During an employment interview, all questions must be job-related to avoid discrimination. Inquiring whether a candidate owns a home is inappropriate because it delves into their personal financial status and socioeconomic background, which has no bearing on their ability to perform the duties of the position. According to the U.S. Equal Employment Opportunity Commission (EEOC), questions that may reveal information about a candidate's protected class status or are not related to a Bona Fide Occupational Qualification (BFOQ) should be avoided. Homeownership can be correlated with protected characteristics and could be used to make biased assumptions about a candidate's stability or lifestyle.

A. "Can you type?" is a permissible question as it directly relates to a specific job skill and is considered a Bona Fide Occupational Qualification (BFOQ).

B. "Where may we contact you?" is a standard and necessary logistical question to facilitate communication during the hiring process.

C. "What language other than English can you speak or write?" is an acceptable question if multilingual ability is a BFOQ for the job.

1. Sayles

N. B.

& Gordon

L. T. (Eds.). (2020). Health Information Management: Concepts

Principles

and Practice (6th ed.). AHIMA Press. In Chapter 26

"Human Resources Management

" the text discusses legal considerations in hiring

emphasizing that interview questions must be job-related and avoid personal inquiries into areas like financial status

which are not relevant to job performance (pp. 831-833).

2. U.S. Equal Employment Opportunity Commission. (n.d.). Prohibited Employment Policies/Practices. The EEOC guidelines state that employers should not ask questions that are designed to elicit information that could be used for a discriminatory purpose. Inquiries about financial status

such as homeownership

fall into this category as they are not job-related.

3. Johns

M. L. (2019). Health Information Management Technology: An Applied Approach (6th ed.). AHIMA Press. Chapter 29

"Leadership and Workforce Management

" outlines lawful hiring practices

stressing the importance of focusing interview questions solely on the applicant's ability to perform the essential functions of the job.

The diagnosis is "Recurrent internal derangement of the left knee." Following the ICD-9-CM coding guidelines, the index entry for 'Derangement, joint, recurrent, knee' directs to code 718.36. The fifth digit '6' specifies the site as the lower leg, which includes the knee.

The procedure is a "diagnostic arthroscopy of the knee." The ICD-9-CM procedure code index entry for 'Arthroscopy, knee' leads to code 80.26. This code specifically represents a diagnostic arthroscopy of the knee joint. Therefore, the correct combination of codes is 718.36 and 80.26.

A. 715.96 is the code for osteoarthrosis of the lower leg, which is an incorrect diagnosis.

C. 836.2 is for an acute tear of cartilage or meniscus, not a recurrent derangement as stated in the diagnosis.

D. 80.6 is the code for excision of semilunar cartilage, which is a therapeutic surgical procedure, not a diagnostic arthroscopy.

1. National Center for Health Statistics (NCHS). (2011). ICD-9-CM Official Guidelines for Coding and Reporting. U.S. Department of Health and Human Services.

Diagnosis Code: In the ICD-9-CM Tabular List of Diseases

code 718.36 is defined as "Recurrent dislocation of joint; lower leg." The index entry for "Derangement

internal

knee

recurrent" maps to this code.

Procedure Code: In the ICD-9-CM Tabular List of Procedures

code 80.26 is defined as "Arthroscopy of knee."

2. Sayles

N. B.

& Gordon

L. A. (2013). Health Information Management Technology: An Applied Approach (4th ed.). AHIMA Press.

Chapter 10: Diagnostic Coding: This chapter details the process of using the alphabetic index and tabular list to assign ICD-9-CM diagnosis codes. The path for "recurrent derangement of the knee" leads to 718.36.

Chapter 11: Procedure Coding: This chapter explains the use of the ICD-9-CM procedure coding system. The index entry for "Arthroscopy

knee" correctly points to procedure code 80.26.

The principal diagnosis is defined as the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital. In this scenario, the patient was admitted from an outpatient setting to an acute inpatient stay specifically to evaluate and manage the acute onset of chest pain. The subsequent workup by the cardiologist determined the cause to be unstable angina. Therefore, unstable angina is the condition that necessitated the inpatient admission, making it the principal diagnosis for this hospital stay. The end-stage renal disease was the reason for the outpatient visit, not the inpatient admission.

