Bundle
All CRCR EXAMS (17 sets) Questions with Answers 100% CORRECT
17 Items
CRCR -Certified Revenue Cycle Representative (2021),100% CORRECT
CRCR -Certified Revenue Cycle Representative (2021) Which of the following statements are true of HFMA's Financial Communications Best Practices - COR... [Show More] RECT ANSWERSThe best practices were developed specifically to help patients understand the cost of services, their individual insurance benefits, and their responsibility for balances after insurance, if any. The patient experience includes all of the following except: - CORRECT ANSWERSThe average number of positive mentions received by the health system or practice and the public comments refuting unfriendly posts on social media sites. Corporate compliance programs play an important role in protecting the integrity of operations and ensuring compliance with federal and state requirements. The code of conduct is: - CORRECT ANSWERSAll of the above Specific to Medicare fee-for-service patients, which of the following payers have always been liable for payment? - CORRECT ANSWERSPublic health service programs, Federal grant programs, veteran affairs programs, black lung program services and work-related injuries and accidents (worker' compensation claims) Provider policies and procedures should be in place to reduce the risk of ethics violations. Examples of ethics violations include: - CORRECT ANSWERSAll of the above Providers are now being reimbursed with a focus on the value of the services provided, rather than volume, which requires collaboration among providers. What is the intended outcome of collaborations made through an ACO delivery system for a population of patients? - CORRECT ANSWERSTo eliminate duplicate services, prevent medical errors and ensure appropriateness of care. Historically, revenue cycle has delt with contractual adjustments, bad debt and charity deductions from gross revenue. Although deductions continue to exist, the definition of net revenue has been modified through the implementation of ASC 606. Developed by the Financial Accounting Standards Board (FASB), this change became effective in 2018. What is the new terminology now employed in the calculation of net patient services revenues? - CORRECT ANSWERSExplicit prices concessions and implicit price concessions Key performance indicators set standards for A/R and provide a method for measuring the control and collection of A/R. What are the two KPIs used to monitor performance related to the production and submission of claims to third party payers and patients (self-pay)? - CORRECT ANSWERSElapsed days from discharge to final bill and elapsed days from final bill to claim/bill submission. Consents are signed as part of the post-services process. - CORRECT ANSWERSTrue **False Patient service costs are calculated in the pre-service process for schedule patients - CORRECT ANSWERS**True False The patient is scheduled and registered for service is a time-of-service activity - CORRECT ANSWERSTrue **False The patient account is monitored for payment is a time-of-service activity - CORRECT ANSWERSTrue **False Case management and discharge planning services are a post-service activty - CORRECT ANSWERSTrue **False Sending the bill electronically to the health plan is a time-of-service activity - CORRECT ANSWERSTrue **False What happens during the post-service stage? - CORRECT ANSWERS**A. Final coding of all services, preparation and submission of claims, payment processing and balance billing and resolution. B. Orders are entered, results are reported, charges are generated, and diagnostic and procedural coding is initiated. C. The encounter record is generated, and the patient and guarantor information is obtained and/or updated as required. D. The focus is on the patient and his/her financial care, in addition to the clinical care provided for the patient. The following statements describe best practices established by the Medical Debt Task Force. Check the box next to the True statements - CORRECT ANSWERS**Educate Patients **Coordinate to avoid duplicate patient contacts Exercise moderate judgement when communicating with providers about scheduled services **Be consistent in key aspects of account resolution Report to healthcare plans when the patient's account is transferred to collection agency **Follow best practices for communication Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle initiative? - CORRECT ANSWERSA. Patient Financial Communications B. Price Transparency C. Medical Account Resolution **D. Process Compliance What is the objective of the HCAHPS initiative? - CORRECT ANSWERS**A. To provide a standardized method for evaluating patients' perspective on hospital care. B. To provide clear communication and good customer service, which will give the provider a competitive edge. C. To conduct evaluations concerning patients' perspective on hospital care. D. To make certain that during registration key information is verified by means of a picture ID and an insurance card. Which option is NOT a department that supports and collaborates with the revenue cycle? - CORRECT ANSWERSA. Information Technology B. Clinical Services C. Finance **D. Assisted Living Services Which option is NOT a continuum of care provider? - CORRECT ANSWERSA. Physician **B. Health Plan Contracting C. Hospice D. Skilled Nursing Facility Which of the following are essential elements of an effective compliance program? - CORRECT ANSWERS**Reasonable methods to achieve compliance with standards, including monitoring systems and hotlines **Established compliance standards and procedures Automatic dismissal of any employee excluded from participation in a federal healthcare program **Designation of a compliance officer employed within the Billing Department **Oversight of personnel by high-level personnel. Annually, the OIG publishes a work plan of compliance issues and objectives that will be focused on throughout the following year. Identify which option is NOT a work plan task mentioned in this course. - CORRECT ANSWERSA. Payments to Physicians for Co-Surgery Procedures B. Denials and Appeals in Medicare Part D C. Medicare Hospital Payments for Claims Involving the Acute- and Post-Acute-Care Transfer Policies **D. Standard Unique Employer Identifier In order to promote the use of correct coding methods on a national basis and prevent payment errors due to improper coding, CMS developed what? - CORRECT ANSWERS**A. The Correct Coding Initiative (CCI) B. The Advance Beneficiary Notice of Noncoverage (ABN) C. The Medicare Secondary Payer (MSP) D. Modifiers Indicate if the activity is described by the appropriate description of the violation involved: - CORRECT ANSWERSTrue - A staff member receives cash in the mail and does not immediately report the case to the manager for special handling. This is an example of financial misconduct False - A mother sees a charge on her hospital bill for a circumcision for a newborn girl. This is an example of falsifying medical records to boost reimbursement. True - A patient access staff member takes several file folders and highlighters home for personal use. This is an example of theft of property. False - A physician documents a fictitious epidural in a patient's medical record in an effort to receive additional payment. This is an example of miscoding claims True - Several unauthorized claims are sent to a health plan with the wrong procedure code. This is an example of overcharging. What do business/organizational ethics represent? - CORRECT ANSWERS**A. Principles and standards by which organizations operate B. A healthcare provider's practices and principles C. An employee's actions influenced by experiences and value system D. The patient privacy standard within healthcare What is the intended outcome of collaborations made through an ACO delivery system? - CORRECT ANSWERS**A. To ensure appropriateness of care, elimination of duplicate services, and prevention of medical errors for a population of patients. B. To create cost-containment provisions to reform the healthcare delivery system. C. To reform the healthcare system into a system that rewards greater value, improves the quality of care and increases efficiency in the delivery of services. D. To provide financial incentives to physicians for reporting quality data to CMS. Which of these statements describes the new methodology for the determination of net patient service revenue: - CORRECT ANSWERSA. Net patient service revenue is defined as the average payment amount for the payer but not recorded until the end of the month processing is completed. B. Gross patient service revenue is recorded as net patient service revenue until such time as all payments are received. **C. Net patient service revenue is defined as the total incurred charges, less the explicit price concession, less any applicable implicit price concession(s) as applied to the specific portfolio of accounts. D. Net patient service revenue is gross revenue minus any contractual adjustments applicable to the account. Any additional adjustments are not recorded until the account reaches a zero balance. E. Net patient service revenue is the sum of the balances of all charges and payments recorded in the accounting period. What are KPIs? - CORRECT ANSWERSA. Benchmarks which are used to compare Key Performance Indicators in an organization to an agreed upon average or expected standard within the same industry. **B. Key performance indicators, which set standards for accounts receivable (A/R) and provide a method of measuring the collection and control of A/R. C. Days in A/R is calculated based on the value of the total accounts receivable on a specific date. D. A component that can divide the accounts receivable into 30, 60, 90, 120 days, and over 120 days categories, based on the date of service/discharge While the highest level of differentiation among patients is scheduled patient vs unscheduled patient, a variety of patient types are routinely identified in both the acute and non-acute settings. Which patient types are typically considered acute care patient types? - CORRECT ANSWERSObservation, newborn, Emergency (ED) Accurate identification of the patient is the first step in the scheduling process. Identifiers used in various combination to achieve accurate patient identification include? - CORRECT ANSWERSFull legal name, date of birth, sex and social security number Pre-registration is defined as: - CORRECT ANSWERSThe collection of demographic information, insurance data, financial information, providing reminders, prep information, and identifying the potential need for financial assistance for scheduled patients. Medicare has unique features not found in other health plan programs. It is government sponsored and financed through taxes and general revenue funds. Which of the following statements accurately describes the various Medicare benefits programs: - CORRECT ANSWERSMedicare Part A provides benefits for inpatient hospital services, skilled nursing care and home health care; Medicare Part B covers outpatient and professional services, Medicare Part C or Medicare Advantage plans are managed care plans combining Part A and Part B Coverages; and Medicare Part D is the prescription drug coverage benefit. Which of the following statements about Medicaid eligibility is not true? - CORRECT ANSWERSMedicaid categories are restricted to children, pregnant women and elderly in nursing homes. Examples of managed care plans include: - CORRECT ANSWERSAll of the above Patient Financial Communications best practices include all of the following activities except: - CORRECT ANSWERSCollecting payment or initiating the process to immediately remove the patient from the service schedule. Which statement includes the required components of an accurate pricing determination? - CORRECT ANSWERSInsurance coverage and benefits, service or test involved, diagnosis and procedure codes, total estimated charges, adjudication calculations based on the patient's benefit package. The value of a robust scheduling and pre-registration process includes all of the following except: - CORRECT ANSWERSIdentification of patients who are likely to be "no shows". Which patients are considered scheduled? - CORRECT ANSWERSA. Observation Patients B. Emergency Department Patients **C. Recurring/Series Patients D. Hospice Care Name the guideline that Medicare established to determine which diagnoses, signs, or symptoms are payable. - CORRECT ANSWERSA. Patient Identifiers **B. Local Coverage Determinations C. Advance Beneficiary Notice D. Scheduling Instructions What is the purpose of insurance verification? - CORRECT ANSWERSA. To identify information that does not have to be collected from the patient. **B. To ensure accuracy of the health plan information. C. To effectively complete the MSP screening process. D. To complete guarantor information if the guarantor is not the patient. Which option is a federally-aided, state-operated program to provide health and long-term care coverage? - CORRECT ANSWERSA. Medicare **B. Medicaid C. Self-Insured Plans D. Liability Coverage Which option is NOT a specific managed care requirement? - CORRECT ANSWERSA. Referrals B. Notification **C. Preferred Provider Organization D. Discharge Planning What is the first component of a pricing determination? - CORRECT ANSWERSA. Identify the service or test involved **B. Verification of the patient's insurance eligibility and benefits C. Inform the patient that physician services are or are not included D. Use a worksheet or other tool for guidance in determining an estimate The correct sequential order of the financial counseling steps for an uninsured patient's surgery case are: - CORRECT ANSWERSGreet patient and give your name Explain organization's financial care approach and patient's financial responsibility Review patient's health plan benefits and status Review anticipated charges and patient's anticipated liability Ask patient to resolve liability by reviewing payment options For uninsured, explain financial assistance options What is the purpose of financial counseling? - CORRECT ANSWERSA. To address the most appropriate ways to conduct financial interactions at every point B. To train staff on how to request payment and conduct conversations **C. To educate the patient on his/her health plan coverage and financial responsibility for healthcare services D. To help the patient understand exactly how a contracted health plan will resolve their benefit package EMTALA prohibits inquiries about health plan or liability payer information if the inquiry will delay examination or treatment. What other requirements apply to the Emergency Department registration work? - CORRECT ANSWERSALL of the above Typical activities which much be performed when an unscheduled patient arrives for service include: - CORRECT ANSWERSIdentification of patient in the MPI or initiation of a new MPI record, insurance verification of eligibility and benefits, managed care screening, medical necessity screening, price estimation and financial counseling to achieve the appropriate account resolution. Case managers are involved from admission with the discharge planning process. The purpose of discharge planning is: - CORRECT ANSWERSTo estimate how long the patient will be in the hospital, identify the expected outcome of the hospitalization and initiate any special requirements for services at or after the time of discharge. The chargemaster is basically a list of services, procedures, room accommodations, supplies, drugs, tests, etc. typically associated with the billing for services rendered to patients. Challenges typically associated with the billing for services rendered to patients. Challenges typically associated with the chargemaster include: - CORRECT ANSWERSOmission of charges, obsolete or invalid codes, and the omission of required modifiers. Ultimately, the services provided in the healthcare system are reduced to standard codes. The primary types of coding systems currently used in healthcare are: - CORRECT ANSWERSICD-10-CM/ICD-10-PCS; CPT/HCPCS codes There are four code sets that provide health plans with additional information as they process claims. Those code sets are: - CORRECT ANSWERSCondition codes, occurrence codes, occurrence span codes and value codes Each type of service has unique billing rules which come into play during the provision of service. For the skilled nursing facility, care is covered if which of the following factors are present: - CORRECT ANSWERSThe patient required skilled services on a daily basis and those services can only be provided on an inpatient basis in a SNF. DRG's are a system of classifying inpatients on the basis of diagnoses, procedures, and co-morbidities for purposes of payment to hospitals. Each DRG includes: - CORRECT ANSWERSA relative weight which is multiplied by the established base payment rate to calculate the reimbursement for a specific DRG. For exceptionally costly cases over a set dollar amount, an outlier payment is added to the calculated payment. PPO networks represent one form of discounting commonly used by commercial payers. The silent PPO represents: - CORRECT ANSWERSA discounting scheme whereby health plans apply generic PPO rates to discount a provider's claims, even though there is no contractual arrangement between the silent PPO and the provider. The concept of timely filing of claims is important to providers, payers and patients. Thus, providers are required to comply with timely claim filing rules. Which of the following statements are NOT true about timely filing limitations: - CORRECT ANSWERSPayers will waive timely filing denials for claims filed over a year from date of service. What does EMTALA require hospitals to do? - CORRECT ANSWERS**A. To provide a medical screening examination and stabilizing treatment to every person presenting at an ED and requesting medical evaluation or treatment. B. To initially triage patients, where a "quick" registration record is generated to specifically allow order entry. C. To complete a standardized form signed by all patients that is used to inform the patient about the admission and conditions which must be agreed upon. D. To confirm information that may be used to identify the patient in the provider's MPI, which includes the patient's full, legal name, SSN, and/or date of birth. In what manner do case managers assist revenue cycle staff? - CORRECT ANSWERSA. By reviewing a patient's individual case and recommend treatment changes. B. With monitoring the progression of high resource consumptive cases. C. By estimating how long the patient will be in the hospital and what the expected outcome will be. **D. Providing assistance with written appeals to health plans related to utilization and other care issues. Why is it critical that a chargemaster is reviewed and updated regularly? - CORRECT ANSWERS**A. To ensure it supports and represents the services provided within the organization. B. To ensure the most appropriate measure of the utilization of resources. C. So the CPT databases can have the most current and accurate information. D. Because charge descriptions can vary greatly between providers. What is the responsibility of HIM? - CORRECT ANSWERS**A. To maintain all patient medical records B. To make information available instantly and securely to authorized users C. To denote the medical procedures performed by a healthcare provider on a patient D. To substantiate health insurance claims filed by the patient, the physician, and the provider What are claim edits? - CORRECT ANSWERSA. Various data sources including Medicare and Medicaid bulletins and manuals, individual health plan manuals B. A multi-stakeholder collaboration of more than 130 organizations — providers, health plans, vendors, and government agencies **C. Rules developed to verify the accuracy and completeness of claims based on each health plan's policies D. The submission, receipt, and processing of automated claims, thereby eliminating mail time and reducing data entry time Which statement is NOT a unique billing rule specific to providers? - CORRECT