8.2 Last-Week Review Map

Study by Domain Weight

Don't review evenly — review proportional to blueprint weight. AHIMA's six RHIT domains are not equal: Data Content, Structure & Information Governance and Revenue Cycle Management tie as the largest (19-25% each), Access/Disclosure/Privacy & Security (14-18%), Data Analytics & Use (12-18%), and Compliance (13-17%) sit in the middle, and Leadership (9-12%) is the smallest.

Give your two strongest review days to Domains 1 and 4.

Memorize the Statistics Formulas Cold

These rate formulas appear every exam. Memorize numerator, denominator, and the standard multiplier:

Watch the denominator trap: mortality and infection rates use discharges including deaths, not admissions. Occupancy uses bed count days (beds × days in the period). The standard reporting multiplier is ×100 (a percentage) except newborn/anesthesia death rates, which use ×1000.

The PPS-to-Setting Map and Code Sets

Prospective Payment Systems (PPS) pair to settings. Know which pays which:

Code-Set Uses (a classic trap)

• ICD-10-CM → diagnoses in all settings.
• ICD-10-PCS → inpatient hospital procedures only.
• CPT / HCPCS Level II → outpatient and physician procedures/services.
• SNOMED CT → clinical reference terminology (EHR documentation), not billing.

If an item asks how to code an outpatient surgery, the procedure is CPT, never PCS.

HIPAA Timelines, Compliance Elements, and Data Sets

HIPAA timelines to know cold

• Breach notification: notify affected individuals without unreasonable delay, no later than 60 days after discovery; notify HHS at the same time when 500 or more individuals are affected (smaller breaches: annual log within 60 days after year-end); notify prominent media when more than 500 residents of one state are affected.
• Right of access: provide records generally within 30 days (one 30-day extension allowed).
• Accounting of disclosures: act within 60 days (one 30-day extension allowed).
• Retention of HIPAA documentation: 6 years.
• TPO (Treatment, Payment, Operations) disclosures need no authorization; psychotherapy notes and most marketing do.

The 7 elements of an effective compliance program (OIG)

1. Written policies/standards of conduct 2. Compliance officer/committee 3. Effective training/education 4. Open lines of communication 5. Internal monitoring/auditing 6. Enforcement via well-publicized discipline 7. Prompt response and corrective action.

Data-set-to-setting map

Recite these four pairings until automatic — they anchor several Domain 1 items.

More Cold-Recall Anchors

Coding-accuracy rules (Domain 1 / 4)

• Principal diagnosis (UHDDS): the condition established after study to be chiefly responsible for the admission — not necessarily the admitting or the most severe diagnosis.
• Sequencing: code the underlying condition first when a "code first" note appears; never code a symptom that is integral to a confirmed diagnosis.
• POA (present on admission) indicators drive whether a hospital-acquired condition reduces MS-DRG payment.
• The CDI query must be non-leading — it presents clinical indicators and asks the provider to clarify, never suggesting a specific diagnosis for reimbursement.

Fraud-and-abuse laws (Domain 5)

Oversight bodies

• RAC (Recovery Audit Contractor): finds and recovers improper Medicare payments (overpayments and underpayments).
• Joint Commission / CMS Conditions of Participation: accreditation and federal participation standards for record content, timeliness, and authentication.

Build a one-page sheet of these anchors and review it the morning of the exam, then dump them onto your note board in the first minute.

A 7-day pacing plan

Use the cycle below so the final week reinforces the heaviest domains last:

• Days 7-6: Domain 1 — data sets, legal health record content, MPI, retention, information governance.
• Days 5-4: Domains 3 and 4 — statistics formula drills plus the PPS-to-setting map, MS-DRG/APC, and the CDI query process.
• Day 3: Domain 2 — HIPAA timelines, release-of-information, authorization vs. TPO.
• Day 2: Domains 5 and 6 — the 7 compliance elements, fraud laws, RAC, and PI methods (PDSA/Lean/Six Sigma).
• Day 1: one full timed practice assessment, then review only the missed items and the anchor sheet — no cramming new material.