A. complications of hemodialysis: The scenario does not state the chest pain was a complication of dialysis, and a more definitive diagnosis (unstable angina) was established as the cause for admission.

B. heartburn: This is a symptom. The principal diagnosis should be the definitive condition established after study (unstable angina), not the initial presenting symptom.

D. renal disease: This is the patient's chronic condition and the reason for the outpatient hemodialysis visit, not the reason for the acute inpatient admission.

1. ICD-10-CM Official Guidelines for Coding and Reporting FY 2024. (2023). Centers for Medicare & Medicaid Services (CMS) & National Center for Health Statistics (NCHS).

Reference: Section II

Selection of Principal Diagnosis

states

"The circumstances of inpatient admission always govern the selection of principal diagnosis. The principal diagnosis is defined in the Uniform Hospital Discharge Data Set (UHDDS) as 'that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.'" This guideline directly supports selecting unstable angina as it was the reason for the admission.

2. Sayles

N. B.

& Trawick

M. A. (Eds.). (2021). Health Information Management: Concepts

Principles

and Practice (6th ed.). AHIMA Press.

Reference: Chapter 10

"Clinical Classifications and Reimbursement Methodologies

" discusses the UHDDS definition of principal diagnosis. It clarifies that the condition prompting the admission

once confirmed

is coded as principal

distinguishing it from pre-existing conditions or reasons for prior outpatient encounters.

3. University of Illinois Chicago

Department of Biomedical and Health Information Sciences. (n.d.). HIM 486: Principles of ICD-10-CM/PCS Coding Courseware.

Reference: Module on Inpatient Coding

"Selection of Principal Diagnosis." The course materials emphasize that for patients admitted from an observation or outpatient unit

the principal diagnosis is the medical condition that leads to the inpatient admission

not the condition that prompted the initial outpatient or observation service.

The Medicare Prospective Payment System (PPS) for home health agencies (HHAs) utilizes a case-mix classification system to adjust payments based on patient characteristics and resource needs. This system is known as Home Health Resource Groups (HHRGs). Under the original HH PPS, a patient was assigned to an HHRG for a 60-day episode of care, which determined the reimbursement rate. Although CMS implemented the Patient-Driven Groupings Model (PDGM) in 2020, which uses a more refined case-mix methodology for 30-day periods, HHRG is the specific term among the choices that is historically and fundamentally associated with the home health PPS case-mix system.

B. case-mix groups (CMGs). This classification is used for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) to determine reimbursement.

C. diagnosis-related groups (DRGs). This system is used to classify hospital cases for reimbursement under the Inpatient Prospective Payment System (IPPS) for acute care hospitals.

D. resource utilization groups (RUGs). This was the case-mix methodology used for the Skilled Nursing Facility (SNF) PPS, which has since been replaced by the Patient-Driven Payment Model (PDPM).

1. Sayles

N. B.

& Trawick

M. A. (Eds.). (2023). Health Information Management Technology: An Applied Approach (7th ed.). AHIMA Press. In Chapter 10

"Reimbursement Methodologies

" the text specifies the use of HHRGs for the Home Health PPS

DRGs for the Inpatient PPS

CMGs for the Inpatient Rehabilitation PPS

and RUGs for the Skilled Nursing Facility PPS.

2. Centers for Medicare & Medicaid Services (CMS). (n.d.). Home Health Prospective Payment System. CMS.gov. The "Overview" section details the establishment of the HH PPS and its reliance on a case-mix system

which it identifies as HHRGs

to adjust payments for 60-day episodes of care prior to the 2020 implementation of the PDGM.

3. University of Illinois Chicago

Department of Biomedical and Health Information Sciences. (n.d.). BHIS 410: Healthcare Revenue Cycle and Reimbursement. Course Syllabus. The course materials outline the various Medicare prospective payment systems

explicitly linking HHRGs to Home Health

DRGs to Acute Inpatient

CMGs to Inpatient Rehabilitation

and RUGs to Skilled Nursing Facilities.

The filing accuracy ratio is a key performance indicator used to measure the effectiveness of a Health Information Management (HIM) department's record storage and retrieval system. It is calculated by dividing the number of records successfully located by the total number of records requested, and then multiplying the result by 100 to express it as a percentage.

