These planning roles may be defined in three categories:
leadership, internal stakeholders, and external stakeholders. The governing body (board) is an example
of which of the following? - ANSWER ☑☑Leadership only

Which one of the following statements most accurately describes the optimal relationship between
strategic planning and strategic IM planning in a healthcare entity? - ANSWER ☑☑The two processes
are clearly related. It is important for the CIO to be incolced in both processes to ensure that IS priorities
are congruent with the overall strategic plans of the entity.

One way to examine readmissions with a given time frame at your facility is to retrieve patient data for
that time frame and look for duplicates of which attribute common in clinical data sets? - ANSWER
☑☑Medical record number

A drug interaction alert would be a typical function of a _______? - ANSWER ☑☑Decision Support
System (DSS)

Which code set would be utilized to create a report showing a hospital's CMI (case mix index)? -
ANSWER ☑☑DRG (diagnosis related group)

A set of standards that provides universal names and codes for laboratory and clinical results is ____? -
ANSWER ☑☑LOINC (logical observations identifiers names and codes)

Your chief financial officer has contacted you because your facility's CMI increased last year. He wishes
to hear your theory on why this is so. Among the options below, which would be best to explain an
increase in the CMI? - ANSWER ☑☑The quality of clinical documentation improved.

Activities of daily living (ADL) are components of ____? - ANSWER ☑☑MDS (minimum data set) and
OASIS (outcome and assessment information set)
Assume you are the manager of a 10-physician group primary care practice. The physicians are
interested in contracting with an application service provider (ASP) to develop and manage patient
records electronically. Which of the following statements in an indication that an ASP may be a good
idea for this practice? - ANSWER ☑☑The practice does not have the upfront capital or IT staff needed
to purchase and implement a system from a health information systems vendor.

Maps from terminologies to classifications (and possibly from classifications to terminologies) are
expected to ____. - ANSWER ☑☑Facilitate "enter once, use many" functionality

Which of the following basic services provided by a HIE (health information exchange) entity ensures
that information can be retrieved as needed? - ANSWER ☑☑Secure data transport

Which one of the following statements most accurately describes the optimal relationship between
strategic planning and strategic IM (information management) planning in a healthcare entity? -
ANSWER ☑☑The two processes are clearly related. It is important for the CIO to be involved in both
processes to ensure that IS priorities are congruent with the overall strategic plans of the entity.

Which type of indicators measure the actual results of care for patients and populations, including
patient and family satisfaction? - ANSWER ☑☑Outcome (relate to recovery, restoration of functionality
and survival of patients)

Which of the following activities is likely to occur in the analysis phase of the systems development life
cycle (SDLC)? - ANSWER ☑☑Examine the current system and identify opportunities for improvement.

Which RVU (relative value unit) component is best suited for measuring physician productivity? -
ANSWER ☑☑wRVU (work RVU assigned based on each patient examination or procedure performed,
reflects relative time and intensity associated with providing a service)

The physician fee schedule is based on what components? - ANSWER ☑☑All of these

Comparing the ICD-9-CM and ICD-10-CM (international classification of diseases) diabetes mellitus codes
and documenting variations creates a ____. - ANSWER ☑☑Data map (matching between a source and a
target, such as between two databases that contain the same data elements but call them by different
names)

Medical severity diagnosis-related groups (MS-DRGs) represent a prospective payment system

implemented by the CMS to reimburse hospitals a predetermined amount for services provided to ____.
- ANSWER ☑☑Inpatients (IPPS, UB-04 bills)

A research instrument that is used to gather data and information from respondents in a uniform
manner through the administration of a predefined and structured set of questions and possible
responses is called a(n) ____. - ANSWER ☑☑Survey (typically a questionnaire either written or online)

An example of a database that depends on standardized data definitions is ____. - ANSWER ☑☑A
statewide cancer data system (system used to provide data that can be used for surveillance,
epidemiology, results, etc)