ANSWERSA. Overall aggregate payments made to a hospice are subject to a "cap amount", calculated by the MAC at the end of the hospice cap period. B. With the exception of physician services, Medicare reimbursement for hospice care is made at one of four pre-determined rates for each day of hospice care. C. When billing services on a UB-04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521). **D. A patient may be balance billed for whatever amount the non-contracting physician charges above the health plan's reimbursement amount. Which of the following statements does not apply to billing during the COVID-19 public health emergency: - CORRECT ANSWERSA. Hospitals may change a sub-acute unit into an acute care unit without advanced approval from CMS. **B. Telemedicine claims are not payable if the patient conducts the telemedicine visit from home. C. CMS developed the concept of hospitals without walls to increase ICU and med-surge inpatient capacity during the COVID-19 pandemic. D. Cost sharing has been waived for testing for COVID-19 in the ED, physician office, urgent care center or other ambulatory location. What is the sequential order for a Silent PPO scheme? - CORRECT ANSWERSThe patient's claims is sent to the listed primary insurance carrier The patient's insurance company (a silent PPO) runs the healthcare provider's tax ID number through a PPO discount database or provides a repricing company a copy of the claim After a successful "hit", the claim is "re-priced" based on the PPO discounts that were accessed. After applying the discount, the silent PPO states on the EOB that the healthcare provider agreed to reduce your bill based on your contract with the PPO The medical provider accepts the health plan's statement on the EOB and writes the discount off-never knowing that the discount was invalid. Which concept is NOT a contracted payment model? - CORRECT ANSWERS**A. Stop-Loss Provision B. Percentage Discount C. Per Diem Payment D. Capitation Credit balances may be created by any of the following activities except: - CORRECT ANSWERSCredits to pharmacy charges posted before the claim final bills Which of the following statements represent common reasons for inpatient claim denials? - CORRECT ANSWERSFailure to obtain a required pre-authorization; failure to complete a continued stay authorization and services provided which were not medically necessary. A 68 year old patient, a Medicare beneficiary, was in a car accident. A medical insurance claim was filed with the auto insurance carrier. Six months later this claim remains unpaid. How can the provider pursue payment from Medicare? - CORRECT ANSWERSThe provider must first bill the auto insurer; however, after a period of 120 days, if the claim remains unpaid, the provider may cancel the liability claim and bill Medicare. The difference between bad debt and financial assistance (charity) is: - CORRECT ANSWERSBad debt represents a refusal to pay; charity represents an inability to pay In order to qualify for financial assistance, a patient or guarantor should: - CORRECT ANSWERSProvide the following documents: prior year tax return, employment check stubs from the prior three months and bank statements for the prior three months. To comply with the requirements of Section 501(r) for tax-exempt hospitals chartered as 510(c)3 providers, the hospital must complete which of the following activities: - CORRECT ANSWERSA community needs assessmenets The three types of bankruptcy as defined in the 1979 Bankruptcy Act are: - CORRECT ANSWERSChapter 7 - Straight Bankruptcy, Chapter 11- Debtor Reorganization and Chapter 13- Debtor Rehabilitation Which of the following medical debt collection practices are recommended as part of HFMA's Best Practices for medical account resolution: - CORRECT ANSWERSEstablish policies and ensure that they are followed Organizations may opt to contract with or outsource to specific vendors for some or all components of revenue cycle processing. This practice has both advantages and disadvantages. Which of the following statements is NOT an advantage of utilizing an outsourcing vendor? - CORRECT ANSWERSThe need for legal review if the outside vendor's staff represents themselves as employees of the healthcare facility. Each hospital covered by the 501(r) regulations is required to develop a financial assistance policy. Which of the following elements is NOT a required element of the policy? - CORRECT ANSWERSThe notice that individuals eligible for financial assistance under this policy may be charged more that the amount generally billed (AGB) to insured patients. Place the daily reconciliation process steps in the correct sequential order: - CORRECT ANSWERSObtain totals of all payments - cash, check, credit card, and debit card Divide remittances into batches and obtain a second total of the electronic remittance advices by payment and contractual allowances Endorse checks immediately. Prepare the bank deposit for all payments. Separate cash payments and contractual adjustments into separate batches and use separate payments and adjustment codes. Post unidentified payments to an unidentified cash account (deposit everything, do not hold unidentified payments) Balance and post batches. Balance payments to the bank deposit. Balance the bank deposit to the general ledger. Sue Smith came into the hospital. Her insurance provider sent an EFT directly into the hospital's account at the bank. John, the hospital representative, receives an electronic Level 2 ERA. What should he do next? - CORRECT ANSWERS**A. Manually match the ERA to the patient account. B. Nothing unless there is an error. What is EFT? - CORRECT ANSWERS**A. The electronic transfer of funds from payer to payee through the banking system. B. The establishment of internal audits by personnel outside the involved department. C. A standardized healthcare claim payment/advice known as the 835 format. D. A process that requires the separation of duties when processing patient payments. Which statement is false regarding credit balances? - CORRECT ANSWERSA. A small credit policy should be matched by a similar policy for small debit balances. B. Tracking reports should be developed to identify internal charge credits versus external charge credits. C. Hospital generated statements should be sent to patients regarding small credit balances. **D. There are no CMS hospital compliance requirements regarding credit balances. Which option is NOT a type of denial? - CORRECT ANSWERSA. Technical B. Clinical C. Underpayment **D. Contractual Adjustment Which option is NOT a lien type? - CORRECT ANSWERSA. Judicial **B. Subrogation C. Statutory D. Agreement (Consensus) Based on what you have just read, which activity is not considered when initiating self-pay follow-up and account resolution activities? - CORRECT ANSWERSA. Poverty Guidelines B. Financial Profile C. Presumptive Financial Assistance Determination **D. Patient Open Balance Billing Which option is NOT a required component of a FAP? - CORRECT ANSWERSA. Eligibility criteria B. Application process C. Application assistance **D. Out-of-network providers Which option is NOT a bankruptcy type governed by the 1979 Bankruptcy Act? - CORRECT ANSWERSA. Straight bankruptcy B. Debtor reorganization **C. Creditor priority D. Debtor rehabilitation Which evaluation criteria demonstrates reputation expectations: - CORRECT ANSWERSA. The agency's Yelp score and consumer comments. B. The amount of monies collected monthly. **C. The employment of staff who have documented experience working in financial areas of health care. D. The high turnover rate for entry level employees. Agency fees are: - CORRECT ANSWERSA. Paid by patients. **B. The cost to the provider for collection agency monies offset by the return on baddebt accounts. C. Only reported annually to the provider. D. Waived for accounts aged greater than one year from date of service. The correct way to handle the retention and payment of agency fees is: - CORRECT ANSWERSA. The agency provides an annual settlement of monies received by the health care provider and the agency. B. Compare estimated collection costs to actual costs incurred. C. Validate bank deposits weekly as funds are received from the agency. **D. Follow the contractual agreement between the agency and the provider as to how monies sent to the agency will be handled. Patient relations include: - CORRECT ANSWERS**A. The ability to sensitively deal with patients or individuals while managing collection efficiency. B. Applying hard-core techniques to collect monies owed regardless of what the patient or individual states during the call. C. Ignoring all patient complaint calls. D. Referring all patient complaint calls to the healthcare provider. Collection agency reports should be provided: - CORRECT ANSWERSA. Whenever staff have the time to generate them. B. Whenever an account is cancelled. **C. In at least two formats regarding accounts assigned on a routine basis. D. As needed to prove recovery rates. Collection results are: - CORRECT ANSWERSA. Always guaranteed by the collection agency. **B. Accurately calculated to demonstrate the actual recovery percentage rate. C. Calculated using agency's private formula. D. Never reported except during contract negotiations. Which option is NOT a HFMA best practice? - CORRECT ANSWERSA. Coordinate the resolution of bad debt accounts with a law firm B. Establish policies and ensure that they are followed NOT - C. Coordinate account resolution activities with business affiliates D. Report back to credit bureaus when an account is resolved True or False: The following statement represents an advantage of outsourcing: Access to qualified staff - CORRECT ANSWERS**True False True or False: The following statement represents an advantage of outsourcing: Vendor absorbs some financial risk based on "efficiency" factor - CORRECT ANSWERS**True False True or False: The following statement represents an advantage of outsourcing: Impact on direct control of accounts receivable - CORRECT ANSWERSTrue **False True or False: The following statement represents an advantage of outsourcing: Capitalizes on the economies of scale - CORRECT ANSWERS**True False True or False: The following statement represents an advantage of outsourcing: Limits internal staffing requirements - CORRECT ANSWERS**True False True or False: The following statement represents an advantage of outsourcing: Impact on customer service - CORRECT ANSWERSTrue **False True or False: The following statement represents an advantage of outsourcing: Legal impact if vendor represents themselves as provider employees - CORRECT ANSWERSTrue **False True or False: The following statement represents an advantage of outsourcing: Ineffective vendor results in increased costs - CORRECT ANSWERSTrue **False ABC Hospital has experienced a 16% increase in new patients over the past 6 months. The hospital is understaffed in its insurance claim and payment processing department and cannot handle this increase in work load. It is considering hiring an outsourcing vendor to assist. What are the steps that the hospital needs to take to establish and ensure a successful vendor relationship? - CORRECT ANSWERS**A. Distribute a RFP to solicit vendor capabilities, evaluate vendor's expertise to provide outsourcing services, visit vendor locations, perform vendor reference checks, talk with vendor clients, interview vendor employees to assess experience level. B. Evaluate vendor's expertise in providing outsourcing services, visit vendor locations, interview vendor employees to assess expertise level. Which function within the revenue cycle is NOT a good candidate for outsourcing? - CORRECT ANSWERS**A. Health Care Patient Services B. Patient Accounting C. Patient Access D. Health Information Management [Show Less]
- Exam
- $15.45
- 0
- 168
CRCR Certification 206 Questions and Answers,100% CORRECT
CRCR Certification 206 Questions and Answers Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - CORR... [Show More] ECT ANSWERSThe Medicare Administrative Contractor (MAC) at the end of the hospice cap period Which of the following is required for participation in Medicaid - CORRECT ANSWERSMeet Income and Assets Requirements In choosing a setting for patient financial discussions, organizations should first and foremost - CORRECT ANSWERSRespect the patients privacy A nightly room charge will be incorrect if the patient's - CORRECT ANSWERSTransfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can - CORRECT ANSWERSPurchase qualified health benefit plans regardless of insured's health status A portion of the accounts receivable inventory which has NOT qualified for billing includes: - CORRECT ANSWERSCharitable pledges What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? - CORRECT ANSWERSRevenue codes This directive was developed to promote and ensure healthcare quality and value and also to protect consumers and workers in the healthcare system. This directive is called - CORRECT ANSWERSPatient bill of rights The activity which results in the accurate recording of patient bed and level of care assessment, patient transfer and patient discharge status on a real-time basis is known as - CORRECT ANSWERSCase management Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? - CORRECT ANSWERSRegistration staff may routinely contact managed are plans for prior authorizations before the patient is seen by the on-duty physician HIPAA had adopted Employer Identification Numbers (EIN) to be used in standard transactions to identify the employer of an individual described in a transaction EIN's are assigned by - CORRECT ANSWERSThe Internal Revenue Service Checks received through mail, cash received through mail, and lock box are all examples of - CORRECT ANSWERSControl points for cash posting What are some core elements if a board-approved financial assistance policy? - CORRECT ANSWERSEligibility, application process, and nonpayment collection activities A recurring/series registration is characterized by - CORRECT ANSWERSThe creation of one registration record for multiple days of service With the advent of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to - CORRECT ANSWERSAssist patients in understanding their insurance coverage and their financial obligation The purpose of a financial report is to: - CORRECT ANSWERSPresent financial information to decision makers Patient financial communications best practices produce communications that are - CORRECT ANSWERSConsistent, clear and transparent Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish - CORRECT ANSWERSWhat services or healthcare items are covered under Medicare Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with - CORRECT ANSWERSThe Provider Reimbursement Review Board Concurrent review and discharge planning - CORRECT ANSWERSOccurs during service Duplicate payments occur: - CORRECT ANSWERSWhen providers re-bill claims based on nonpayment from the initial bill submission An individual enrolled in Medicare who is dissatisfied with the government's claim determination is entitled to reconsideration of the decision. This type of appeal is known as - CORRECT ANSWERSA beneficiary appeal Insurance verification results in which of the following - CORRECT ANSWERSThe accurate identification of the patient's eligibility and benefits The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: - CORRECT ANSWERSJudicial review by a federal district court Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the providermay not ask about a patient's insurance information if it would delay what? - CORRECT ANSWERSMedical screening and stabilizing treatment Ambulance services are billed directly to the health plan for - CORRECT ANSWERSServices provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility Key performance indicators (KPIs) set standards for accounts receivables (A/R) and - CORRECT ANSWERSProvide a method of measuring the collection and control of A/R he patient discharge process begins when - CORRECT ANSWERSThe physician writes the discharge orders The nightly room charge will be incorrect if the patient's - CORRECT ANSWERSTransfer from ICU to the Medical/Surgical floor is not reflected in the registration system. The soft cost of a dissatisfied customer is - CORRECT ANSWERSThe customer passing on info about their negative experience to potential pts or through social media channels An advantage of a pre-registration program is - CORRECT ANSWERSThe opportunity to reduce the corporate compliance failures within the registration process It is important to have high registration quality standards because - CORRECT ANSWERSInaccurate or incomplete patient data will delay payment or cause denials Telemed seeks to improve a patient's health by - CORRECT ANSWERSPermitting 2-way real time interactive communication between the patient and the clinical professional Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a monthly fee is known as a - CORRECT ANSWERSHMO Identifying the patient, in the MPI, creating the registration record, completing medical necessity screening, determining insurance eligibility and benefits resolving managed care, requirements and completing financial education/resolution are all - CORRECT ANSWERSThe data collection steps for scheduling and pre-registering a patient Medicare Part B has an annual deductible, and the beneficiary is responsible for - CORRECT ANSWERSA co-insurance payment for all Part B covered services The standard claim form used for billing by hospitals, nursing facilities, and other inpatient - CORRECT ANSWERSUB-04 Charges are the basis for - CORRECT ANSWERSSeparation of fiscal responsibilities between the patient and the health plan All of the following are forms of hospital payment contracting EXCEPT - CORRECT ANSWERSContracted Rebating The most common resolution methods for credit balances include all of the following EXCEPT: - CORRECT ANSWERSDesignate the overpayment for charity care Ambulance services are billed directly to the health plan for - CORRECT ANSWERSThe portion of the bill outside of the patient's self-pay A claim for reimbursement submitted to a third-party payer that has all the information and documentation required for the payer to make a decision on it is known as - CORRECT ANSWERSA clean claim The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to - CORRECT ANSWERSMedicare and Medicaid payments The Correct Coding Initiative Program consists of - CORRECT ANSWERSEdits that are implemented within providers' claim processing systems To provide a patient with information that is meaningful to them, all of the following factors must be included EXCEPT - CORRECT ANSWERSThe actual physician reimbursement Which department supports/collaborates with the revenue cycle? - CORRECT ANSWERSInformation Technology Medicare Part B has an annual deductible and the beneficiary is responsible for - CORRECT ANSWERSa co-insurance payment for all Part B covered services The two types of claims denial appeals are - CORRECT ANSWERSBeneficiary and Provider Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) - CORRECT ANSWERSRegistration staff members routinely contact managed care plans for prior authorizations before the patient is seen by the on duty physician Rural Health Clinics (RHC) personnel can provide services in all of the following locations, EXCEPT - CORRECT ANSWERSProviding inpatient services in the RHC The patient discharge process begins when - CORRECT ANSWERSThe physician writes the discharge order Departments that need to be included in charge master maintenance include all of the following EXCEPT - CORRECT ANSWERSQuality Assurance The first thing a health plan does when processing a claim is - CORRECT ANSWERSCheck if the patient is a health plan beneficiary and what is the coverage Vital to accurate calculations of a patient's self-pay amount is - CORRECT ANSWERS The most accurate way to validate patient information is to - CORRECT ANSWERSrequire clinical staff to verify information at each treatment encounter In order for Regulation Z to apply, a hospital must - CORRECT ANSWERS All of the following are