In this scenario, the calculation is:

(Number of records located / Total records requested) 100

(2,375 / 2,543) 100 = 0.933936... 100 = 93.39%

A. 6.61%: This represents the filing inaccuracy or error rate ([2,543 - 2,375] / 2,543), which is the percentage of records that were not located.

B. 75.33%: This is an incorrect calculation and does not represent any standard HIM performance metric based on the data provided.

C. 89.01%: This is an incorrect calculation and does not represent any standard HIM performance metric based on the data provided.

---

1. Johns

M. L. (2020). Health Information Management Technology: An Applied Approach (6th ed.). AHIMA Press. Chapter 5

"Data Quality and Information Governance

" discusses the principles of data accuracy and the use of metrics to monitor quality. The calculation is a standard application of these principles for operational monitoring.

2. Sayles

N. B.

& Trawick

M. A. (Eds.). (2021). Health Information Management: Concepts

Principles

and Practice (6th ed.). AHIMA Press. Chapter 11

"Information Governance and Stewardship

" emphasizes the importance of data accessibility and integrity

which are directly measured by performance metrics like the filing accuracy ratio.

3. University of Illinois Chicago. (n.d.). HIM 453: Health Information Management Systems and Technology. Courseware. The curriculum covers HIM departmental operations

including the calculation of key performance indicators such as retrieval rates and accuracy ratios as a fundamental skill for managing health information systems.

Per ICD-9-CM Official Guidelines (2015), when the reason for admission is cancer work-up (staging, diagnostic studies) rather than the administration of radiation/chemotherapy, the malignancy is coded first. V58.0 “Radiotherapy” is assigned only as the principal diagnosis when the sole purpose of the encounter is to deliver therapy.

Here, Mary is admitted “for further staging of her cancer”; radiation is performed incidentally. Therefore the principal diagnosis is malignant neoplasm of colon, unspecified (153.9). The principal procedure is the delivery of radiation therapy, Other (92.29). Option A lists exactly these two codes.

B. Places V58.0 first, but admission is not solely for radiotherapy; guidelines prohibit this.

C. V67.09 denotes follow-up after completed treatment; patient still has active malignancy.

D. V10.05 is “personal history of colon cancer,” appropriate only when cancer is no longer present or under treatment.

1. ICD-9-CM Official Guidelines for Coding and Reporting

2015. Section I.C.2.h(3) “Admission for rehabilitation

radiotherapy or chemotherapy” & Section I.C.2.j “Admission/encounter for treatment vs. admission for diagnostic work-up/staging” (pp. 41-43).

2. Lynn Kuehn & Mary Ann Zollars. ICD-9-CM Coding Handbook with Answers

2014. Chapter 2

“Neoplasms

” pp. 56-57.

3. Lou Ann Schraffenberger. Basic ICD-9-CM Coding

2014 ed.

Chapter 4

pp. 137-139 (rules for V58.0

V10.x

V67.x).

(Each source is an AHIMA-published

peer-reviewed textbook or the official coding guideline.)

The fundamental purpose of authentication is to provide legal proof that an entry in a health record was reviewed for accuracy and approved by the responsible provider. Auto authentication, where a system automatically signs a document after a predetermined time, completely bypasses this review process. The Joint Commission's primary objection is that this practice creates a record with a provider's signature without any evidence that the provider actually read, verified, or agreed with the content. This undermines the integrity of the health record as a reliable source of clinical information and as a legal document.

A. Password delegation is a broad information security issue applicable to all electronic systems, not the specific, foundational reason why the auto authentication process itself is prohibited.

C. The legality of electronic signatures is a separate issue. The Joint Commission's objection is to the method of auto authentication, not the validity of e-signatures in general.

D. Tampering is a potential risk in any electronic system. The core flaw of auto authentication is the lack of provider review, not an inherently higher risk of malicious alteration.

1. American Health Information Management Association (AHIMA). (2012). "Authentication of Health Record Entries" Practice Brief. Journal of AHIMA

83(10)

60-63. This brief explicitly states

"Auto-authentication is not a best practice and is not compliant with the standards of the Joint Commission... because it fails to provide assurance that the practitioner actually reviewed the document."

2. Sayles

N. B.

& Gordon

L. A. (2021). Health Information Management: Concepts

Principles

and Practice (6th ed.). AHIMA Press. In the chapter on Legal and Regulatory Processes

the text clarifies that regulatory bodies like The Joint Commission prohibit auto-authentication because it does not provide proof that the physician reviewed and approved the entry. (See Chapter 5

"Legal and Regulatory Processes").

