RHIT Exam Prep: Domain Map, 6-Week Study Plan, and 30 Practice Questions

Answer and explanation

C is correct. The H&P must be completed no more than 30 days before or 24 hours after admission, and before surgery or a procedure requiring anesthesia. When it was done in the 30 days before admission, an updated examination must also be documented within 24 hours after admission and before surgery. May 28 is 13 days before admission, and the update was done before surgery.

Why the others miss: A: May 1 is more than 30 days before admission, and there is no update. B: It comes after surgery, so it fails even if it was completed within 24 hours of admission. D: 48 hours after admission is outside the 24-hour limit.

Source: 42 CFR 482.24, Medical record services (hospital Condition of Participation), §482.24(c)(4)(i)(A)–(B)

Answer and explanation

B is correct. The hospital CoP requires a final diagnosis with completion of medical records within 30 days following discharge. That is the federal floor; a hospital's own medical staff rules can set a shorter deadline.

Why the others miss: A: 14 days is not the federal requirement, though a hospital may choose a shorter internal deadline. C: 45 days exceeds the federal requirement. D: 60 days exceeds the federal requirement.

Source: 42 CFR 482.24, Medical record services (hospital Condition of Participation), §482.24(c)(4)(viii)

Answer and explanation

B is correct. Patient matching links one patient's data by comparing multiple demographic fields, such as name, birth date, phone number, and address. Two matching fields leave the address conflict unresolved, so the analyst gathers more evidence and follows the organization's verification process before merging.

Why the others miss: A: Merging on two fields risks combining two different people's records (an overlay). C: Deleting an entry destroys information without settling who the patient is. D: A third entry adds another possible duplicate.

Source: ASTP/ONC, Patient Identity and Patient Record Matching, definition of patient matching

Answer and explanation

C is correct. HHS explains that the right of access reaches all designated record sets maintained by or for a covered entity, electronic or paper. That explicitly includes billing and payment records, claims, and insurance information. Where a record is stored doesn't remove it.

Why the others miss: A: Access isn't limited to what a portal displays. B: Format doesn't matter; electronic and paper records are both covered. D: Too broad. The set covers records used to make decisions about individuals, not every business document.

Source: HHS HIPAA FAQ on the right of access and designated record sets, answer text

Answer and explanation

A is correct. The guideline says "with" in the Index or Tabular List presumes a causal relationship. The conditions are coded as related even without an explicit provider link. The exceptions are documentation that clearly says they're unrelated, or another guideline that requires an explicit link.

Why the others miss: B: The presumption replaces the need for "due to" wording. C: A query isn't required to apply the presumption, though conflicting documentation would call for one. D: Dropping the diabetes leaves a documented condition uncoded.

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.A.15, p. 11; CDC/NCHS, ICD-10-CM FY 2027 Tabular List and Alphabetic Index, icd10cm-index-2027.xml: Diabetes, diabetic → type 2 → with → chronic kidney disease (E11.22)

Answer and explanation

D is correct. The guidelines list BMI among the items that can be taken from other clinicians' documentation. The associated diagnosis, such as obesity, must be documented by the patient's provider. A BMI code is not reportable without an associated reportable diagnosis documented by the provider. A clinically supported query may be appropriate.

Why the others miss: A: The dietitian can supply the BMI, not the diagnosis. B: Too strict. BMI is one of the listed exceptions. C: BMI is specifically allowed to come from other clinicians.

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.B.14, pp. 15–16; Section I.C.21.c.3 (Z68), p. 95

Answer and explanation

B is correct. The covered entity must act on an access request no later than 30 days after receipt. It may take one extension of no more than 30 days. Within the original 30 days, it must give the patient a written statement of the reason for the delay and the expected completion date.

Why the others miss: A: 15 days isn't the HIPAA deadline, and one extension is allowed. C: 60 days is the accounting-of-disclosures deadline, not the access deadline. D: Only one extension is permitted.

Source: 45 CFR 164.524, Access of individuals to protected health information, §164.524(b)(2)

Answer and explanation

D is correct. Psychotherapy notes are expressly excluded from the right of access. When part of a request is excluded, the covered entity must still give access to the other requested information, to the extent possible.