minimum requirements for new patients with no MPI number EXCEPT - CORRECT ANSWERSAddress A typical routine patient financial discussion would include - CORRECT ANSWERSExplaining the benefits identified through verifying the patients insurance Components of financial education include informing the patient of the hospital's financial policies, assessing the patient's ability to pay and - CORRECT ANSWERSReviewing payment alternatives with the patient so appropriate resolution of the health care financial obligation is achieved HFMA best practices indicate that the technology evaluation is conducted to - CORRECT ANSWERSContinually align technology with processes rather than technology dictating processes Scheduler instructions are used to prompt the scheduler to - CORRECT ANSWERSComplete the scheduling process correctly based on service requested When billing Rural Health Clinic services on a UB-04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521). Although codes are collapsed into a single revenue code, it is still important to list the appropriate CPT codes as part - CORRECT ANSWERSThese codes will be used to determine medical necessity and useful in determining what happened during the encounter What is likely to occur if credit balances are not identified separately from debit balances in accounts receivable? - CORRECT ANSWERSThe accounts receivable level would be understated The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as - CORRECT ANSWERSinsurance verification and reimbursable charges Unless the patient encounter is an emergency, it is more efficient and effective to - CORRECT ANSWERSCollect all information after the patient has been discharged Applying the contracted payment amount to the amount of total charges yields - CORRECT ANSWERSA pricing agreement "Hard-coded" is the term used to refer to - CORRECT ANSWERSCodes for services, procedures, and drugs automatically assigned by the charge master The advantages to using a third-party collection agency include all of the following EXCEPT - CORRECT ANSWERSProviders pay pennies on each dollar collected Which of the following is usually covered on a Conditions of Admission form - CORRECT ANSWERSRelease of information The 501(r) regulations require not-for-profit providers (501(c)(3) organizations) to do which of the following activities. - CORRECT ANSWERSComplete a community needs assessment and develop a discount program for patient balances after insurance payment To be eligible for Medicaid, an individual must - CORRECT ANSWERSmeet income and asset requirements Eliminating mail time and reducing data entry time, electronically monitoring the receipt of claims and online claim adjudication, more prompt payment are all benefits achieved by - CORRECT ANSWERSThe electronic submission of claims using electronic transfers There are unique billing requirements based on - CORRECT ANSWERSThe provider type The unscheduled "direct" admission represents a patient who: - CORRECT ANSWERSIs admitted from a physician's office on an urgent basis In resolving medical accounts, a law firm may be used as: - CORRECT ANSWERSA substitute for a collection agency The legal authority to request and analyze provider claim documentation to ensure that - CORRECT ANSWERSThe Office of the U.S. Inspector General (OIG) The office of inspector general (OIG) publishes a compliance work plan - CORRECT ANSWERSAnnually Room and bed charges are typically posted - CORRECT ANSWERSFrom the midnight census All of the following information should be reviewed as part of schedule finalization EXCEPT: - CORRECT ANSWERSThe results of any and all test Revenue cycle activities occurring at the point-of-service include all of the following EXCEPT: - CORRECT ANSWERSProviding charges to the third-party payer as they are incurred HFMA's patient financial communications best practices specify that pts should be told about the - CORRECT ANSWERSThe service providers that typically participate in the service, e.g. radiologists ,pathologists, etc. The core financial activities resolved within patient access include: - CORRECT ANSWERSScheduling, pre-registration, insurance verification and managed care processing A decision on whether a patient should be admitted as an inpatient or become about patient observation patient requires medical judgments based on all of the following EXCEPT - CORRECT ANSWERSThe patient's home care coverage Which option is a benefit of pre-registering a patient for services - CORRECT ANSWERSThe patient arrival process is expedited, reducing wait times and delays Days in A/R is calculated based on the value of - CORRECT ANSWERSThe total accounts receivable on a specific date Case Management requires that a case manager be assigned - CORRECT ANSWERSTo a select patient group Which of the following is required for participation in Medicaid? - CORRECT ANSWERSMeet income and assets requirements All of the following are steps in safeguarding collections EXCEPT - CORRECT ANSWERSIssuing receipts The Electronic Remittance Advice (ERA) data set is : - CORRECT ANSWERSA standardized form that provides third party payment details to providers All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT - CORRECT ANSWERSServices and procedures that are custodial in nature Medicare beneficiaries remain in the same "benefit period" - CORRECT ANSWERSUntil the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days It is important to calculate reserves to ensure - CORRECT ANSWERSStable financial operations and accurate financial reporting A claim is denied for the following reasons, EXCEPT: - CORRECT ANSWERSThe submitted claim does not have the physicians signature HFMA best practices call for patient financial discussions to be reinforced - CORRECT ANSWERSBy changing policies to programs Patients should be informed that costs presented in a price estimate may - CORRECT ANSWERSVary from estimates, depending on the actual services performed The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physicians to do all of the following EXCEPT: - CORRECT ANSWERSObtain higher compensation for physicians Charges as the most appropriate measurement of utilization enables - CORRECT ANSWERSAccuracy of expense and cost capture Once the EMTALA requirements are satisfied - CORRECT ANSWERSThe remaining registration processing is initiated at the bedside or in a registration area Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite discharge, the HFMA best practice is to: - CORRECT ANSWERSSupport that choice, providing that the discussion does not interfere with patient care or disrupt patient flow In Chapter 7 straight bankruptcy filling - CORRECT ANSWERSThe court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt Chapter 13 Bankruptcy, debtor rehabilitation is a court proceeding - CORRECT ANSWERSThat reorganizes a debtor's holdings and instructs creditors to look to the debtors' future earnings for payment This concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits - CORRECT ANSWERSClaims processing The importance of Medical records being maintained by HIM is that the patient records: - CORRECT ANSWERSAre the primary source for clinical data required for reimbursement When there is a request for service, the scheduling staff member must confirm the patient's unique identification information to - CORRECT ANSWERSEnsure that she/he accesses the correct information in the historical database Maintaining routine contact with the health plan or liability payer, making sure all required information is provided and all needed approvals are obtained is the responsibility of: - CORRECT ANSWERSCase Management Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and - CORRECT ANSWERSProvide a method of measuring the collection and control of A/R With any remaining open balances, after insurance payments have been posted, the account financial liability is - CORRECT ANSWERSPotentially transferred to the patient Pricing transparency is defined as readily available information on the price of healthcare services, that together with other information, help define the value of those services and enable consumers to - CORRECT ANSWERSIdentify, compare, and choose providers that offer the desired level of value All of the following are potential causes of credit balances EXCEPT - CORRECT ANSWERSA patient's choice to build up a credit against future medical bills A comprehensive "Compliance Program" is defined as - CORRECT ANSWERSSystematic procedures to ensure that the provisions of regulations imposed by a government agency are being met An originating site is - CORRECT ANSWERSThe location of the patient at the time the service is provided Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare established guideline(s) used to determine: - CORRECT ANSWERSWhich diagnoses, signs, or symptoms are reimbursable If further treatment can only be provided in a hospital setting, the patient's condition cannot be evaluated and/or treated within 24 hours, or if there is not an anticipation of improvement in the patient's condition with 24 hours, the patient - CORRECT ANSWERSWill be admitted as an inpatient The benefit of Medicare Advantage Plan is - CORRECT ANSWERSPatients generally have their Medicare-coverage healthcare through the plan and do not need to worry about "part a" or "part b" benefits The process of creating the pre-registration record ensures - CORRECT ANSWERSAccurate billing Claims with dates of service received later than one calendar year beyond the date of service, will be - CORRECT ANSWERSDenied by Medicare A portion of the accounts receivable inventory which has NOT qualified for billing includes - CORRECT ANSWERSCharitable pledges The standard claim form used for billing by hospitals, nursing facilities, and other in-patient - CORRECT ANSWERSUB-04 Once the price is estimated in the pre-service stage, a provider's financial best practice is to - CORRECT ANSWERSExplain to the patient their financial responsibility and to determine the plan for payment Internal controls addressing coding and reimbursement changes are put in place to guard against - CORRECT ANSWERSCompliance fraud by upcoding Health Plan Contracting Departments do all of the following EXCEPT - CORRECT ANSWERSEstablish a global reimbursement rate to use with all third-party payer For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: - CORRECT ANSWERSShould take place between the patient or guarantor and properly trained provider representatives What type of account adjustment results from the patient's unwillingness to pay a self-pay balance? - CORRECT ANSWERSBad debt adjustment Most major health plans including Medicare and Medicaid, offer - CORRECT ANSWERSElectronic and/or web portal verification The important Message from Medicare provides beneficiaries information concerning their - CORRECT ANSWERSRight to appeal a discharge decision if the patient disagrees with the plan Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the provider may not ask about a patient's insurance information if it would delay what? - CORRECT ANSWERSMedical screening and stabilizing treatment Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implement - CORRECT ANSWERSMonitor compliance Medicare will only pay for tests and services that - CORRECT ANSWERSMedicare determines are "reasonable and necessary" The physician who wrote the order for an inpatient service and is in charge of the patients - CORRECT ANSWERSThe attending physician When primary payment is received, the actual reimbursement - CORRECT ANSWERSIs compared to the expected reimbursement, the remaining contractual adjustments are posted, and secondary claims are submitted The ICD-10 codes set and CPT/HCPCS code sets combines provide - CORRECT ANSWERSThe specificity and coding needed to support reimbursement claims In a self-insured (or self-funded) plan, the costs of medical care are - CORRECT ANSWERSBorne by the employer on a pay-as-you-go basis Indemnity plans usually reimburse: - CORRECT ANSWERSA certain percentage of the charges after the patient meets the policy's annual deductible The first and most critical step in registering a patient, whether scheduled or unscheduled, is - CORRECT ANSWERSVerifying the patient's identification When Recovery Audit Contractors (RAC) identify improper payments as over payments, the - CORRECT ANSWERSSend a demand letter to the provider to recover the over payment amount Across all care settings, if a patient consents to a financial discussion during a medical encounter - CORRECT ANSWERSSupport that choice, providing that the discussion does not interfere with patient care or disrupt patient flow Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by: - CORRECT ANSWERSEach state's Medicaid plan Medicare patients are NOT required to produce a physician order to receive which of these services - CORRECT ANSWERSScreening Mammography, flu vaccine or pneumonia vaccine EFT (electronic funds transfer) is - CORRECT ANSWERSAn electronic transfer of funds from payer to payee The importance of medical records being maintained by HIM is that the patient records - CORRECT ANSWERSAre the primary source for clinical data required for reimbursement by health plans and liability payers Days in A/R is calculated based on the value of: - CORRECT ANSWERSThe time it takes to collect anticipated revenue To maximize the value derived from customer complaints, all consumer complaints should be - CORRECT ANSWERSResponded to within two business days A scheduled inpatient represents an opportunity for the provider to do which of the following? - CORRECT ANSWERSComplete registration and insurance approval before service In the pre-service stage, the requested service is screened for medical necessity, health - CORRECT ANSWERSPre-authorization are obtained Hospitals need which of the following information sets to assess a patient's financial status: - CORRECT ANSWERSPatient and guarantor's income, expenses and assets Patients are contacting hospitals to proactively inquire about costs and fees prior to - CORRECT ANSWERSThe fact that charge master lists the total charge, not net charges that reflect charges after a payer's contractual adjustment HIPAA had adopted Employer Identification Numbers (EIN) to be used in standard transactions to identify the employer of an individual described in a transaction EIN's are assigned by - CORRECT ANSWERSThe Internal Revenue Service The HCAHPS (hospital consumer assessment of healthcare providers and systems) initiative - CORRECT ANSWERSProvide a standardized method for evaluating patient's perspective on hospital care. A large number of credit balances are not the result of overpayments but of - CORRECT ANSWERSPosting errors in the patient accounting system A Medicare Part A benefit period begins: - CORRECT ANSWERSWith admission as an inpatient Chapter 13 Bankruptcy, debtor rehabilitation, is a court proceeding - CORRECT ANSWERSThat reorganizes a debtor's holdings and instructs creditors to look to the debtor's future earnings for payment Which of the following in NOT included in the Standardized Quality Measures - CORRECT ANSWERSCost of services The disadvantages of outsourcing include all of the following EXCEPT: - CORRECT ANSWERSReduced internal staffing costs and a reliance on outsourced staff Improving the overall patient experience requires revenue cycle leadership and staff to simultaneously be: - CORRECT ANSWERSClear on policies and consistent in applying the policies Because 501(r) regulations focus on identifying potential eligible financial assistants patients hospitals must: - CORRECT ANSWERSHold financial conversations with patients as soon as possible Which of the following is NOT contained in a collection agency agreement? - CORRECT ANSWERSA mutual hold-harmless clause HFMA best practices stipulate that a reasonable attempt should be made to have the financial - CORRECT ANSWERSAs early as possible, before a financial obligation is incurred Recognizing that health coverage is complicated and not all pts are able to navigate this terrain, HFMA best practices specify that - CORRECT ANSWERSPatients should be given the opportunity to request a patient advocate, family member or other designee to help them In these discussions For scheduled patients, important revenue cycle activities In the Time of Service stage DO NOT INCLUDE: - CORRECT ANSWERSFinal bill is presented for payment HFMA's patient financial communication best practices specify that patients should be told about the types of services provided and - CORRECT ANSWERSThe service providers that typically participate in the service, e.g., radiologists, pathologists, etc. Successful account resolution begins with - CORRECT ANSWERSCollecting all deductibles and copayments during the pre-service stage Recognizing that health coverage is complicated and not all patients are able to navigate this terrain, HFMA best practices specify that - CORRECT ANSWERSPatients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions In the balance resolution process, providers should: - CORRECT ANSWERSAsk the patient if he or she would like to receive information about payment options and supportive financial assistance programs Business ethics, or organizational ethics represent: - CORRECT ANSWERSThe principles and standards by which organizations operate Which option is a government-sponsored health care program that is financed through taxes and general revenue funds - CORRECT ANSWERSMedicare Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on; a monthly fee is known as a - CORRECT ANSWERSHMO In a Chapter 7 Straight Bankruptcy filing - CORRECT ANSWERSThe court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt When there is a request for service the scheduling staff member must confirm the patient's - CORRECT ANSWERSEnsure that she/he accesses the correct information in the historical database A four digit number code established by the National Uniform Billing Committee (NUBC)that categorizes/classifies a line item in the charge master is known as - CORRECT ANSWERSRevenue codes Appropriate training for patient financial counseling staff must cover all of the following EXCEPT: - CORRECT ANSWERSDocumenting the conversation in the medical records The ACO investment model will test the use of pre-paid shared savings to - CORRECT ANSWERSEncourage new ACOs to form in rural and underserved areas When recovery audit contractors (RAC) identify improper payments as over payments the claims processing contractor must - CORRECT ANSWERSSend a demand letter to the provider to recover the over payment amount The purpose of the ACA mandated Community Health Needs Assessment is - CORRECT ANSWERSTo identify significant health needs, prioritize those needs and identify resources to address them A balance sheet is - CORRECT ANSWERSA statement of assets, liabilities, and capital for an organization at a specified point in time Hospitals can only convert an inpatient case to observation if the hospital utilization review committee determines this status before the patient is discharged and - CORRECT ANSWERSPrior to billing, that an observation setting will be more appropriate During pre-registration, a search for the patients MPI number is initiated using which of the following data sets? - CORRECT ANSWERSPatient's full legal name and date of birth or the patient's Social Security number Because case managers document the clinical reasons for treatment, they are - CORRECT ANSWERSA good resource when developing written appeals of denials The Truth in Lending Act establishes - CORRECT ANSWERSDisclosure rules for consumer credit sales and consumer loans What is Continuum of Care? - CORRECT ANSWERSThe coordination and linkage of resources needed to avoid the duplication of services and the facilitation of a seamless movement among care settings HIPAA privacy rules require covered entities to take all of the following actions EXCEPT - CORRECT ANSWERSUse only designated software platforms to secure patient data The Two Midnight Rule allows hospitals to account for total hospital time when determining if an inpatient admission order should be written based on - CORRECT ANSWERSA beneficiary needing a minimum of 48 hours of care Since passage of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to - CORRECT ANSWERSAssist patients in understanding their insurance coverage and their financial obligation HFMA patient financial communications best practices call for annual training for all staff EXCEPT - CORRECT ANSWERSNursing The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as - CORRECT ANSWERSInsurance verification of reimbursable charges Net Accounts Receivable is - CORRECT ANSWERSThe amount an entity is reasonably confident of collecting from overall accounts receivable. ED patients should be informed that their ability to pay - CORRECT ANSWERSWill not interfere with treatment of any emergency medical conditions Providers are advised that it is best to establish patient financial responsibility and assistance policies and make sure they are followed internally and by - CORRECT ANSWERSBusiness affiliates Incorrect data gathering can cause all of the following EXCEPT - CORRECT ANSWERSThe inability to discuss quality with physicians All Hospitals are required to establish a written financial assistance policy that applies to - CORRECT ANSWERSAll emergency and medically necessary care All of the following are reference resources used to help guide in the application of business ethics EXCEPT - CORRECT ANSWERSConsumer satisfaction reports Each patient is assigned a unique number, commonly called the - CORRECT ANSWERSMaster Patient Index (MPI) number HIPAA contains all of the following goals EXCEPT - CORRECT ANSWERSTo ensure proper coding across the continuum of care Which of the following is NOT included in the Standardized Quality Measures? - CORRECT ANSWERS Account Receivable (A/R) Aging reports - CORRECT ANSWERSDivide accounts receivable into 30, 60, 90 ,120 days past due categories Patients expect value for their healthcare dollar, including greater transparency of - CORRECT ANSWERSQuality and price information The impact of denials on the revenue cycle includes all of the following EXCEPT - CORRECT ANSWERSPatient outcomes Examples of ethics violations that impact the revenue cycle include all of the following EXCEPT - CORRECT ANSWERSSeeking payment options for patient self-pay Scheduled procedures routinely include - CORRECT ANSWERSPatient preparation instructions ICD-10-CM and ICD-10-PCS codes sets are modifications of - CORRECT ANSWERSThe International ICD-10 codes as developed by the WHO (World Health Organization) The result of accurate census balancing on a daily basis is - CORRECT ANSWERSThe correct recording of room charges All of the following are steps in verifying insurance EXCEPT - CORRECT ANSWERSThe patient signing the statement of financial responsibility Health Information Management (HIM) is responsible for - CORRECT ANSWERSAll patient medical records This form contains major items, subdivided into a total of 55 detailed items, and is used by professional service providers and not hospitals for submitting claims for services to health plans this form is called - CORRECT ANSWERSThe 1500 Which of the following is NOT a factor in self-pay follow-up? - CORRECT ANSWERSThe type of patient (inpatient, out-patient) The Office of Inspector General (OIG) was created - CORRECT ANSWERSDetect and prevent fraud, waste, and abuse - CORRECT ANSWERS [Show Less]
- Exam
- $11.45
- 0
- 305
CRCR EXAM 154 Questions and Answers 2023,100% CORRECT
CRCR EXAM 154 Questions and Answers 2023 What do Case Managers do? - CORRECT ANSWERSMonitor high resource cases to ensure effective utilization What ... [Show More] is HIM responsible for? - CORRECT ANSWERSall pt medical records: transcribe, coding, release to biling, answer requests for documentation What is utilization management responsible for? - CORRECT ANSWERSmanage cases: services correct, on time What are the three types of utilization review? - CORRECT ANSWERSProspective, Concurrent, Retrospective Where can home health services be offered? - CORRECT ANSWERSHome, Assist Living, neighbors: just not SNF nor Hospital To receive -Care payments, what must a SNF have when receiving a pt from a hosp? - CORRECT ANSWERSA transfer agreement approved by -Care. Can a home health agency employ another agency to provide services? - CORRECT ANSWERSYes, so long as at least one employee of the original agency provides care. What is the Net Collection Rate? - CORRECT ANSWERShow much cash was collected as a % of available to collect? What is the Net Collection Rate benchmark? - CORRECT ANSWERS95% What is the benchmark for denials - CORRECT ANSWERS<2% on first submission Formual for cost to collect - CORRECT ANSWERStotal PFS expenses/gross pt care collections What is the benchmark for cost to collect - CORRECT ANSWERS2.25% What % of the UB-04 source of data is from pt access? - CORRECT ANSWERS40% What % of the UB-04 source of data is from service depts? - CORRECT ANSWERS11% What % of the UB-04 source of data is from HIM? - CORRECT ANSWERS20% What % of the UB-04 source of data is from billing? - CORRECT ANSWERS20% What % of the UB-04 source of data is not used? - CORRECT ANSWERS9% What % of the CMS 1500 source of data is from pt access? - CORRECT ANSWERS53% What % of the CMS 1500 source of data is from service? - CORRECT ANSWERS14% What % of the CMS 1500 source of data is from HIM - CORRECT ANSWERS7% What % of the CMS 1500 source of data is from billing? - CORRECT ANSWERS26% From whom is the UB-04 directed? - CORRECT ANSWERSinstitutional: hospitals, SNF, hospice From whom is the CMS 1500? - CORRECT ANSWERSnon-institutional: physicians, DME In the FDCA, what is Title I - CORRECT ANSWERSTruth in Lending Act What is the Truth in Lending Act - CORRECT ANSWERS5 points must be triggered (such as interest will be charged), then must disclose APR, total payments, late payment charges, etc. What are the penalties for violating the FDCA? - CORRECT ANSWERScreditors can be sued Who enforces the FDCA for hospitals? - CORRECT ANSWERSFTC In the FDCA, what is Title III - CORRECT ANSWERSlimits garnishments In the FDCA, what is Title IV - CORRECT ANSWERSFair Credit Reporting Act What is the Fair Credit Reporting Act? - CORRECT ANSWERSprovides consumer rights in reporting loans Are there rules for how a debt collector communicates with debtor? - CORRECT ANSWERSYes, eg no profane language, can't contact before 8 AM Is a newborn a scheduled or unscheduled pt - CORRECT ANSWERSunscheduled What are the three types of pt access incoming to a HCO? - CORRECT ANSWERSscheduled, unscheduled, recurring What is LCD - CORRECT ANSWERSlocal coverage determinants, in absence of NCD, LCD dtermines whether -Care will pay for an item or service What is NCD - CORRECT ANSWERSnational coverage determinants:' nationwide determination of whether Medicare will pay for an item or service What % of pts should be pre-registered of all scheduled pts? - CORRECT ANSWERS98% What is the code for HIPAA transaction set for HC eligibility and benefit responses - CORRECT ANSWERS270 outgoing 271 response What are some payer data elements needed to process payment? - CORRECT ANSWERSpolicy type, covered persons, mail address, cvr type (HMO), deductible What is an PPO - CORRECT ANSWERSclosest to indemnity plan, only preferred doctors in network get contracted prices What is an EPO - CORRECT ANSWERSexclusive provider - limits services to only EP What is POS - CORRECT ANSWERSpoint of service - if doc makes referral out, plan will pay, if pt requests out of service, pt pays What is CDHP - CORRECT ANSWERSconsumer directed healthplan, often with a HSA What is the % discount model in MCO - CORRECT ANSWERSa % is discounted What is the DRG model in MCO - CORRECT ANSWERSpymt based on predetermined fixed amount What is the APG model in MCO - CORRECT ANSWERSdivides outpt services into 600 procedural groups, each APG assigned a relative payment weight What is a case rate - CORRECT ANSWERSpt's condition forms basis for payment for all services What is stop loss - CORRECT ANSWERSplan covers 80% of charges to 100%, stop loss is plan covers 50% of charges >$120k What are some managed care requirments? - CORRECT ANSWERSpre-certification/pre-authorization, referral (PCP->specialist), notification - providers notify payer pt is requesting service, days approval, continued stay review, site of service limitations (eg only colonosco as outpt) What are some concerns with EMTALA - CORRECT ANSWERSsign posted on walls, no prior authorization, women in active labor must be assisted thru delivery, on-call MD must respond, no dumping, no transfer (unless cannot provide service), must do mental health screening, must keep pt log What is the referring MD - CORRECT ANSWERSthe one to referred to another MD What is the attending MD - CORRECT ANSWERSOne who wrote order for service What is the consulting MD - CORRECT ANSWERSwho consults with another MD How long does Medicare Part A cover inpat services? - CORRECT ANSWERS60 days, then 30 co-insurance, then pt can use 60 days of lifetime reserve HICN - CORRECT ANSWERShealthcare insurance claim # issued by SSN to those elgible for SSN How often does Medicare update co-insurance amounts for Part B? - CORRECT ANSWERSyearly done by OPPS, outpt prospective pymnt system How are payments under -Care A paid? what system? - CORRECT ANSWERSbased on DRGs (more than more ACOs), reasonable cost at CAHs, rehab hosp, psych, ped, lg term care hosp How are payments under -Care B paid? what system? - CORRECT ANSWERSpaid on ambulatory paymt classification (APC), prospective pymt rates What are some unique sources of information that must be provided when submitting a claim to -Caid? - CORRECT ANSWERS-Caid ID # must be on form, newborn weight must be incl Can IHS pts receive care at other clinics? - CORRECT ANSWERSYes, but IHS must be the payer of last resort What must be on the UB-04 or CMS 1500 for BCBS pts? - CORRECT ANSWERSAlpha prefix - specifies specific BCBS What law governs self insured companies - CORRECT ANSWERSERISA - ergo not controlled by state legislation Can -Care be billed after billing a liability payer? - CORRECT ANSWERSyes, after 120 days. Must release liability and -Care will pursue liability payer What are typical claim edits? - CORRECT ANSWERSmedical necessity, invalid demo info, invalid codes, missing NPI #s Name three aspects to the Hospital Readmit Reduction Act - CORRECT ANSWERSCMS reduces pymt to hosp w/ excessively high readmit for heart, COPD, pneumonia, knee replace; also to MDs who do not report qual data Why is the charge master imptt even in managed care? - CORRECT ANSWERSreimbursemt based on % of charges or stop loss based on total What are the two components of the charge master - CORRECT ANSWERSroom and board (by nursing unit, room type) and ancillary charges - will list UB-04 rev code, CPT/HCPCS code and charge amount What are level 1 CPT codes - CORRECT ANSWERSfive numbers (for procedures) What are level 2 CPT codes - CORRECT ANSWERSfor supplies, ambulance (alpha and 4 digits) What are level 3 CPT codes - CORRECT ANSWERSnot common What are level 1 CPT modifiers - CORRECT ANSWERSeg would be 23 - unusual anesthesia What are level 11 CPT modifiers - CORRECT ANSWERSeg: LT - left side, E4 - lower right eyelid What are level III CPT modifiers - CORRECT ANSWERSXI - FDA approved drug Is there a chain to modifiers? - CORRECT ANSWERSYes, a HCPCS level III has higher precedence than a HCPCS NP level II for example In Pay for Performance, what do hospitals do in the Hosp Qual Initiative? - CORRECT ANSWERShosp must submit data about 10 quality measures In Pay for Performance, what must hospitals do in the Premier Hosp Quality initiative? - CORRECT ANSWERSIf hosp score in top 10%, receive a 2% bonus, if not meet objectives, subject to reductions In Pay for Performance, what must hospitals do in the capitation type initiative? - CORRECT ANSWERSfor chronically ill, must guarantee CMS a savings of at least 5% over similar population What is Pay for Performance? - CORRECT ANSWERSPay-for-performance" is an umbrella term for initiatives aimed at improving the quality, efficiency, and overall value of health care. Pay-for-performance has become popular among policy makers and private and public payers, including Medicare and Medicaid. Formula for Net Days in Pt A/R - CORRECT ANSWERSNet Pt A/R _____________________ Net Revenue/365 (or time period) What does Net Days in Pt A/R tell us? - CORRECT ANSWERSindication of efficiency of collections, revenue posting, and financial ops of A/R Does Net Days in Pt A/R get aged from date of service, date bill sent, or? - CORRECT ANSWERSDate of service What is goal for aging A/R >90 days - CORRECT ANSWERS15-18% What is goal for aging A/R >1 yr - CORRECT ANSWERS<1% What is goal for time for charge posting - CORRECT ANSWERSw/in 1-3 days of service What is goal for credit balance - CORRECT ANSWERS<1% of billed A/R What is goal for charity and bad debt - CORRECT ANSWERS5-8% of billed A/R What should be taken into account when estimating net revenue (for future) - CORRECT ANSWERShistorical adjustments, new payer contracts, charity care, bad debt What are reserves? - CORRECT ANSWERShow much is not yet collected What is important about reserves - CORRECT ANSWERSneeds to be as accurate as possible - if caught off guard, could impact available funds What % of reserves are self pay bills >120 days from 1st bill - CORRECT ANSWERS100% What % of reserves are self pay bills 90-120 days from 1st bill - CORRECT ANSWERS50% What % of reserves are self pay bills 60-90 days from 1st bill - CORRECT ANSWERS25% What % of reserves are medicare bills >365 days past discharge - CORRECT ANSWERS20% What % of reserves are medicare bills 180-365 days past discharge - CORRECT ANSWERS10% Are gross charges or contractural amounts posted to a pt's account? - CORRECT ANSWERSIf know contractural amount can post, otherwise post gross charge to pt's account until insurance pays What are instances when -care is a 2ndry payer? - CORRECT ANSWERSDisability (pt <65, has LGHP), ESRD (in 30 day coordination period), working aged, accident (when no liability exists) What is the correct coding initiative? - CORRECT ANSWERSthe purpose of the CCI is to ensure that the most comprehensive groups of codes are billed, rather than the component parts. developed by CMS What are some ways to avoid problems with cash postings? - CORRECT ANSWERSlarge write-offs such as bad debt should be done by managers. What does CMS require when there is a credit balance? - CORRECT ANSWERSreporting to CMS What does HFMA recommend a HCO do with a small credit to a pt payer? - CORRECT ANSWERSabsorb if pt does not claim after a certain period of time What is a bank lock box? - CORRECT ANSWERScontracting with a bank to receive, deposit, and electronically report payments from pts and payers What were the four goals of HIPAA passed in 1996? - CORRECT ANSWERSportability - the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs; Reduces health care fraud and abuse; Mandates industry-wide standards for health care information on electronic billing and other processes; and Requires the protection and confidential handling of protected health information What is APC? - CORRECT ANSWERSAmbulatory payment classification: United States government's method of paying for facility outpatient services for Medicare. analogous to the Medicare prospective payment system for hospital inpatients (DRG). APCs are an outpatient prospective payment system applicable only to hospitals. What is case rate? - CORRECT ANSWERSfixed price for specified procedure. Gives provider opportunity to manage costs before capitation. What is a silent PPO - CORRECT ANSWERSinsurance companies that offer providers less payment, invalid discounts (they try to look like a contracted PPO) What is electronic remittance advice 835 data set? - CORRECT ANSWERSused to send hc claim payments and advice - four levels from receipt (then paper trail) to level 4 - all electronic and links bank. -Care uses level 4. Can a Medicare beneficiary request an appeal? - CORRECT ANSWERSyes, must be an amount >$130, judicial review if over $1260 Can a provider request a -Care appeal? - CORRECT ANSWERSyes, must be >$1000; and on Part A, only on medical necess If a beneficiary knew services would not be provided, is he liable for payment? - CORRECT ANSWERSYes If neither provider nor beneficiary knew services wouldn't be covered, are they liable? - CORRECT ANSWERSNo, -Care must cover. But must have been reasonable to have not known. If provider should have known services wouldn't be covered and didn't give ABN, are they liable? - CORRECT ANSWERSYes What criteria should be used to evaluate a collection agency? - CORRECT ANSWERSreputation, pt relations, agency fees (they should give an estimated recovery amount), 'no recovery, no fee' What is a rentention account (in regards collection agency)? - CORRECT ANSWERSHolding trust account where recovered monies are kept until transferred to the provider What is Chpt 7 bankruptcy? - CORRECT ANSWERSstraight bankruptcy What is Chpt 11 bankruptcy? - CORRECT ANSWERSdebtor reorg - bankruptor has continuing management of business, debtor creates plan to reorg, creditors must approve, may also involve reduction in debt amounts What is Chpt 13 bankruptcy? - CORRECT ANSWERSdebt rehab - no liquidation, reorg holdings, creditors look to future earnings (eg garnishment) What is exempt in bankruptcy? - CORRECT ANSWERSproperty (like house, personal items), alimony, tools of trade What is exempted from discharge in bankruptcy? - CORRECT ANSWERSeducation loans, gvt fines, unpaid alimony/child care, debts arisen from lying FAP (financial assistance program) and its charity agreements? - CORRECT ANSWERSnon-profits will have limitations on charges to uninsured how should a HCO determine poverty guidelines? - CORRECT ANSWERSCan use the federal poverty guidelines, income does not include capital gain, injury comp, sale of property - and is state defined What is catastrophic charity - CORRECT ANSWERSin the event of catastrophic injury or illness what is an open insurance balance? - CORRECT ANSWERSAfter 60 days, pt must pay or fight with insurance co. to pay (unless prohibitions in contract) what is subrogation? - CORRECT ANSWERShealth plan bills liability insurance Will -Care pay for worker's comp - CORRECT ANSWERSNo Will -Care pay for auto liability? - CORRECT ANSWERSYes, after auto is exhausted What percent of claims and type are 80% of AR? - CORRECT ANSWERS15-20% of high fee What's an example of a claim rejection for technical reasons? - CORRECT ANSWERSdemographic errors, no pre-authorization, exceeded frequency (only 1 PAP/yr) What's an example of a claim rejection for clinical reason? - CORRECT ANSWERSmissing doc to support, HCPCS incorrect, not medically necessary What does a recovery audit contractor do? - CORRECT ANSWERSReview -Care claims to save gvt $ and prevent abuse What is unique about a rural health clinic and how it bills -Care part B - CORRECT ANSWERSCan collapse CPT codes to 520, but HFMA recommends still use CPT for medical necessity Are all -Care services in a RHC defined as rural health? - CORRECT ANSWERSNo, such as SNF How are -Caid claims paid in a RHC? - CORRECT ANSWERSstate by state rules Will -Care pay for a VA hospice? - CORRECT ANSWERSNo, VA must pay Will - Care pay for hospice? - CORRECT ANSWERSOnly if pt is entitled to -Care part A Can hospice be denied under -Care? - CORRECT ANSWERSyes, if worker's comp related or >210 days of hospice How is hospice payment worker compensation related? - CORRECT ANSWERSCould be cancer caused by exposure, worker's comp must cover, but -Care would then cover respite care, eg Will -Care cover hospice in a SNF? - CORRECT ANSWERSOnly hospice symptom managemnt, not room and board Will -Care cover SNF? - CORRECT ANSWERSonly if discharge not transfer What is mandatory if -Care will cover SNF? - CORRECT ANSWERSmust be to cover condition had at inpt, must have 3+ days inpt (can be at 1+ hosp, if consec), must need daily, skilled nursg service, MD must sign Is there co-insurance at a SNF for -Care? - CORRECT ANSWERSYes, from 21st-100th day How are SNFs paid under -Care? - CORRECT ANSWERSper diem based on case mix According to the ACA, when must claims be submitted by? - CORRECT ANSWERSw/in 1 year, starts on: institution: through date, MD: from date Hospice type payments are? - CORRECT ANSWERSA - routine (paid ~ rate each day), B- continuous (/24 to get hrly rate), C-inpt respite (5 days for family respite), D-inpt general - a, C, D - one rate applies each day, B - determined on # of hrs continuous care provided that day Are all ambulance bills paid directly to an ambulance company? - CORRECT ANSWERSNo, if ambulance use is required for transfer w/in hosp, then billed under Part A (eg, obese pt who cannot fit in MRI) Is there only one way an ambulance bill is billed? - CORRECT ANSWERSNo, can be one rate (incl all), or one rate for services, separate for mileage, opposite of last, base rate, separate charges for both How is medical necessity determined in ambulance? - CORRECT ANSWERSbased on services provided, not type of ambulance used What is the FCA - CORRECT ANSWERSFalse Claims Act of 2009, fraud enforcement and recovery act, encourage whistleblowers When is -Care a MSP? - CORRECT ANSWERSgroup health plan, only if >20 employees, accident (some specifics on liability), disability (Unless >65), ESRD in 30 coordination period What is the 2 midnight rule - CORRECT ANSWERS2 midnights or less can be outpt What is the CCI - CORRECT ANSWERScorrect coding initiative - modifiers to help indicate a special circumstance (eg performed by > 1 MD) What are the 9 forms that should be on hand on admission - CORRECT ANSWERSconsent to treatment condition of admission (financial agreement, surgical consent, release of info, assignment of benefits) privacy notice impt msg from -Care (can dispute) ADP Pt bill of rights How should a PFS introduce payment when speaking with a pt? - CORRECT ANSWERS1. greet 2. review HCO PFS policies 3. review insurance 4. review charges and liability 5. how will pt resolve liability? What are some problems if pt access not done correctly? - CORRECT ANSWERS1. billing (lost revenue) 2. clinical - in wrong file 3. case review - where insurance must be notified w/in 24 hrs 4. legal What is the FDCA? - CORRECT ANSWERSFair Debt Collection Act Hosp benchmark days A/R - CORRECT ANSWERS40-45 [Show Less]