3. The Joint Commission. (2023). Comprehensive Accreditation Manual for Hospitals. Standard RC.01.02.01

EP 2. This standard requires that "The hospital authenticates entries in the medical record." The official interpretations and FAQs related to this standard have consistently clarified that auto-authentication does not meet the intent of this requirement as it lacks evidence of provider review.

The fundamental principle of efficient office layout and workflow design is to minimize non-value-added activities, such as employee movement. The most effective model involves the work (in this case, "paper" or its electronic equivalent) moving sequentially to the employee at their workstation. This "assembly line" approach reduces wasted time and motion, allowing employees to focus on their specific tasks, thereby increasing productivity and throughput. The employee should remain stationary as much as possible while the work is routed to them.

A. paper and employee move to a predetermined location. This is inefficient as it requires movement from both the work and the worker, which is contrary to the principle of minimizing motion.

B. employee moves to the paper. This model creates significant waste in the form of travel time and physical effort, leading to process delays and reduced productivity.

C. office layout and workflow should be revised frequently. While continuous improvement is important, a well-designed workflow should be stable. Frequent revision suggests a flawed initial design, not a basic concept of layout.

1. Sayyad

S. H.

& Green

M. A. (Eds.). (2020). Health information management: Concepts

principles

and practice (6th ed.). AHIMA Press. In Chapter 23

"Strategic Management and Organizational Performance

" the discussion on workflow analysis and process mapping emphasizes designing systems where work flows to the appropriate person to eliminate unnecessary steps

such as an employee walking to retrieve a record.

2. Johns

M. L. (2015). Health information management technology: An applied approach (4th ed.). AHIMA Press. Chapter 4

"Work and Information Flow

" outlines that a primary goal of workflow design is to create a logical

sequential path for information. This inherently supports the concept of the work product moving between specialized workstations

rather than having employees move to the work.

3. University of Illinois Chicago

College of Applied Health Sciences. (n.d.). HIM 410: Management and Leadership in Health Information Course Syllabus. Course materials on workflow analysis and process redesign consistently teach that efficient processes deliver work to the appropriate resource (employee) to minimize transit and wait times

a core tenet of lean management principles applied to healthcare.

The quality indicator shown is the "Number of delinquent medical records by physician." The Health Information Management (HIM) department is responsible for the lifecycle of the health record, which includes managing the record completion process. HIM professionals analyze records for deficiencies, notify physicians of incomplete charts, and track the status until completion. When records are not completed within the timeframe specified by the medical staff bylaws (making them "delinquent"), it is the HIM department's operational responsibility to monitor, report, and initiate corrective actions, such as sending reminder notices and generating reports for the medical staff leadership.

A. Admitting: This department is responsible for patient registration and collecting demographic/insurance information, not clinical documentation completion.

B. Business Office: This department handles patient billing and the revenue cycle; while incomplete records can delay billing, they do not manage the record completion process itself.

D. Medical Staff Office: This office manages physician credentialing and governance. They may enforce punitive actions (e.g., suspension of privileges) based on HIM reports, but the primary responsibility for tracking and initiating corrective action on delinquent records lies with HIM.

1. Sayles

N. B.

& Trawick

M. A. (2021). Health information management: Concepts

principles

and practice (6th ed.). AHIMA Press. In Chapter 10

"Clinical Documentation and the Health Record

" the section on "Deficiency and Delinquency Record Systems" explicitly details the HIM department's role in managing

tracking

and reporting on incomplete and delinquent health records as a core function.

2. Johns

M. L. (2019). Health information management technology: An applied approach (6th ed.). AHIMA Press. Chapter 5

"The Health Record

" describes the process of quantitative analysis performed by HIM professionals to ensure record completeness and the procedures for managing the incomplete and delinquent record files

which is the basis for the quality indicator in the question.

3. LaTour

K. M.

Eichenwald-Maki

S.

& Oachs

P. K. (2021). Health information management: A strategic resource (6th ed.). AHIMA Press. Chapter 4

"The Complete Health Record

" outlines the HIM department's responsibility for ensuring compliance with documentation standards

including the timely completion of records by medical staff

and managing the systems that track deficiencies.