Why the others miss: A: The right of access has exceptions, and psychotherapy notes are one of them. B: A partial exclusion doesn't justify denying the rest. C: No court order is needed for a patient's own access.

Source: 45 CFR 164.524, Access of individuals to protected health information, §164.524(a)(1)(i) and (d)(1)

Answer and explanation

C is correct. Disclosures made under a valid authorization are on the list of exclusions from the accounting requirement. The accounting otherwise covers the preceding six years, unless the individual requests a shorter period. The covered entity has 60 days to provide it, with one 30-day extension if it gives the required written notice within the first 60 days.

Why the others miss: A: Court-ordered disclosures aren't on the exclusion list. B: Public health disclosures aren't on the exclusion list. D: Health-oversight disclosures are generally included; a qualifying written or documented oral agency statement can temporarily suspend the accounting right.

Source: 45 CFR 164.528, Accounting of disclosures, §164.528(a)(1)(iv), (a)(2)–(3), and (c)(1)

Answer and explanation

A is correct. A breach is treated as discovered on the first day any workforce member (other than the person who committed it) knows of it, or would have known with reasonable diligence. Notice must go out without unreasonable delay and no later than 60 calendar days after discovery. Sixty days is the outer limit, not a target.

Why the others miss: B: Discovery isn't delayed until the privacy officer is told. C: The clock starts at discovery, not at the end of the investigation. D: The rule counts calendar days, not business days.

Source: 45 CFR 164.404, Breach notification to individuals, §164.404(a)(2) and (b); 45 CFR 164.412, Law enforcement delay, conditions for a delayed notification

Answer and explanation

D is correct. HHS says each workforce member who uses a system containing e-PHI needs a unique name and/or number. That way activity can be traced to an individual, whatever the entity's size.

Why the others miss: A: A stronger shared secret still doesn't identify who acted. B: Rotation changes the password, not the shared identity. C: A workstation identifies a place, not a person.

Source: HHS HIPAA FAQ on shared log-on IDs (Security Rule unique user identification), answer text; 45 CFR 164.312(a)(2)(i)

Answer and explanation

B is correct. Occupancy = inpatient service days ÷ (bed count × days in period) × 100 = 5,100 ÷ (200 × 30) × 100 = 5,100 ÷ 6,000 × 100 = 85.0%.

Why the others miss: A: Uses 31 days: 5,100 ÷ 6,200 × 100. C: Reports the decimal 0.85 as a percent without multiplying by 100. D: Turns the fraction upside down: 6,000 ÷ 5,100 × 100.

Source: Pennsylvania Department of Health, Occupancy Rates in Health Facilities, p. 1, occupancy formula and available bed days; p. 2, capacity changes

Answer and explanation

C is correct. Average daily census = total inpatient service days ÷ days in the period = 5,100 ÷ 30 = 170 patients per day.

Why the others miss: A: Divides by the bed count instead of the days. B: That is the occupancy rate written as a decimal (5,100 ÷ 6,000), not a census. D: Uses 31 days.

Source: Pennsylvania Department of Health, Occupancy Rates in Health Facilities, p. 1, inpatient days of care as the sum of daily inpatient census values; arithmetic mean derived from that definition

Answer and explanation

A is correct. 4,896 ÷ 1,020 = 4.8 days. The question defined the method, so use it. Inpatient service days and discharge days measure different things.

Why the others miss: B: Uses inpatient service days (5,100) instead of discharge days. C: Divides inpatient service days by beds. D: Divides discharge days by the days in the month.

Source: Pennsylvania Department of Health, Average Length of Stay in Hospitals, p. 1, Method 1 and definitions of total discharge days and total discharges; CDC/NCHS, Average length of stay definition, AHA admissions-based method, for contrast

Answer and explanation

D is correct. CMI = sum of MS-DRG weights ÷ number of discharges = 5.40 ÷ 4 = 1.35. A higher CMI means a more complex, resource-intensive caseload. (Real CMIs specify the eligible discharge population and period; four cases just keep the arithmetic visible.)