- Exam
- $14.45
- 0
- 146
CRCR Exam Prep 146 Questions and Answers 2022/2023,100% CORRECT
CRCR Exam Prep 146 Questions and Answers 2022/2023 What are collection agency fees based on? - CORRECT ANSWERSA percentage of dollars collected Self-... [Show More] funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - CORRECT ANSWERSBirthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - CORRECT ANSWERSCase rates What customer service improvements might improve the patient accounts department? - CORRECT ANSWERSHolding staff accountable for customer service during performance reviews What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - CORRECT ANSWERSInform a Medicare beneficiary that Medicare may not pay for the order or service What type of account adjustment results from the patient's unwillingness to pay for a self-pay balance? - CORRECT ANSWERSBad debt adjustment What is the initial hospice benefit? - CORRECT ANSWERSTwo 90-day periods and an unlimited number of subsequent periods When does a hospital add ambulance charges to the Medicare inpatient claim? - CORRECT ANSWERSIf the patient requires ambulance transportation to a skilled nursing facility How should a provider resolve a late-charge credit posted after an account is billed? - CORRECT ANSWERSPost a late-charge adjustment to the account an increase in the dollars aged greater than 90 days from date of service indicate what about accounts - CORRECT ANSWERSThey are not being processed in a timely manner What is an advantage of a preregistration program? - CORRECT ANSWERSIt reduces processing times at the time of service What are the two statutory exclusions from hospice coverage? - CORRECT ANSWERSMedically unnecessary services and custodial care What core financial activities are resolved within patient access? - CORRECT ANSWERSScheduling, insurance verification, discharge processing, and payment of point-of-service receipts What statement applies to the scheduled outpatient? - CORRECT ANSWERSThe services do not involve an overnight stay How is a mis-posted contractual allowance resolved? - CORRECT ANSWERSComparing the contract reimbursement rates with the contract on the admittance advice to identify the correct amount What type of patient status is used to evaluate the patient's need for inpatient care? - CORRECT ANSWERSObservation Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has received what? - CORRECT ANSWERSMedically necessary inpatient hospital services for at least 3 consecutive days before the skilled nursing care admission When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - CORRECT ANSWERSWhen the patient is the insured What are non-emergency patients who come for service without prior notification to the provider called? - CORRECT ANSWERSUnscheduled patients If the insurance verification response reports that a subscriber has a single policy, what is the status of the subscriber's spouse? - CORRECT ANSWERSNeither enrolled not entitled to benefits Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act, establishes what? - CORRECT ANSWERSDisclosure rules for consumer credit sales and consumer loans What is a principal diagnosis? - CORRECT ANSWERSPrimary reason for the patient's admission Collecting patient liability dollars after service leads to what? - CORRECT ANSWERSLower accounts receivable levels What is the daily out-of-pocket amount for each lifetime reserve day used? - CORRECT ANSWERS50% of the current deductible amount What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as an RHC services? - CORRECT ANSWERSInpatient care What code indicates the disposition of the patient at the conclusion of service? - CORRECT ANSWERSPatient discharge status code What are hospitals required to do for Medicare credit balance accounts? - CORRECT ANSWERSThey result in lost reimbursement and additional cost to collect When an undue delay of payment results from a dispute between the patient and the third party payer, who is responsible for payment? - CORRECT ANSWERSPatient Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include: - CORRECT ANSWERSA valid CPT or HCPCS code With advances in internet security and encryption, revenue-cycle processes are expanding to allow patients to do what? - CORRECT ANSWERSAccess their information and perform functions on-line What date is required on all CMS 1500 claim forms? - CORRECT ANSWERSonset date of current illness What does scheduling allow provider staff to do - CORRECT ANSWERSReview appropriateness of the service request What code is used to report the provider's most common semiprivate room rate? - CORRECT ANSWERSCondition code Regulations and requirements for coding accountable care organizations, which allows providers to begin creating these organizations, were finalized in: - CORRECT ANSWERS2012 What is a primary responsibility of the Recover Audit Contractor? - CORRECT ANSWERSTo correctly identify proper payments for Medicare Part A & B claims How must providers handle credit balances? - CORRECT ANSWERSComply with state statutes concerning reporting credit balance Insurance verification results in what? - CORRECT ANSWERSThe accurate identification of the patient's eligibility and benefits What form is used to bill Medicare for rural health clinics? - CORRECT ANSWERSCMS 1500 What activities are completed when a scheduled pre-registered patient arrives for service? - CORRECT ANSWERSRegistering the patient and directing the patient to the service area In addition to being supported by information found in the patient's chart, a CMS 1500 claim must be coded using what? - CORRECT ANSWERSHCPCS (Healthcare Common Procedure Coding system) What results from a denied claim? - CORRECT ANSWERSThe provider incurs rework and appeal costs Why does the financial counselor need pricing for services? - CORRECT ANSWERSTo calculate the patient's financial responsibility What type of provider bills third-party payers using CMS 1500 form - CORRECT ANSWERSHospital-based mammography centers How are disputes with nongovernmental payers resolved? - CORRECT ANSWERSAppeal conditions specified in the individual payer's contract The important message from Medicare provides beneficiaries with information concerning what? - CORRECT ANSWERSRight to appeal a discharge decision if the patient disagrees with the services Why do managed care plans have agreements with hospitals, physicians, and other healthcare providers to offer a range of services to plan members? - CORRECT ANSWERSTo improve access to quality healthcare If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days, what is the SNF permitted to do? - CORRECT ANSWERSSubmit interim bills to the Medicare program. 90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims after what happens? - CORRECT ANSWERS120 days passes, but the claim then be withdrawn from the liability carrier What data are required to establish a new MPI entry? - CORRECT ANSWERSThe patient's full legal name, date of birth, and sex What should the provider do if both of the patient's insurance plans pay as primary? - CORRECT ANSWERSDetermine the correct payer and notify the incorrect payer of the processing error What do EMTALA regulations require on-call physicians to do? - CORRECT ANSWERSPersonally appear in the emergency department and attend to the patient within a reasonable time At the end of each shift, what must happen to cash, checks, and credit card transaction documents? - CORRECT ANSWERSThey must be balanced What will cause a CMS 1500 claim to be rejected? - CORRECT ANSWERSThe provider is billing with a future date of service Under Medicare regulations, which of the following is not included on a valid physician's order for services? - CORRECT ANSWERSThe cost of the test how are HCPCS codes and the appropriate modifiers used? - CORRECT ANSWERSTo report the level 1, 2, or 3 code that correctly describes the service provided If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? - CORRECT ANSWERSDiagnostic and clinically-related non-diagnostic charges provided on the Tuesday, Wednesday, Thursday, and Friday before admission What is a benefit of pre-registering patient's for service? - CORRECT ANSWERSPatient arrival processing is expedited, reducing wait times and delays What is a characteristic of a managed contracting methodology? - CORRECT ANSWERSProspectively set rates for inpatient and outpatient services What do the MSP disability rules require? - CORRECT ANSWERSThat the patient's spouse's employer must have less than 20 employees in the group health plan what organization originated the concept of insuring prepaid health care services? - CORRECT ANSWERSBlue Cross and blue Shield What is true about screening a beneficiary for possible MSP situations? - CORRECT ANSWERSIt is acceptable to complete the screening form after the patient has completed the registration process and been sent to the service department If the patient cannot agree to payment arrangements, what is the next option? - CORRECT ANSWERSWarn the patient that unpaid accounts are placed with collection agencies for further processing In services lines such as cardiology or orthopedics, what does the case-rate payment methodology allow providers to do? - CORRECT ANSWERSReceive a fixed for specific procedures What will comprehensive patient access processing accomplish? - CORRECT ANSWERSMinimize the need for follow-up on insurance accounts Through what document does a hospital establish compliance standards? - CORRECT ANSWERSCode of conduct How does utilization review staff use correct insurance information? - CORRECT ANSWERSTo obtain approval for inpatient days and coordinate services When is it not appropriate to use observation status? - CORRECT ANSWERSAs a substitute for an inpatient admission What is a serious consequence of misidentifying a patient in the MPI? - CORRECT ANSWERSThe services will be documented in the wrong record When a patient reports directly to a clinical department for service, what will the clinical department staff do? - CORRECT ANSWERSRedirect the patient to the patient access department for registration What process can be used to shorten claim turnaround time? - CORRECT ANSWERSSend high-dollar hard-copy claims with required attachments by overnight mail or registered mail How are patient reminder calls used? - CORRECT ANSWERSTo make sure the patient follows the prep instructions and arrives at the scheduled time for service If a patient declares a straight bankruptcy, what must the provider do? - CORRECT ANSWERSWrite off the account to the contractual adjustment account According to the Department of Health and Human Services guidelines, what is NOT considered income? - CORRECT ANSWERSSale of property, house, or car The situation where neither the patient nor spouse is employed is described to the patient using: - CORRECT ANSWERSA condition code What option is an alternative to valid long-term payment plans? - CORRECT ANSWERSBank loans What is an advantage of using a collection agency to collect delinquent patient accounts? - CORRECT ANSWERSCollection agencies collect accounts faster than hospital does What statement DOES NOT apply to revenue codes? - CORRECT ANSWERSrevenue codes identify the payer When a patient's illness results in an unusually high amount of medical bills not covered by insurance or other patient pay resources, what type of account is created - CORRECT ANSWERScatastrophic charity What happens when a patient receives non-emergent services from and out-of-network provider? - CORRECT ANSWERSPatient payment responsibility is higher Every patient who is new to the healthcare provider must be offered what? - CORRECT ANSWERSA printed copy of the provider's privacy notice How may a collection agency demonstrate its performance? - CORRECT ANSWERSCalculate the rate of recovery What is true of the information the provider supplies to indicate that an authorization for service has been received from the patient's primary payer? - CORRECT ANSWERSIt is posted on the remittance advice by the payer What standard claim forms are currently used by the healthcare industry to submit claims to third-party payers? - CORRECT ANSWERSThe UB-04 and the CMS 1500 Unless the patient encounter is an emergency, what is the efficient and effective procedure for obtaining information? - CORRECT ANSWERSObtain the required demographic and insurance information before services are rendered what protocol was developed through the Patient Friendly Billing Project? - CORRECT ANSWERSProvide information using language that is easily understood by the average reader What technique is acceptable way to complete the MSP screening for a facility situation? - CORRECT ANSWERSAsk if the patient's current services was accident related What is a valid reason for a payer to delay a claim? - CORRECT ANSWERSFailure to complete authorization requirements IF outpatient diagnostic services are provided within three days of the admission of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these charges - CORRECT ANSWERSThey must be combined with the inpatient bill and paid under the MS-DRG system What do large adjustments require? - CORRECT ANSWERSManager-level approval What items are valid identifiers to establish a patient's identification? - CORRECT ANSWERSPhoto identification, date of birth, and social security number What must a provider do to qualify an account as a Medicare bad debts? - CORRECT ANSWERSPursue the account for 120 days and then refer it to an outside collection agency What restriction does a managed care plan place on locations that must be used if the plan is to pay for the services provided? - CORRECT ANSWERSSite-of-service limitation What is an example of an outcome of the Patient Friendly Billing Project? - CORRECT ANSWERSRedesigned patient billing statements using patient-friendly language What statement describes the APC (Ambulatory payment classification) system? - CORRECT ANSWERSAPC rates are calculated on a national basis and are wage-adjusted by geographic region What is a benefit of insurance verification? - CORRECT ANSWERSPre-certification or pre-authorization requirements are confirmed What is an effective tool to help staff collect payments at the time of service? - CORRECT ANSWERSDevelop scripts for the process of requesting payments What is a benefit of electronic claims processing? - CORRECT ANSWERSProviders can electronically view patient's eligibility What does Medicare Part D provide coverage for? - CORRECT ANSWERSPrescription drugs What are some core elements of a board-approved financial policy - CORRECT ANSWERSCharity care, payment methods, and installment payment guidelines What circumstance would result in an incorrect nightly room charge? - CORRECT ANSWERSIf the patient's discharge, ordered for tomorrow, has not been charted What is NOT a typical charge master problem that can result in a denial? - CORRECT ANSWERSDoes not include required modifiers Access - CORRECT ANSWERSAn individual's ability to obtain medical services on a timely and financially acceptable level Administrative Services Only (ASO) - CORRECT ANSWERSUsually contracted administrative services to a self-insured health plan Case management - CORRECT ANSWERSThe process whereby all health-related components of a case are managed by a designated health professional. Intended to ensure continuity of healthcare accessibility and services Claim - CORRECT ANSWERSA demand by an insured person for the benefits provided by the group contract Coordination of benefits (COB) - CORRECT ANSWERSa typical insurance provision that determines the responsibility for primary payment when the patient is covered by more than one employer-sponsored health benefit program Discounted fee-for-service - CORRECT ANSWERSA reimbursement methodology whereby a provider agrees to provide service on a fee for service basis, but the fees are discounted by certain packages Eligibility - CORRECT ANSWERSPatient status regarding coverage for healthcare insurance benefits First dollar coverage - CORRECT ANSWERSA healthcare insurance policy that has no deductible and covers the first dollar of an insured's expenses Gatekeeping - CORRECT ANSWERSA concept wherein the primary care physician provides all primary patient care and coordinates all diagnostic testing and specialty referrals required for a patient's medical care Health plan - CORRECT ANSWERSan insurance company that provides for the delivery or payment of healthcare services Indemnity insurance - CORRECT ANSWERSnegotiated healthcare coverage within a framework of fee schedules, limitations, and exclusions that is offered by insurance companies or benevolent associations Medically necessary - CORRECT ANSWERSHealthcare services that are required to preserve or maintain a person's health status in accordance with medical practice standards Out-of-area benefits - CORRECT ANSWERShealthcare plan coverage allowed to covered persons for emergency situations outside of the prescribed geographic area of the HMO Out-of-pocket payments - CORRECT ANSWERSCash payments made by the insured for services not covered by the health insurance plan Pre-admission review - CORRECT ANSWERSthe practice of reviewing requests for inpatient admission before the patient is admitted to ensure that the admission is medically necesary Pre-existing condition limitation - CORRECT ANSWERSA restriction on payments for charges directly resulting from a pre-existing health conditions Same-day admission - CORRECT ANSWERSA cost containment practice that reduces a surgical patient's inpatient stay by requiring that pre-procedure testing and preparation are completed on an outpatient basis and the patient is admitted the same day as the procedure Self-insured - CORRECT ANSWERSLarge employers who assume direct responsibility or risk for paying employees' healthcare without purchasing health insurance Subrogation - CORRECT ANSWERSSeeking, by