Which of the following is an external user of data? - ANSWER ☑☑Public health department

Which of the following indexes and databases includes patient-identifiable information? - ANSWER
☑☑Master population/patient index (MPI, patient master index, electronic database that holds
demographic information on every patient who receives healthcare services; MPI aims to accurately
match and link records by uniquely identifying individuals)

HIM may be the hub of identifying, mitigating, and correcting MPI (patient master index) errors, but that
information often is not shared with other departments within the healthcare entity. After identifying
procedural problems that contribute to the creation of the MPI errors, which department should the
MPI manager work with to correct these procedural problems? - ANSWER ☑☑Registration or patient
access (registration goal is enrollment into records of the hospital; patient access goal is to educate and
support individuals to obtain or deliver comprehensive quality healthcare)

The inpatient data set incorporated into federal law and required for Medicare reporting is the ____. -
ANSWER ☑☑Uniform Hospital Discharge Data Set (UHHDDS; implemented in 1974 originally an
initiative of what is now HHS as a result of the founding Medicare program, allows for comparison
between hospitals)
Standardized sets of valid, reliable, and evidence-based measures implemented by the Joint Commission
are called ___. - ANSWER ☑☑Core (performance) measures (set of care or treatment standards
identified by CMS and/or Joint Commission (TJC) that have been shown through best scientific evidence
to decrease the risk of complications, prevent recurrences, and improve patient clinical outcomes
overall)

The computer-based process of extracting, quantifying, and filtering discrete data that reside in a
relational database is called ____. - ANSWER ☑☑Data mining (practice of examining large DBs in order
to generate new information)

In terms of grouping and reimbursement, how are the MS-LTC-DRGs and acute care MS-DRGs similar? -
ANSWER ☑☑Organized into MDCs (major diagnostic category)

Which of the following is not a valid use of the relative weight assigned to each MS-DRG? - ANSWER
☑☑Measure cost of living (this is adjusted by wage index for most states)

The leader of the coding performance improvement team wants all team members to clearly
understand the coding process. What tool could help accomplish this objective? - ANSWER
☑☑Flowchart (diagram that represents a workflow or process providing a step by step approach to
solving a task)

Which of the following elements is found in a charge description master? - ANSWER ☑☑Procedure or
service charge (charge description master (CDM) is the DB of all billable items that go on patients'
accounts; includes descriptions, revenue codes, department associations, alternate CPT/HCPCS codes by
payer, and prices)

The nominal group technique gives each member of the team an opportunity to select the most
important ideas from an affinity diagram. This technique allows groups to do which of the following?
(nominal group technique steps are silent listing, recording each participant's list, discussing, and rank
ordering the priority) - ANSWER ☑☑Narrow the focus of discussion without extending involvement

You are asked to write a report to capture patient injuries by diagnosis code. To determine which
injuries happened while the patient was in the hospital, you look to the present on admission indicator.
Which indicator would show you the injuries occurring while the patient was in the hospital? (Y=yes,
N=no, U=unknown, W=clinically undetermined) - ANSWER ☑☑N (no diagnosis was not present at the
time of inpatient admission)
Which of the following is a system which may include alerts, reminders, and links for clinical care
providers? - ANSWER ☑☑Clinical decision support system (health information technology system that is
designed to provide physicians and other health professionals with clinical decision support)

Which data element would be used to verify if the present on admission coding was correct on a patient
with an admitting diagnosis of decubitus ulcer (bed sore)? - ANSWER ☑☑Skin exam (documented by a
provider and can be used to verify POA coding)

HEDIS (healthcare effectiveness data and information set) is a set of measures to be used by consumers
and purchasers of healthcare to compare performance of managed care plans. Which hospital
department would be responsible for entering and tracking data for this? - ANSWER ☑☑Quality (uses
HEDIS data for quality management)

One way to examine readmissions with a given time frame at your facility is to retrieve patient data for
that time frame, and look for duplicates of which attribute common in clinical data sets? - ANSWER
☑☑Medical record number (unique identifier assigned to each health record, used to ensure all
information about the patient is entered in the correct record)