Why the others miss: A: The sum, not divided by the number of discharges. B: The median of the four weights, not the mean. C: The highest single weight.

Source: California HCAI Case Mix Index dataset definition, definition; CMS, Case Mix Index, Description: average DRG relative weight for Medicare discharges

Answer and explanation

C is correct. The median is the middle value of the ordered data: 2, 3, 3, 4, 23 → 3 days. The one 23-day request pulls the mean up to 7, but it barely affects the median. That's why the median often describes a typical case better when there's an extreme value.

Why the others miss: A: The mean: 35 ÷ 5 = 7. B: The maximum. D: The range: 23 − 2.

Source: NIST/SEMATECH e-Handbook, Measures of Location, mean and median definitions

Answer and explanation

B is correct. Yes/no queries may not be used when only clinical indicators are present and the condition hasn't been documented. A multiple-choice query with cited indicators, clinically supported options, and an "other" choice lets the provider answer without being led.

Why the others miss: A: A yes/no format can't be used to obtain a new, undocumented diagnosis. C: Code assignment rests on the provider's diagnostic statement, not on lab values. D: Still a yes/no query for a new diagnosis; changing the formatting doesn't fix the unsupported query format.

Source: ACDIS/AHIMA, Guidelines for Achieving a Compliant Query Practice (August 2026), §V.II.A, pp. 10–11; §V.II.B, pp. 12–13 (written query formats); ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.A.19, p. 12

Answer and explanation

A is correct. A query must never mention the impact on reimbursement, quality measures, or other reportable data. A note about adding an MCC points the provider toward a financially desirable answer.

Why the others miss: B: Quoting and sourcing clinical indicators is recommended. C: An "other" option is required for multiple-choice queries. D: This is the kind of neutral, non-leading question the brief recommends.

Source: ACDIS/AHIMA, Guidelines for Achieving a Compliant Query Practice (August 2026), §V.I.B, p. 7; §V.II.A, p. 10

Answer and explanation

D is correct. The query should present the record's data, with its source, without the query professional's interpretation. The AHIMA/ACDIS brief uses this exact case: don't write "anemia" for a hemoglobin of 10 g/dL.

Why the others miss: A: Inserts a diagnosis the provider hasn't made. B: Inserts a diagnosis and asks the provider to confirm it. C: The query professional added interpretation and emphasis. Preserving formatting already present in the source record is different.

Source: ACDIS/AHIMA, Guidelines for Achieving a Compliant Query Practice (August 2026), §V.I.C.1–3, p. 8; §XII.II.E, p. 25

Answer and explanation

C is correct. When the reason for admission is sepsis plus a localized infection such as pneumonia, the code for the underlying systemic infection goes first. The localized infection is assigned as a secondary diagnosis.

Why the others miss: A: When admission is for the localized infection and sepsis develops afterward, the localized infection is sequenced first. Here both are the reason for admission and sepsis is present on admission. B: The guideline sets the order; it isn't optional here. D: Severe sepsis isn't documented, and an R65.2 code can never be principal anyway.

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.1.d.4, pp. 24–25; I.C.1.d.3

Answer and explanation

B is correct. When treatment is directed toward the secondary site only, the secondary neoplasm is the principal diagnosis, even though the primary cancer is still present.

Why the others miss: A: Treatment in this admission is directed only at the secondary site, not the primary lung cancer. C: A history code requires the primary to have been excised or eradicated, no further treatment directed to that site, and no evidence of remaining primary malignancy there. This primary is still present. D: This admission is for treatment of the metastasis, not solely pain control.

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.2.b, pp. 33–34; I.C.2.d, pp. 34–35; I.C.2.e.2, p. 35; I.C.6.b.5, p. 48

Answer and explanation

A is correct. CMS describes CARCs as the overall explanation for a financial adjustment, supplemented by RARCs for more specific explanation. Group codes separately assign financial responsibility for the unpaid portion.

Why the others miss: B: Confuses remittance codes with clinical code sets. C: Remittance codes explain adjustments, not policy identity. D: Group codes keep their own role; RARCs don't replace them.