legal or administrative means, reimbursement from another party that is primarily responsible for a patient's medical expenses Subscriber - CORRECT ANSWERSAn employer, a union, or an association that contracts with an insurance company for the healthcare plan it offers to eligible employees Sub-specialist - CORRECT ANSWERSA healthcare professional who is recognized to have expertise in a specialty of medicine or surgery Third-part administrator (TPA) - CORRECT ANSWERSProvides services to employers or insurance companies for utilization review, claims payment and benefit design Third-party reimbursement - CORRECT ANSWERSA general term used for the healthcare benefit payments - used to identify that for benefit plans there are three parties in the transaction Usual, customary, and reasonable (UCR) - CORRECT ANSWERSHealth insurance plan reimbursement methodology that limits payment to the lower billed charges, the provider's customary charge, or the prevailing charge for the service in the community Utilization review - CORRECT ANSWERSReview conducted by professional healthcare personnel of the appropriateness of, quality of, and need for healthcare services provided to patients Charge - CORRECT ANSWERSThe dollar amount a provider sets for services rendered before negotiating any discounts. The charge can be different from the amount paid Cost - CORRECT ANSWERSThe definition of cost varies by party incurring the expense Price - CORRECT ANSWERSthe total amount a provider expects to be paid by payers and patients for healthcare services Care purchaser - CORRECT ANSWERSIndividual or entity that contributes to the purchase of healthcare services Payer - CORRECT ANSWERSAn organization that negotiates or sets rates for provider services, collects revenue through premium payments or tax dollars, processes provider claims for service, and pays provider claims using collected premium or tax revenues Provider - CORRECT ANSWERSAn entity, organization, or individual that furnishes a healthcare service Out of pocket payment - CORRECT ANSWERSThe portion of the total payment for medical services and treatment for which the patient is responsible, including copayments, coinsurance, and deductibles Price transparency - CORRECT ANSWERSIn health care, readily available information on the price of healthcare services that, together, with other information helps define the value of those services and enables patients and other care purchasers to identify, compare, and choose providers that offer the desired level of value Value - CORRECT ANSWERSThe quality of a healthcare service in relation to the total price paid for the service by care purchasers What areas does the code of conduct typically focus on? - CORRECT ANSWERSHuman resources. Privacy/confidentiality. Quality of care. Billing/coding. Conflicts of interest. Laws/regulations FERA - CORRECT ANSWERSFraud Enforcement and Recovery act ESRD - CORRECT ANSWERSEnd-stage renal disease. The patient has permanent kidney failure, is covered by a GHP, and has not yet completed the 30-month coordination period What is the purpose of a compliance program? - CORRECT ANSWERSMitigate potential fraud and abuse in the industry-specific key risk areas What is important about an effective corporate compliance program? - CORRECT ANSWERSA program that embodies many elements to create a program that is transparent, clearly articulated and emphasized at all employee levels as a seriously held personal and organizational responsibility, one that relies on full communication inside and outside the organization What is a CCO - CORRECT ANSWERSChief compliance officer - they typically report directly to the board of directors/trustees as well as the chief executive officer, and has limited responsibilities for other operational aspects of the organization What are the situations where another payer may be completely responsible for payment? - CORRECT ANSWERSWork-related accidents, black lung program services, patient is enrolled in Medicare Advantage, Federal grant programs Under Medicare rules, certain outpatient services that are provided within three days of the admission date, by hospitals or by entities owned or controlled by hospitals, must be billed as part of an inpatient stay. - CORRECT ANSWERSTRUE The OIG has issued compliance guidance/model compliance plans for all of the following entities: - CORRECT ANSWERShospices. physician practices. ambulance providers Providers who are found to be in violation of CMS regulations are subject to: - CORRECT ANSWERSCorporate integrity agreements What MSP situation requires LGHP - CORRECT ANSWERSDisability [Show Less]
- Exam
- $14.95
- 0
- 228
CRCR Exam 54 Questions with Answers 2022/2023,100% CORRECT
CRCR Exam 54 Questions with Answers 2022/2023 UB-04/CMS-1450 - CORRECT ANSWERSUniform Billing 2004 NUBC - CORRECT ANSWERSNational Uniform Billing C... [Show More] ommittee 0111 Bill Type - CORRECT ANSWERSHospital, Inpatient, Admit through Direct Claim 0117 Bill Type - CORRECT ANSWERSHospital, Inpatient, Correction of Prior Claim 0131 Bill Type - CORRECT ANSWERSHospital, Outpatient, Admit Discharge Claim 0137 Bill Type - CORRECT ANSWERSHospital, Outpatient, Correction of Prior Claim 0110 Bill Type - CORRECT ANSWERSHospital, Inpatient, Information Bill 01 Occurrence Code - CORRECT ANSWERSAuto Accident 02 Occurrence Code - CORRECT ANSWERSAuto Accident (no-fault) 03 Occurrence Code - CORRECT ANSWERSTort Liability 04 Occurrence Code - CORRECT ANSWERSWorkers Compensation 05 Occurrence Code - CORRECT ANSWERSOther Accident 06 Occurrence Code - CORRECT ANSWERSCrime Victim 11 Occurrence Code - CORRECT ANSWERSDate of onset of symptoms or illness 70 Span Code - CORRECT ANSWERSQualifying Stay Dates 02 Condition Code - CORRECT ANSWERSCondition is employment related 04 Condition Code - CORRECT ANSWERSInformation Bill Only 05 Condition Code - CORRECT ANSWERSLien has been filled 08 Condition Code - CORRECT ANSWERSBeneficiary would not provide info about insurance coverage 09 Condition Code - CORRECT ANSWERSNeither patient or spouse employed 20 Condition Code - CORRECT ANSWERSBeneficiary request billing (non-covered charges) 011X Revenue Code - CORRECT ANSWERSRoom Accommodations Code 0450 Revenue Code - CORRECT ANSWERSEmergency Room 0360 Revenue Code - CORRECT ANSWERSSurgery/OR 0760 Revenue Code - CORRECT ANSWERSTreatment/Observation Room 01 Value Code - CORRECT ANSWERSMost Common Semi-Private Room Rate 02 Value Code - CORRECT ANSWERSAll Patient Room Hospital 0270 Revenue Code - CORRECT ANSWERSMedical Supplies Field Locator 4 (FL4) - CORRECT ANSWERSType of Bill Field Locator 6 (FL6) - CORRECT ANSWERSStatement covers period from/through HIPAA - CORRECT ANSWERSHealth Insurance Portability and Accountability Act 835 Transaction Set - CORRECT ANSWERSRemittance 837 Transaction Set - CORRECT ANSWERSClaims 270-271 Transaction Set - CORRECT ANSWERSInsurance eligibility Field Locator 17 (FL17) - CORRECT ANSWERSPatient Discharge Status Field Locator 42 (FL 42) - CORRECT ANSWERSRevenue Code HCPCS - CORRECT ANSWERSHealthcare Common Procedure Coding System CPT - CORRECT ANSWERSCurrent Procedural Terminology ICD-10 - CORRECT ANSWERSInternational Classification of Disease- 10th Modification Field Locator 67 (FL 67) - CORRECT ANSWERSPrincipal Diagnosis Code 01 Discharge Status - CORRECT ANSWERSDischarge Home 03 Discharge Status - CORRECT ANSWERSDischarge to SNF 06 Discharge Status - CORRECT ANSWERSDischarge to Home Health 07 Discharge Status - CORRECT ANSWERSLeft Against Medical Advice 30 Discharge Status - CORRECT ANSWERSStill Patient 41 Discharge Status - CORRECT ANSWERSExpired in a medical facility Deductible - CORRECT ANSWERSPortion of a claim to be paid by the insured before the insurer makes any payment Co-insurance - CORRECT ANSWERSa percentage amount the insured shares of the covered costs Co-payment - CORRECT ANSWERSa flat amount the employee is responsible for paying at the time services are obtained Medical Necessity - CORRECT ANSWERSaccepted health care services and supplies provided by health care entities, appropriate to the evaluation and treatment of a disease, condition, illness or injury and consistent with the applicable standard of care 0300 Revenue Code - CORRECT ANSWERSLaboratory 0636 Revenue Code - CORRECT ANSWERSDrugs Requiring Detailed Coding EOB - CORRECT ANSWERSExplanation of Benefits HSA - CORRECT ANSWERSHealth Savings Account [Show Less]
- Exam
- $11.45
- 0
- 143
CRCR Exam Unit 1|33 Questions with Answers 2023,100% CORRECT
CRCR Exam Unit 1|33 Questions with Answers 2023 Net Days in AR - CORRECT ANSWERSMeasures how fast receivables are collected. It is a trending indicator ... [Show More] of overall A/R performance & revenue cycle efficiency. A/R Aging - CORRECT ANSWERSReports divide the AR into 30, 60, 90, and 120 day categories, based on discharge. Credit Balances - Days Outstanding - CORRECT ANSWERSThe dollars in credit balance at the account level divided by the three month daily average of total net patient service revenue. Credit balances should be resolved timely and should be benchmarked at <1% of the days outstanding in the AR. 3 Critical Elements of the Healthcare Revenue Cycle - CORRECT ANSWERSPre-Service, Time of Service, Post Service Provision of Care - CORRECT ANSWERSDescribing elective vs. non-elective services to the patient, and discussing prior balances the patient has (if applicable). Emergency Medical Treatment and Active Labor Act (EMTALA) - CORRECT ANSWERSSays that no patient financial discussions should occur before a patient is screened and stabilized. HFMA's Adopter Program - CORRECT ANSWERSProviders who implement and support the best practices of Patient Financial Communication are eligible and encouraged to apply for recommendation by HFMA as an Adopter of Patient Financial Communication Best Practices. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Initiative - CORRECT ANSWERSImplemented by CMS to provide a standardized method for evaluating patient's perspective on hospital care. 27 total questions on the survey. Key Question is "Would you recommend this hospital to your friends and family?" Continuum of Care - CORRECT ANSWERSInvolves healthcare providers in multiple settings and multiple levels coming together with the overall goal of coordinating patients' healthcare Transfer Agreements - CORRECT ANSWERSTo participate in the Medicare program, a SNF must have written transfer agreement with one or more participating hospitals providing for the transfer of patients between the hospital and the SNF, and for the interchange of medical and other information. Office of the Inspector General (OIG) - CORRECT ANSWERSDeveloped the Model Compliance Plan for clinical Laboratories in 1997, and the Compliance Program Guidance for Hospitals in 1998, followed by almost a dozen other guidance documents. Oversees medical billing compliance. Essential Elements in a Corporate Compliance Program - CORRECT ANSWERSHave a Plan Follow the Plan Review the Code of Conduct to verify you follow the plan Fraud Enforcement and Recovery Act (FERA) - CORRECT ANSWERSSigned into law in 2009, which amended the False Claims Act (FCA) in several important respects, including the closure of loopholes and enhancement of the ability of government whistleblowers, and reporting individuals to identify and successfully pursue entities and individuals who improperly receive government funds. The Healthcare Insurance and Portability Act (HIPPA) - CORRECT ANSWERSPassed in 1996, includes requirements that specifically address compliance include the following: Coordinating a fraud and abuse control program Establishing a fraud and abuse control account Increasing the civil money penalties Permitting the exclusion of individuals with ownership or control interest in a sanctioned entity. Also created National Provider Identifiers (NPI) were created to eliminate the myriad of other provider IDs previously used. The Health Information Technology for Electronic and Clinical Health (HITECH) - CORRECT ANSWERSPassed in 2009 to promote the adoption of meaningful use of health IT. Addressed the privacy and security concerns associated with the electronic transmission of health information. The rule became effective on March 26th and compliance was required as of 9.23.13. Medicare DRG Three-Day Payment Window - CORRECT ANSWERSAll diagnostic services provided to a Medicare beneficiary on the day of the patient's IP admission or during the 3 calendar days (or in the case of a non-IPPS hospital, 1) immediately following preceding the date of admission are required to be included on the bill for the inpatient stay, unless there is no Part A coverage. Advanced Beneficiary Notification Requirements (ABN) - CORRECT ANSWERSAs soon as a provider determines that Medicare will most likely not pay, it must advise the beneficiary that, in the provider's opinion, he/she will be personally responsible for the payment. This involves the timely and effective delivery of the approved CMS form to the individual beneficiary or to the beneficiary's authorized representative. Two Midnight Rule - CORRECT ANSWERSCreated in FY 2014 to address ambiguity surrounding who decides what services must be performed in an IP setting. Says CMS will generally consider hospital admissions spanning two midnights as appropriate for payment under IPPS. Hospital stays of < 2 midnights will generally be considered OP cases, regardless of clinical severity. Procedures defined as "IP-only" are exceptions to the rule and may be appropriately furnished on an IP basis regardless of the beneficiary's LOS, not do not constitute an all-inclusive list. Medicare Secondary Payer (MSP) - CORRECT ANSWERSFrom the beginning of the Medicare program, specific to traditional fee-for-service, certain payers have always been liable for payment of claims. In these cases, Medicare does not make a secondary payment. The amounts paid by the primary payers are considered payment in full. Typical MSPs are Worker's Comp, Veterans Administration, and Federal grant programs. Medicare Secondary Payer Situations - CORRECT ANSWERSWorking Aged (employer has <20 employees), Accident or other Liability, Disability, and ESRD patients (after the 30-month coordination period) Correct Coding Initiative (CCI) - CORRECT ANSWERSCreated to promote the use of correct coding methods on a national basis. Purpose is to ensure that the most comprehensive groups of codes, rather than component parts, are billed. Consists of edits that are implemented within providers' claim processing systems. Ethics Violations Examples - CORRECT ANSWERSFinancial Misconduct, Overcharging, Theft of Property, Falsifying records to boost reimbursement, Miscoding claims. Affordable Care Act (ACA) - CORRECT ANSWERSFederal legislation passed in 2010 designed to reform the healthcare system into one that rewards greater value, improves quality of care, and increases efficiency in delivery of services. Accountable Care Organizations (ACO) - CORRECT ANSWERSDelivery system of physicians, hospitals, and other healthcare providers, working collaboratively to manage and coordinate the care of a patient population. The point is to ensure appropriateness of care, elimination of duplicate services, and prevention of medical errors for a population of patients. Types of ACOs being tested - CORRECT ANSWERSMedicare Shared Saving Program, Pioneer ACO, Investment Model ACO, Comprehensive ESRD Model Income Statement - CORRECT ANSWERSTies directly to the Balance Sheet and is the summary of the organization's revenues and expenses and any excess or loss from operations. Balance Sheet - CORRECT ANSWERSA summary of the organization's wealth as of the date of the statement. It represents the summary of the organization's assets, liabilities, and accumulated excesses from operations less any accumulated losses. The net value of excesses and losses may be known as net assets. Cash Flow Statement - CORRECT ANSWERSSummary of how cash was used and where it was obtained. Accrual Accounting - CORRECT ANSWERSRevenue is recorded when it is earned to permit the alignment of revenue with the associated expenses. Healthcare providers usually use this method. Fund Accounting - CORRECT ANSWERSRecord-keeping method to manage categories of net assets to ensure compliance with the restrictions on those funds. Gross Revenue - CORRECT ANSWERSTotal of charges entered for all patients for the services they received Net Revenue - CORRECT ANSWERSThe difference between the amount billed and the amount that the payer(s) has committed to pay based on an agreement with the provider. Contra-Account Amounts - CORRECT ANSWERSAdjustments posted at the time of billing. this increases the accuracy of the receivable and minimizes the need to estimate contractual reserves. [Show Less]
- Exam
- $12.45
- 0
- 171
CRCR EXAM 80 Questions with Answers 2023,100% CORRECT
CRCR EXAM 80 Questions with Answers 2023 Which of the following statements are true of HFMA's Patient Financial Communications Best Practices? - CORRECT... [Show More] ANSWERSThe best practices were developed specifically to help patients understand the cost of services, their individual insurance benefits, and their responsibility for balances after insurance, if any. The patient experience includes all of the following except: - CORRECT ANSWERSRecognition that revenue cycle processes must be patient-centric and efficient. This is especially true in the areas of scheduling, registration, admitting, financial counseling and account resolution conversation with patients. Corporate compliance programs play an important role in protecting the integrity of operations and ensuring compliance with federal and state requirements. The code of conduct is: - CORRECT ANSWERSA critical tool to ensure compliance, essential and integral component, fosters an environment, (all of the above) Specific to Medicare free-for-service patients, which of the following payers have always been liable for payment? - CORRECT ANSWERSBlack lung service programs, veteran affairs program, working aged programs, ESRD, and disability Provider policies and procedures should be in place to reduce the risk of ethics violations. Examples include: - CORRECT ANSWERSfinancial misconduct, theft of property, applying policies in inconsistent manner (all of the above) What is the intended outcome of collaborations made through an ACO delivery system for a population of patients? - CORRECT ANSWERSTo eliminate duplicate services, prevent medical errors and ensure appropriateness of care What is the new terminology now employed in the calculation of net patient service revenues? - CORRECT ANSWERSexplicit price concessions and implicit price concessions What are the two KPIs used to monitor performance related to the production and submission of claims to third party payers and patients (self-pay)? - CORRECT ANSWERSElapsed days from discharge to final bill and elapsed days from final bill to claim/bill submission What happens during the post-service stage? - CORRECT ANSWERSFinal coding of all services, preparation and submission of claims, payment processing and balance billing and resolution. The following statements describe best practices established by the Medicaid Debt Task Force. Select true statements. - CORRECT ANSWERSeducate patients, coordinate to avoid duplicate patient contacts, be consistent in key aspects of account resolution, follow best practices for communication Which option is NOT a main HFMA Healthcare Dollars & Sense revenue cycle initiative? - CORRECT ANSWERSProcess Compliance What is the objective of the HCAHPS initiative? - CORRECT ANSWERSTo provide a standardized method for evaluating patient's perspective on hospital care Which option is NOT a department that supports and collaborates with the revenue cycle? - CORRECT ANSWERSAssisted Living Services Which option is NOT a continuum of care provider? - CORRECT ANSWERSHealth Plan Contracting Which of the following are essential elements of an effective compliance program? - CORRECT ANSWERSestablished compliance standards and procedures, oversight of personnel by high-level personnel, reasonable methods to achieve compliance