A hospital that is installing bedside monitoring devices that must feed data into the electronic health
record (EHR) should be sure to conform to which of the following standards? - ANSWER ☑☑DICOM
(digital imaging and communications in medicine, develops standards for exchange of clinical images)

What entity is responsible for maintaining vital statistics data? - ANSWER ☑☑State government
(responsibility for the collection of vital statistics rests with the states and then the states share
information with NCHS (national center for health statistics))

Which of the following items are packaged under the Medicare hospital outpatient prospective payment
system (HOPPS)? - ANSWER ☑☑Surgical procedures (the APC system uses a partially packaged system
methodology; services or items such as recovery room, anesthesia, and some pharmaceuticals, are
packaged into the APC payment for the service or procedure with which they are associated)

DRGs or MS-DRGs may be grouped into categories called ____. - ANSWER ☑☑MDCs (major diagnostic
category; each DRG falls into a MDC grouping similar DRGs together using a grouper program based on
patient demographic data and coded data from the inpatient case)
The amount of copay or deductible due from a patient is transmitted to the provider via a ____. -
ANSWER ☑☑Claims processing code (when claims are not paid or are not paid entirely, the payer
reports the reasons for the lack of payment or the claim error on an EOB statement or Remittance
Advice using a variety of codes)

If the total practice expense for a group is $1,500,000 and the total RVUs provided by that practice is
125,000, what is the break even conversion factor? - ANSWER ☑☑$12 (break even conversion factor
(BECF) can be used to create a fee schedule: total practice expenses/total RVUs)

Once all data has been posted to the patient's account, the claim can be reviewed for accuracy and
completeness. Many facilities have an internal auditing system that runs each claim through a set of
edits. This internal auditing is known as a ____. - ANSWER ☑☑Scrubber (part of the auditing system
that includes a set of edits specifically designed for that 3rd party payer; the goal of a scrubber is to
detect and eliminate errors in billing codes, reducing the number of claims to medical insurers that are
denied or rejected)

Which information found on the chargemaster describes payment codes for services or items, and
usually a 3 or 4 digit number? - ANSWER ☑☑Revenue code (nationally recognized four digit code that
provides a general identification of what the line item charge represents. There are more than 500
revenue codes that represent categories like room and board, lab services, radiology services, pharmacy
items, therapy services, supply items and surgical procedures)

In which of the following phases of system selection and implementation would the process of running a
mock query to assess the functionality of a DB be performed? - ANSWER ☑☑Testing (connecting to the
sandbox and thoroughly testing and adjusting systems and applications to discover flaws in
development and execution is a necessary step in the implementation cycle)

Which national database includes data on all discharged patients regardless of payer? - ANSWER
☑☑Healthcare Cost and Utilization Project (HCUP; family of databases and related software tools and
products developed through a federal-state-industry partnership and sponsored by AHRQ, derived from
administrative data and contain encounter-level, clinical and non clinical information including all listed
diagnoses and procedures, discharge status, patient demographics, and charges for all patients
regardless of payer)
OASIS data is used to assess the ____ of home health services. - ANSWER ☑☑Outcomes (OASIS is a key
component of Medicare's partnership with the home care industry to foster and monitor improved
home healthcare outcomes; stands for Outcome and Assessment Information Set)

The federal initiative to collect data for research about the delivery and organization of healthcare in the
US is called ____. - ANSWER ☑☑HCUP (A major initiative for AHRQ has been the Healthcare Cost and
Utilization Project (HCUP); HCUP uses data collected at the state level from either claims data from the
UB-04 or discharge-abstracted data, including UHDDS items reported by individual hospitals in in some
cases by free standing ambulatory care centers. Which data are reported depends on the state. Data
many be reported by the facilities to a state agency or to the state hospital association depending on
state regulations. The data are then reported from the state to AHRQ where they become part of the
HCUP DBs)

Benchmarking may be used to ____. - ANSWER ☑☑Determine areas of improvement

The American Productivity and Quality Center (APQC) describes benchmarking as "the process of
improving performance by continuously identifying, understanding and adapting outstanding practices
and processes found inside and outside the organization" (APQC 1999; White 2013, 161).