Source: CMS, Health Care Payment and Remittance Advice, Electronic Remit Advice section

Answer and explanation

D is correct. Multiple-choice queries must include "other" (or similar wording) so the provider can give their own answer. The listed options should be clinically relevant only. At least one clinically supported option is required, together with "other" or an equivalent open-ended option.

Why the others miss: A: Building options around CC/MCC status brings payment impact into the query. B: Clinically irrelevant options should be excluded. C: Reimbursement impact must never appear in a query.

Source: ACDIS/AHIMA, Guidelines for Achieving a Compliant Query Practice (August 2026), §V.II.A, p. 10

Answer and explanation

C is correct. The FY 2027 guidelines apply from October 1, 2026, through September 30, 2027, and this entire stay falls in that period. Keeping the code set and guidelines current is part of monitoring regulatory change.

Why the others miss: A: FY 2026 ended September 30, 2026. B: Software version doesn't decide which official rules apply. D: The April FY 2026 update was superseded on October 1, 2026.

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, title page (effective dates)

Answer and explanation

B is correct. The guidelines state that adherence is required under HIPAA when assigning ICD-10-CM diagnosis codes. They are approved by the four Cooperating Parties: AHA, AHIMA, CMS, and NCHS.

Why the others miss: A: Not optional, and not from AHIMA alone. C: The HIPAA requirement isn't limited to Medicare. D: The guidelines include outpatient rules (Section IV).

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, introduction, p. 1

Answer and explanation

A is correct. The AHIMA/ACDIS brief calls it noncompliant to keep asking the same query, of the same or different providers, until a desired response is received. A legitimate clarification or escalation is different from repeating a query solely to change an unwanted answer.

Why the others miss: B: The problem is repeating the query solely to obtain the preferred diagnosis, not simply asking another provider. C: Clinical indicators don't fix a pattern of query shopping. D: Specialty doesn't change the rule.

Source: ACDIS/AHIMA, Guidelines for Achieving a Compliant Query Practice (August 2026), §IX, pp. 20–21

Answer and explanation

D is correct. The CoP requires retention for at least 5 years. "At least" makes it a floor: state law or organizational policy can require longer.

Why the others miss: A: Shorter than the federal minimum. B: Shorter than the federal minimum. C: Shorter than the federal minimum.

Source: 42 CFR 482.24, Medical record services (hospital Condition of Participation), §482.24(b)(1)

Answer and explanation

A is correct. It names the population, the measure, a baseline, a target, and a deadline, so the team can check whether it worked. AHRQ recommends goals that are measurable and feasible, with SMART (specific, measurable, achievable, realistic, time-bound) incremental objectives. The numbers are invented for practice, not a standard.

Why the others miss: B: No measure or deadline. C: An attitude, not a measurable outcome. D: An activity, not a goal.

Source: AHRQ CAHPS Ambulatory Care Improvement Guide, Section 4, Section 4.B.1.a

Answer and explanation

D is correct. PDSA plans a small, focused test, carries it out while recording results, studies whether the goal was met, and then acts. Act means adjusting the change for the next cycle or spreading it if it worked.

Why the others miss: A: Skips the small test and the learning step. B: Never reaches Do or Study. C: Installation isn't evidence of improvement.

Source: AHRQ Health Literacy Universal Precautions Toolkit, Tool 2B: Plan-Do-Study-Act, Plan, Do, Study, Act directions

Answer and explanation

C is correct. The policy should specify the queries' record status and how they are stored and managed. Actual queries must remain part of the health record or retrievable in the business record. Retention also follows applicable state requirements and organizational policy.

Why the others miss: A: Queries are kept for auditing, monitoring, and compliance. B: Written and verbal queries are both allowed; verbal ones must be recorded. D: Keeping queries only in one person's email does not establish the required organizational storage, management, and retrieval process.

Source: ACDIS/AHIMA, Guidelines for Achieving a Compliant Query Practice (August 2026), §V.I.G, p. 9; §XIII, p. 27; §XIII.VIII, p. 28