Mary Smith, RHIA, has been asked to work on the development of a hospital trauma data registry.
Which of the following data sets would be most helpful in developing this registry? - ANSWER
☑☑DEEDS (data elements for emergency department systems; data set designed to support the
uniform collection of information in hospital-based emergency departments)

A patient born with a neural tube defect would be included in which type of registry? - ANSWER
☑☑Birth defects (these registries use a variety of criteria to determine which cases to include in the
registry. Some registries limit cases to thos borth defects during within the first year of life while others
include those children with a major defect that occurred in the 1-5 years of life. Still other registries
include only children who were live-born or still-born babes with discernible birth defects.)

Which work measurement tool uses random sample observations to obtain information about the
performance of an entire department? - ANSWER ☑☑Work sampling (technique of work measurement
that involves using statistical probability to characterize the performance of the department and its
functional work units)
Resource-based relative value (RBRVS) rates are calculated based on practice, expense, malpractice cost,
and physician work and are then adjusted by a ____. - ANSWER ☑☑Geographical practice cost index
(GPCI; RBRVS fee schedule formula: [(RVUw*GPCIw)+(RVUpe*GPCIpe)+RVUm*GPCIm)]*CF = Payment)

What term refers to information that provides physicians with pertinent health information beyond the
health record itself used to determine treatment options? - ANSWER ☑☑Clinical practice guidelines
(statements that include recommendations intended to optimize patient care; based on systematic
statements or clinical algorithms of proven care options; often professional organizations and
associations, health plans, and government agencies such as AHRQ develop these guidelines)

A clinical documentation improvement (CDI) program facilitates accurate coding and helps coders avoid:
- ANSWER ☑☑Using non-specific codes

Under RBRVS, which elements are used to calculate a Medicare payment? - ANSWER ☑☑Work value
and practice expenses

Total fees received by Physician Group A is $130,500. If the break-even conversion factor is $29,000 how
many claims were paid? (BECF=Total Practice Expenses/Total RVUs) - ANSWER ☑☑4,500

You have been asked to build a survey to measure patient health literacy to a given degree of precision.
Which of the following statements accurately describes the relationship between variability in literacy
levels, precision (as measure by CI), and the minimum number of patients you must survey to attain the
precision? - ANSWER ☑☑As variability in levels of literacy increases, the needed sample size increases

It is the year 20XX. The federal government is determined to lower the overall payments to physicians.
To incur the least administrative work, which of the following elements of the physician payment system
would the government reduce? - ANSWER ☑☑Conversion factor (CF is an across the board multiplier;
transforms the geographic adjusted RVU into a Medicare Physician Fee Schedule amount)

The practice of using a code that results in a higher payment to the provider than the code that actually
reflects the service or item provided is known as ____. - ANSWER ☑☑Upcoding

When undertaking an LHR (Legal Health Record) project the stakeholder group must include individuals
from various levels of the organization. Which of the following should be included among the stake
holders? - ANSWER ☑☑IT staff (record custodians are also expected to develop proper organization,
management, guidelines, and processes related to the use of business records as a protective legal
defense tool; most of the time this effort is performed in conjunction with other stakeholders like IT,
compliance and risk management)

Which code set would be utilized to create a report showing a hospital's case mix index? - ANSWER
☑☑DRG

The CMI for a hospital should be monitored over time. This is done by establishing a valid baseline to
track any deviations over a period of time. Which of the following are used to track and validate and
organization's CMI? - ANSWER ☑☑Average relative weight, percent of discharge by specialty, ALOS, and
average charges (CMI informs administrators about resources consumed for patients with similar
diagnoses and treatments; CMI is a weighted average of the sum of the relative weights of all patients
treated during a specified time period)

Your CFO has contacted you because your facility's CMI increased last year. He wishes to hear your
theory on why this is so. Among the options provided, which would best explain an increase in the CMI?
- ANSWER ☑☑Quality of clinical documentation improved

In long term care settings, the resident's care plan is based on data collected in the ____. - ANSWER
☑☑MDS (assessing the functional capacity of each patient via the resident assessment instrument (RAI)
is a requirement of these nursing facilities; all RAIs include the MDS, resident assessment protocols
(RAPs), and utilization guidelines)

The CFO of your hospital is concerned that the CMI is increasing while the number of discharges is
remaining the same. You suggest that this is due to which of the following? - ANSWER ☑☑More higher
weighted DRGs than before (by missing diagnoses or procedures that should be coded, or failing to
assign the most specific coding possible, the coding staff can cause the CMI to be lower than it should
be)

The federal law that directed the Secretary of Health and Human Services to develop healthcare
standards governing electronic data interchange and data security is the ____. - ANSWER ☑☑HIPAA

What term is used for a centralized database that captures, sorts, and processes patient data and then
sends it back to the user? - ANSWER ☑☑Clinical data repository
Which of the following are phases of SDLC? - ANSWER ☑☑Analysis, design and implementation

CMS pays for inpatient services provider to Medicare patients via ____. - ANSWER ☑☑IPPS

In which EHR database model is all of the healthcare entity's patient health information stored in one
system? - ANSWER ☑☑Centralized (most health record systems are organized according to one of two
DB models: decentralized or distributed; or a hybrid of the two models; centralized DB model all of the
organization's patient health information is stored in one system)

Under the OPPS payment system, the payment is based primarily on ____. - ANSWER ☑☑The weight of
the APC

RVUs are used as the basis of Medicare payment for which type of provider? - ANSWER ☑☑Physician
(RVUs are assigned to CPT and HCPCS codes to determine the Medicare fee schedule payment)

In which form of the DB would data mining to support complex data analysis most effectively take
place? - ANSWER ☑☑Clinical data warehouse (when complex reporting and analytics are to be
performed on data, a clinical data warehouse (CDW) may be the more appropriate database structure to
use)

Which of the following sites is considered a facility in the RBRVS payment system? - ANSWER
☑☑Ambulance (facility = anything not considered a non facility like physician office, dialysis center,
independent laboratory)

The ambulatory payment classification (APC) system is based on the categorization of ____ services. -
ANSWER ☑☑Outpatient care (OPPS uses a grouping methodology called APCs to group hospital
outpatient services that use similar amounts and types of resources; APCs are not coded but are based
on the CPT or HCPCS codes assigned to the outpatient care)

Facility based cancer registries received approach as part of the facility cancer program from which of
the following agencies? - ANSWER ☑☑American College of Surgeons (approval process for cancer
programs requires a cancer registry is part of the program)
If My Town Practice is looking for a way to justify higher compensation for the physicians that provide
the highest level of resource intensity, which of the following metrics is the most appropriate? -
ANSWER ☑☑Number of RVUs (this is a measure of resource intensity required to deliver a service or
procedure to a patient)

How do healthcare providers use the administrative data they collect? - ANSWER ☑☑For regulatory,
operational, and financial purposes (administrative data is coded information contained in secondary
records such as billing records, describing patient identification, diagnoses, procedures, and insurance)

Mary Smith, RHIA, has been charged with the responsibility of designing a data collection form to be
used on admission of patients to the acute-care hospital in which she works. What is the first resource
she should use? - ANSWER ☑☑UHDDS

What is clustering? - ANSWER ☑☑Practice of coding or charging one or two middle levels of service
codes exclusively under the philosophy that although some will be higher and some lower the charges
will average out over an extended period

In long-term care, the resident's care plan is based on data collected in the ____. - ANSWER ☑☑MDS