with standards, including monitoring systems and hotlines Annually, the OIG publishes a work plan of compliance issues and objects that will be focused on the throughout the following year. Identify which option is NOT a work plan task mentioned in this course. - CORRECT ANSWERSStandard Unique Employer Identifier In order to promote the use of correct coding methods on a national basis and prevent payment errors due to improper coding, CMS developed what? - CORRECT ANSWERSThe Correct Coding Initiative(CCI) What do business/organizational ethics represent? - CORRECT ANSWERSPrinciples and standards by which organizations operate What is the intended outcome of collaborations made through an ACO delivery system? - CORRECT ANSWERSTo ensure appropriateness of care, elimination of duplicate services, and prevention of medical errors for a population of patients Which of these statements describes the new methodology for the determinations of net patient service revenue? - CORRECT ANSWERSNet patient service revenue is defined a the total incurred charges, less the explicit price concession, less any applicable implicit price concession(s) as applied to the specific portfolio of accounts. What are KPIs? - CORRECT ANSWERSKey Performance Indicators, which set standards for accounts receivable (A/R) and provide a method of measuring the collection and control of A/R Which patient types are typically considered acute care patient types? - CORRECT ANSWERSObservation, newborn, Emergency(ED) Accurate identification of the patient is the first step in the scheduling process. Identifiers used in various combination to achieve accurate patient identification include: - CORRECT ANSWERSFull legal name, date of birth, sex and social security number Pre-registration is defined as: - CORRECT ANSWERSThe collection of demographic information, insurance data, financial information, providing reminders, prep information, and identifying the potential need for financial assistance for scheduled patients. Which of the following statements accurately describe the various Medicare benefit programs: - CORRECT ANSWERSMedicare part A provides benefits for inpatient hospital services, skilled nursing care and home health care; Medicare Part B covers outpatient and professional services; Medicare Part C or Medicare Advantage plans are managed care plans combining Part A and Part B coverages; and Medicare Part D is the prescription drug coverage benefit. Which of the following statements about Medicaid eligibility is not true? - CORRECT ANSWERSMedicaid categories are restricted to children, pregnant women, and elderly in nursing homes Examples of managed care plans include: - CORRECT ANSWERSHMO, PPO, EPO, POS, Concierge plans, Medicare Advantage plans, Direct contracting for specific services from specific providers (all of the above) Patient Financial Communications best practices include all of the following activities except: - CORRECT ANSWERSCollecting payment or initiating the process to immediately remove the patient from the service schedule. Which statement includes the required components of an accurate pricing determination: - CORRECT ANSWERSInsurance coverages and benefits, service or test involved, diagnosis and procedure codes, total estimated charges, adjudication calculations based on the patient's benefit package. The value of a robust scheduling and pre-registration process includes all of the following except: - CORRECT ANSWERSIdentification of patients who are likely to be "no shows". Which patients are considered scheduled? - CORRECT ANSWERSRecurring/Series Patients Name the guideline that Medicare established to determine which diagnoses, signs, or symptoms are payable. - CORRECT ANSWERSLocal Coverage Determination What is the purpose of insurance verification? - CORRECT ANSWERSTo ensure accuracy of the health plan information. Which option is federally-aided, state-operated program to provide health and long-term care coverage? - CORRECT ANSWERSMedicaid Which option is NOT a specific managed care requirement? - CORRECT ANSWERSPreferred Provider Organization What is the first component of a pricing determination? - CORRECT ANSWERSVerification of the patient's insurance eligibility and benefits. What is the purpose of financial counseling? - CORRECT ANSWERSTo educate the patient on his/her health plan coverage and financial responsibility for healthcare services EMTALA prohibits inquiries about health plan or liability payer information if the inquiry will delay examination or treatment. What other requirements apply to the Emergency Department registration work? - CORRECT ANSWERSPatients are initially triaged by medical personnel... , identification and verification of insurance eligibility... , No additional registration may occur (all of the above) Typical activities which must be performed when an unscheduled patient arrives for service include: - CORRECT ANSWERSIdentification of patient in the MPI or initiation of a new MPI record, insurance verification of eligibility and benefits, managed care screening, medical necessity screening, price estimations and financial counseling to achieve the appropriate account resolution Case managers are involved from admission with the discharge planning process. The purpose of discharge planning is: - CORRECT ANSWERSTo estimate how long the patient will be in the hospital, identify the expected outcome of the hospitalization and initiate any special requirements for services at or after the time of discharge The chargemaster is basically a list of services, procedures, room accommodations, supplies, drugs, tests, etc, typically associated with the billing for services rendered to patients. Challenges typically associated with the chargemaster include: - CORRECT ANSWERSOmission of charges, obsolete or invalid codes, and the omission of required modifiers Ultimately, the services provided in the healthcare system are reduced to standard codes. The primary types of coding systems currently used in healthcare are: - CORRECT ANSWERSICD-10-CM/ICD-10-PCS;CPT/HCPCS codes There are four code sets that provide health plans with additional information as they process claims. Those code sets are: - CORRECT ANSWERSCondition codes, occurrence codes, occurrence span codes and value codes Each type of service has unique billing rules which come into play during the provision of service. For the skilled nursing facility, care is covered if which of the following factors are present? - CORRECT ANSWERSThe patient required skilled services on a daily basis and those services can only be provided on an inpatient basis in a SNF. DRG's are a system of classifying inpatients on the basis of diagnoses, procedures, and co-monitoring for purposes of payment to hospitals. Each DRG includes: - CORRECT ANSWERSA relative weight which is multiplied by the established base payment rate to calculate the reimbursement for a specific DRG. For exceptionally costly cases over a set dollar amount, an outlier payment is added to the calculated payment PPO networks represent one form o discounting commonly used by commercial payers. The silent PPO represents: - CORRECT ANSWERSA discounting scheme whereby health plans apply generic PPO rates to discount a provider's claims, even though there is no contractual arrangement between the silent PPO and the provider. The concept of timely filing of the claims is important to providers, payers and patients. Thus, providers are required to comply with timely claim filing rules. Which of the following statements are not true about timely filing limitations: - CORRECT ANSWERSPayers will waive timely filing denials for claims filed over a year from date of service What does EMTALA require hospitals to do? - CORRECT ANSWERSTo provide a medical screening examination and stabilizing treatment to every person presenting at an ED and requesting medical evaluation or treatment In what manner do case managers assist revenue cycle staff? - CORRECT ANSWERSProviding assistance with written appeals to health plans related to utilization and other care issues. Why is it critical that a chargemaster is reviewed and updated regularly? - CORRECT ANSWERSTo ensure it supports and represents the services provided within the organization What are claim edits? - CORRECT ANSWERSRules developed to verify the accuracy and completeness of claims based on each health plan's policies Which statement is NOT a unique billing rule specific to providers? - CORRECT ANSWERSA patient may be balance billed for whatever amount the non-contracting physician charges above the health plan's reimbursement amount. Which of the following statements does not apply to billing during the COVID-19 public health emergency? - CORRECT ANSWERSTelemedicine claims are not payable if the patient conducts the telemedicine visit from home Which concept is NOT a contracted payment model? - CORRECT ANSWERSStop-Loss Provision Credit balances may be created by any of the following activities except: - CORRECT ANSWERSCredits to pharmacy charges posted before the claim final bills. Which of the following statements represent common reasons for inpatient claim denials: - CORRECT ANSWERSFailure to obtain a required pre-authorization; failure to complete a continued stay authorization and service provided which were not medically necessary. A 68 year old patient, a Medicare beneficiary, was in a car accident. A medical insurance claim was filed with the auto insurance carrier. Six months later this claim remains unpaid. How can the provider pursue payment from Medicare? - CORRECT ANSWERSThe provider must first bill the auto insurer; However, after a period of 120 days, if the claim remains unpaid, the provider may cancel the liability claim and bill Medicare The difference between bad debt and financial assistance (charity) is: - CORRECT ANSWERSBad debt represents a refusal to pay, charity represents an inability to pay. In order to qualify for financial assistance, a patient or guarantor should: - CORRECT ANSWERSProvide the following documents: prior year tax return, employment check stubs from the prior three months and bank statements from the prior three months To comply with the requirements of Section 501(r) for tax-exempt hospitals chartered as 510(c)3 providers, the hospital must complete which of the following activities: - CORRECT ANSWERSA community needs assessment The three types of bankruptcy as defined in the 1979 Bankruptcy Act are: - CORRECT ANSWERSChapter 7- Straight Bankruptcy, Chapter 11- Debtor Reorganization and Chapter 13- Debtor Rehabilitation Which of the following medical debt collection practices are recommended as part of HFMA's Best Practices for medical account resolution: - CORRECT ANSWERSEstablish policies and ensure that they are followed Organizations may opt to contract with or outsource to specific vendors for some or all components of revenue cycle processing. This practice has both advantages and disadvantages. Which of the following statements is not an advantage of utilizing an outsourcing vendor? - CORRECT ANSWERSThe need for legal review if the outside vendor's staff represents themselves as employees of the healthcare facility Each hospital covered by the 501(r) regulations is required to develop a financial assistance policy. Which of the following elements is not a required element of the policy? - CORRECT ANSWERSThe notice that individuals eligible for financial assistance under this policy may be charged more than the amount generally billed (AGB) to insured patients Sue Smith came into the hospital. Her insurance provider sent an EFT directly into the hospital's account at the bank. John, the hospital representatives, receives an electronic Level 2 ERA. What should he do next? - CORRECT ANSWERSManually match the ERA in the patient account What is EFT - CORRECT ANSWERSThe electronic transfer of funds from payer to payee through the banking system Which statement is false regarding credit balances? - CORRECT ANSWERSThere are no CMS hospital compliance requirements regarding credit balances Which option is NOT a type of denial? - CORRECT ANSWERSContractual Adjustment Which option is NOT a lien type? - CORRECT ANSWERSSubrogation Based on what you have just read, which activity is not considered when initiating self-pay follow-up and account resolution activities? - CORRECT ANSWERSPatient Open Balance Billing Which option is NOT a required component of a FAP? - CORRECT ANSWERSOut-of-network providers Which option is NOT a bankruptcy type governed by th 1979 Bankruptcy Act? - CORRECT ANSWERSCreditor priority Agency fees are: - CORRECT ANSWERSThe cost to the provider for collection agency monies offset by the return on baddebt accounts The correct way to handle the retention and payment of agency fee is: - CORRECT ANSWERSFollow the contractual agreement between the agency and the provider as to how monies sent to the agency will be handled Patient relations include: - CORRECT ANSWERSThe ability to sensitively deal with patients or individuals while managing collection efficiency Collection agency reports should be provided: - CORRECT ANSWERSIn at least two formats regarding accounts assigned on a routine basis Collection results are: - CORRECT ANSWERSAccurately calculated to demonstrate the actual recovery percentage rate Which option is NOT a HFMA best practice? - CORRECT ANSWERSCoordinate the resolution of bad debt accounts with a law firm Which function within the revenue cycle is NOT a good candidate for outsourcing? - CORRECT ANSWERSHealth Care Patient Services What are the steps that the hospital needs to take to establish and ensure a successful vendor relationship? - CORRECT ANSWERSDistributes a RFP to solicit vendor capabilities, evaluate vendor's expertise to provide outsourcing services, visit vendor locations, perform vendor reference checks, talk with vendor clients, interview vendor employees to assess experience level [Show Less]
- Exam
- $11.45
- 0
- 281
CRCR Practice 141 Questions with Answers 2023,100% CORRECT
CRCR Practice 141 Questions with Answers 2023 The 501(r) regulations require not-for-profit providers 501(c) (3) to do which of the following activities... [Show More] ? A. Complete a community needs assessment and develop a discount program for patient balances after insurance payment. B. Pursue extraordinary collection activities with all patients eligible for financial assistance. C. Implement a financial assistance program for uninsured and underinsured patients. D. Discount all charges to self-pay patients to an amount generally billed to all other patients. - CORRECT ANSWERSA. Complete a community needs assessment and develop a discount program for patient balances after insurance payment The accurate capture of charges remains critically important because: A. Of the potential of fraud and abuse charges from erroneous billing. B. Charges remain one of the few consistent indicators available to monitor resource use. C. Charges are means of measuring physician productivity. D. Charges provide the data used in activity based costing. - CORRECT ANSWERSB. Charges remain one of the few consistent indicators available to monitor resource use The ACO investment model will test the use of pre-paid shared savings to: A. Invest in treatment protocols that reduce costs to Medicare B. Attract physicians to participate in the ACO payment system. C. Raise quality ratings in designated hospitals. D. Encourage new ACOs to form in rural and underserved areas. - CORRECT ANSWERSD. Encourage new ACOs to form in rural and underserved areas Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite discharge, the HFMA best practice is to: A. Have a patient financial responsibilities kit ready for the patient, containing all of the required registration forms and instructions. B. Make sure that the attending staff can answer questions and assist in obtaining required patient financial data. C. Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow. D. Decline such request as finance discussions can disrupt patient care and patient flow. - CORRECT ANSWERSC. Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow Activities completed when the scheduled, pre-registered patient arrives for service includes: A. Verifying insurance, activating the record and directing the patient to the service area. B. Scanning the driver's license or other phot identification and directing the patient to the financial counselor. C. Activating the record, obtaining signatures and finalizing financial issues. D. Registering the patient and directing the patient to the service area. - CORRECT ANSWERSC. Activating the record, obtaining signatures and The activity which results in the accurate recording of patient bed and level of care assessment, patient transfer and patient discharge status on a real-time basis is known as: A. Utilization review B. Case Management C. Census Management D. Patient through-put - CORRECT ANSWERSA. Utilization review or B. Case Management An advantage of a pre-registration program is: A. The markets value of such a program B. The ability to eliminate no-show appointments. C. The opportunity to reduce processing times at the time of service. D. The opportunity to reduce corporate compliance failures within the registration process. - CORRECT ANSWERSC. The opportunity to reduce processing times at the time of service. The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can: A. Obtain price estimates for medical services B. Negotiate the price of medical services with providers C. Purchase qualified health benefit plans regardless of insured's health status D. Meet federal mandates for insurance coverage and obtain the corresponding tax deduction - CORRECT ANSWERSC. Purchase qualified health benefit plans regardless of insured's health status. All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT: A. Offered in an outpatient setting B. Medically unnecessary C. Not delivered in a Medicare licensed care setting. D. Services and procedures that are custodial in nature - CORRECT ANSWERSC. Not delivered in a Medicare licensed care setting All of the following are reference resources used to help guide in the application for business ethics EXCEPT: A. Consumer satisfaction reports B. Mission & Value Statements C. Code of Ethics / Code of Conduct D. Compliance Office & Policies - CORRECT ANSWERSA. Consumer satisfaction reports All of the following are steps in safeguarding collections EXCEPT: A. Placing collections in a lock-box for posting review the next business day. B. Posting the payment to the patient's account C. Completing balancing activities D. Issuing receipts - CORRECT ANSWERSA. Placing collections in a lock-box for posting review the next business day All of the following are steps in verifying insurance EXCEPT: A. Sequencing plans involved in a coordination of benefits (COB) situation. B. The patient signing the statement of financial responsibility. C. Identifying and documenting the patient's health plan benefits D. Confirming the patient's eligibility for benefits - CORRECT ANSWERSB. The patient signing the statement of financial responsibility All of the following information is used to identify a patient EXCEPT: A. Date of Birth B. Gender C. Social Security Number D. Address - CORRECT ANSWERSD. Address All of the following information should be reviewed as part of schedule finalization EXCEPT: A. The estimated patient financial obligations B. The service to be provided C. The arrival time and procedure time D. The patient's preparation instructions - CORRECT ANSWERSA. The estimated patient financial obligations Ambulance services are billed directly to the health plan for : A. All pre-admission emergency transports B. Transport deemed medically necessary by the attending paramedic-ambulance crew C. Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility D. The portion of the bill outside of the patient's self-pay - CORRECT ANSWERSC. Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or the another facility Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons on a monthly fee is known as a: A. HMO B. PPO C. MSO D. GPO - CORRECT ANSWERSA. HMO Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with: A. The Provider Reimbursement Review Board B. The Department of Health and Human Services Provider Relations Division C. A court appointed federal mediator D. The Office of the Inspector General - CORRECT ANSWERSA. The Provider Reimbursement Review Board Applying the contracted payment methodology to the total charges yields: A. An estimated price B. An anticipated health plan payment C. A price justified revenue accrual D. A pricing agreement - CORRECT ANSWERSA. An estimated price Appropriate training for the patient financial counselling staff must cover all of the following EXCEPT: A. Patient financial communications best practices specific to staff role B. Financial assistance policies C. Documenting the conversation in the medical record D. Available patient financing options - CORRECT ANSWERSC. Documenting the conversation in the medical record The basis for qualification in Medicaid is typically: A. The Federal Poverty Guidelines B. Financial need as demonstrated by the prior two-years federal income tax fillings C. The patient's score on the Internal Revenue Service's Personal Wealth and Spending indicator D. Bank statements for the previous 18 months - CORRECT ANSWERSA. The Federal Poverty Guidelines Because 501(r) regulations focus on identifying potentially eligible financial assistance patients, hospitals must: A. Capture their experience with such patients to properly budget B. Hold financial conversations with patients as soon as possible C. Build the necessary processes to handle the potentially lengthy payment schedules D. Expedite payment processing of normal accounts receivables to protect cash flow - CORRECT ANSWERSB. Hold financial conversations with patients as soon as possible Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implementation, identifying and processing accounts and: A. Obtain the patients income tax statements from the prior 2 years B. Having the account triaged for any partial payment possibilities C. Monitor compliance D. Assist in arranging for a commercial bank loan - CORRECT ANSWERSC. Monitor compliance The benefit of a Medicare Advantage Plan is: A. It is a less costly plan compared to traditional Medicare B. Patients may retain a primary care physician and see another physician for a second opinion at no charge C. Patients generally have their entire Medicare-covered healthcare through the plan and do not need to worry about "Part A" or "Part B' benefits D. Patients receive significant discounting on services contracted by the federal government - CORRECT ANSWERSC. Patients generally have their entire Medicare-covered healthcare through the plan and do not need to worry about "Part A" or "Part B" benefits A benefit period begins: A. With admission as an inpatient B. Upon the day the coverage premium is paid C. The first day in which a patient is furnished extended care services in the period the patient is entitled to hospital insurance D. Immediately once authorization for treatment is provided by the health plan - CORRECT ANSWERSC. The first day in which a patient is furnished extended care services in the period the patient is entitled to hospital insurance The best practice in billing is to generate bills and financial information that is: A. Timely and specifies the patient's next steps B. Clear, concise, correct and patient-friendly C. Comprehensive and all-inclusive D. Direct in summarizing charges and in requesting prompt payment - CORRECT ANSWERSB. Clear, concise, correct and patient-friendly Case management requires that a case manager be assigned: A. To a select group of resource intensive patient cases B. To every patient C. To specific cases designated by third-party contractual agreement D. To patients of any physician requesting case management - CORRECT ANSWERSB. To every patient Claims edits are: A. Rules developed to verify the accuracy of claims based on each health plan's policies B. The specific reimbursement areas of a claim that are denied by the health plan C. Special addendums to the claim allowing the provider to submit additional documentation D. Triggers in the health plan claim adjudication system that disallows reimbursement - CORRECT ANSWERSA. Rules developed to verify the accuracy of claims based on each health plan's policies Claims with dates of service received later than one year beyond the date of service, will be: A. Denied by Medicare B. The full responsibility of the patient C. The provider's responsibility but can be deemed charity care D. Fully paid with interest - CORRECT ANSWERSA. Denied by Medicare A "Compliance Program" is defined as: A. Educating staff on regulations B. The development of operational policies that correspond to regulations C. Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met D. Annual legal audit and review for adherence to regulations - CORRECT ANSWERSC. Systematic procedures to ensure that provisions of regulations imposed by government agency are being met The concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits: A. Billing B. Account resolution C. Claims Processing D. Third-party invoicing - CORRECT ANSWERSC. Claims processing Concurrent review and discharge planning: A. Occurs during service B. Is performed by the health plan during the time of service C. Is a significant part of quality and is performed by the clinical treatment team D. Is performed at discharge with the patient - CORRECT ANSWERSC. Is a significant part of quality and is preformed by the clinical treatment team A decision of whether a patient should be admitted as an inpatient or become an outpatient observation patient requires medical judgments based on all of the following EXCEPT: A. The patient's medical history B. The safe-guarding against medical error C. Current medical needs D. The Medical predictability of something adverse happening - CORRECT ANSWERSB. The safe-guarding against medical error The disadvantages of outsourcing include all the following EXCEPT: A. Increased costs due to vendor ineffectiveness B. Possible staff job cuts due to vendor efficiencies C. The impact of customer service or patient relations D. The impact of direct control of accounts receivable - CORRECT ANSWERSB. Possible staff job cuts due to vendor efficiencies During the pre-registration, a search for the patient's MPI is initiated using which of the following data sets? A. Patient's full legal name and address B. Patient's full legal name and health plan group numbers C. Patient's full legal name and date of birth or the patient's Social security number D. Patient's Social Security number and home address - CORRECT ANSWERSC. Patient's full legal name and date of birth or the patient's Social Security number Each time a patient is transferred: A. Any additional charges must be explained to the patient B. The attending physician must sign-off on the transfer request C. The patient must give consent D. A transfer request must be made to staff responsible for bed assignments - CORRECT ANSWERSD. A transfer request must be made to staff responsible for bed assignments The enhanced data-mining opportunities that results from the more detailed coding under ICD-10 allow senior leadership to work with physicians to do all of the following EXCEPT: A. Improve outcomes B. Obtain higher compensation for physicians C. Embrace new reimbursement models D. Drive significant improvements in areas of quality and the patient experience - CORRECT ANSWERSB. Obtain higher compensation for physicians Failure to take the appropriate precautions with a bankruptcy account, to identify and isolate the debtor's accounts from further collection activity: A. Provides evidence of unauthorized extraordinary collections activity B. Could be in violation of a court's order C. May violate the provisions of the patient protection regulations D. Could potentially create under "write-offs" - CORRECT ANSWERSB. Could be in violation of a court's order The first thing a health plan does when processing a claim is: A. Review to make sure the claim is complete B. Verify if the provider(s) is(are) in network or not C. Check if the patient is covered D. Confirm if deductibles and con-insurance requirements have been met - CORRECT ANSWERSC. Check if the patient is covered For Medicare patients, an important component of the pre-registration process is: A. Obtaining clear physician's orders B. Verifying Medicare eligibility C. Clear authorization for all services covered in Part A D. The effective completion of the Medicare Secondary Payer (MSP) screening process - CORRECT ANSWERSD. The effective completion of the Medicare Secondary Payer (MSP) screening process For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: A. May take place between the patient and discharge planning B. Should take place between the patient or guarantor and properly trained provider representatives C. Are optional D. Are focused on verifying required third-party information - CORRECT ANSWERSB. Should take place between the patient or guarantor and properly trained provider representatives For scheduled patients, important revenue cycle activities in the time-of-service stage DO NOT include: A. Pre-registration record is activated, consents are signed, and co-payments are collected B. Positive patient identification is completed, and the patient is given an armband C. Obtaining or updating patient and guarantor information D. Pre-processed patients report to a designated "express arrival" desk - CORRECT ANSWERSC. Obtaining or updating patient and guarantor information A four digit number code established by the National Uniform Billing (NUBC) that categorizes/classifies a line item in the chargemaster is known as: A. HCPCs codes B. ICD-10 Procedural codes C. CPT codes D. Revenue codes - CORRECT ANSWERSD. Revenue codes The fundamental approach in managing denials is: A. To create billing "double-check" processes B. To analyze the type and sources of denials and consider process changes to eliminate further denials C. To standardize and centralize all billing activity to focus on compliance with contractual agreements D. to review all claims processing for compliance with contractual agreements - CORRECT ANSWERSB. To analyze the type and sources of denials and consider process changes to eliminate further denials The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statues and regulations pertaining to: A. Patient financial obligations for the entire cost of treatment B. Unregulated market activity for third-party payers C. Medicare and Medicaid payments D. Commercial third-party payers - CORRECT ANSWERSC. Medicare and Medicaid payments Health Information Management (HIM) is responsible for: A. All patient medical records B. The maintenance of all software applications C. The maintenance of the entire technology infrastructure D. Clean claims being filed - CORRECT ANSWERSA. All patient medical records Health Plan Contracting Departments do all the following EXCEPT: A. Reimbursement rate setting B. Review all managed care contracts for accuracy and load contract terms into the patient accounting system C. Review payment schemes to ensure that the health plan and provider understand how reimbursements must be calculated D. Review contracts to ensure the appeals process for denied claims is clearly specified - CORRECT ANSWERSA. Reimbursement rate setting HFMA best practices call for patient financial discussions to be reinforced: A. By obtaining some type of collateral B. With a written statement of the conversation C. By issuing a new invoice to the patient D. Ny copying the provider's attorney on a written statement of the conversation - CORRECT ANSWERSB. With a written statement of the conversation HFMA best practice specify that, In an Emergency Department setting: A. Financial conversations are inappropriate B. Financial conversations be brief and focused on obtaining third-party payer information C. Financial conversations be focused on obtaining basic demographic data needed to create the patient account D. No patient financial discussions should occur before a patient is screened and stabilized - CORRECT ANSWERSD. No patient financial discussions should occur before a patient is screened and stabilized HFMA best practices stipulate that a reasonable attempt should be made to have the financial responsibilities discussion: A. As early as possible, before a financial obligation is Incurred B. During the registration process C> Before scheduling of services D. No later than the evening of the day of admission - CORRECT ANSWERSA. As early as possible, before a financial obligation is incurred HFMA patient financial communications best practices call for annual training for all staff EXCEPT: A. Staff who engage in patient financial communications discussions B. Patient access C. Nursing D. Customer service representatives - CORRECT ANSWERSC. Nursing HIPPA contains all of the following goals EXCEPT: A. To expand health coverage by improving the portability and continuity of health insurance coverage in group and individual markets B. To ensure proper coding across the continuum of care C. To give patients access to their health files and the right to request amendments or make corrections D. To facilitate the electronic exchange of medical information with respect to financial and administrative transactions carried out by health plans, healthcare clearing houses, and healthcare providers - CORRECT ANSWERSB. To ensure proper coding across the continuum of care HIPAA has adopted Employer Identification Numbers (EINs) to be used in standard transactions to identify the employer of an individual described transaction. EINs are created and assigned by: A. The Social Security Administration B. The United States Department of the Treasury C. The United States Department of Labor D. The Internal Revenue Service - CORRECT ANSWERSD. The Internal Revenue Service HIPAA privacy rules require covered entitles to take all of the following actions EXCEPT: A. Develop written policies and procedures including a description of staff who have access to protected information B. Define protected health information and access thereto by individuals, health plans, and business associates C. Ensure that a privacy officer is hired/designated D. Use only designated software platforms to secure patient data - CORRECT ANSWERSD. Use only designated software platforms to secure patient data Hospitals can only convert an inpatient case to observation if the hospital utilization review committee determines this status before the patient is discharged and: A. With the consent of the third-party payer's medical director that and observation setting will be more appropriate B. After any billing C. Before closing the patient's account D. Prior to billing, that an observation setting will be more appropriate - CORRECT ANSWERSD. Prior to billing, that an observation setting will be more appropriate ......... [Show Less]
- Exam
- $114.45
- 0
- 150
CRCR Cohort 6| 72 Questions with Answers 2023,100% CORRECT
CRCR Cohort 6| 72 Questions with Answers 2023 EMTALA - CORRECT ANSWERS- Emergency Medical Treatment and Labor Act - requires hospitals to provide a... [Show More] medical screening examination and any needed stabilizing treatment to every person presenting at an ED and requesting medical evaluation or treatment - EMTALA prohibits inquiries about insurance or payment if the inquiry will delay examination or treatment MRN - CORRECT ANSWERSMedical Record Number. Will have 1 MRN wherever they go in the facility (Cerner) EDI - CORRECT ANSWERSElectronic Data Interchange is the technology used for translating, standardizing, and sending transactions electronically The outbound inquiry from the provider to the payer Transaction includes the identification number and the date of birth of the insured party UB-04 - CORRECT ANSWERSHospital claims submitted via UB-04 Electronic version is the 837i CMS 1500 - CORRECT ANSWERSStandard professional services claim form. Electronic version is the 837p Clean Claim - CORRECT ANSWERSa clean claim is defined as a claim that is sent to a payer either electronically or on paper that has no defect, impropriety, or particular circumstance requiring special treatment that prevents prompt payment HCPCS (hic pics) - CORRECT ANSWERSHealthcare Common Procedure Coding System Created to provide standardized coding system for describing specific items and services provided in the delivery of healthcare Procedure used to fix diagnoses. Outpatient procedures Created to make up for what was lacking in the CPT codes - drugs, supplies, etc. Claim Edits - CORRECT ANSWERSClaim Edits are rules developed to verify the accuracy and completeness of claims based on each payer's policies Claim editing lets providers identify and resolve claim issues to ensure clean claim submission to the payer Result is prompt payment, reduced AR outstanding, and increased cash flow Managed Care Plans - CORRECT ANSWERSComprehensive healthcare plans that attempt to reduce costs through contractural agreements with providers and through care management initiatives Common billing rules for managed care plans include coordination of all care by the primary care physician and obtaining the appropriate authorization and referrals Authorization and referral numbers must be included when submitting claims. Ex - PPO, HMO, EPO, POS Medicare Part A - CORRECT ANSWERSbenefits provide coverage for inpatient hospital services, skilled nursing care and home healthcare. Hospital Care Medicare Part B - CORRECT ANSWERSBenefits are available for outpatient and professional service coverage, but the beneficiary must pay a monthly premium for the additional coverage. Pays for physician visits, non-hospital services, X-rays, lab tests, PT, emergency room visits, etc. HICN - CORRECT ANSWERSHealth Insurance Claim Number APCs - CORRECT ANSWERSAmbulatory Payment Classifications Government's method of paying for facility outpatient services for Medicare. APC payments are made to hospitals when the medicare outpatient is discharged from the ED or clinic, or is transferred to another hospital that is not affiliated with the initial hospital where the patient received outpatient services. ABN - CORRECT ANSWERSAdvanced Beneficiary Notice. Mechanism used by providers to explain to Medicare beneficiaries that the ordered test or services probably will not be covered by the Medicare program because the diagnosis info provided by the physician does not support the need for these services. By providing the notice in advance the Medicare beneficiary is given the cost of the test and the option to refuse or pay for the service. Allows the beneficiary to make informed decisions about whether or not to receive the items or services which he/she may pay out of pocket. Medicare Part C - CORRECT ANSWERSMedicare Advantage. managed care that must cover services in Part A and B and usually covers prescription drugs. Additional premiums and cost-sharing obligations will vary by plan. Provdides private managed care or preferred provider plans to Medicare beneficiaries Medicare Part D - CORRECT ANSWERSPays for prescription drugs. Extra premium Critical Access Hospitals - CORRECT ANSWERSPurpose is to keep small rural hospitals open by providing higher payments. hospitals with 25 or fewer beds located at least 35 miles from another facility that offers 24 hour hospital services CPT Code - CORRECT ANSWERSCurrent Procedural Terminology Codes. Codes created by AMA to create a uniform system for cataloging medical, surgical, and diagnostic services. Provides a single code for each physician visit and the other procedures. There are 6 sections of codes: (1) evaluation and management (E&M) codes covering office visits, emergency room visit, preventative (2) anesthesia codes (3) surgical codes (4)radiology codes (5) pathology (6) medicine codes RVU - CORRECT ANSWERSRelative Value Unit Common metric to compare the human and other resources needed to provide physician services. RVU system gives each CPT code a "value" that is supposed to reflect the amount of resources needed to deliver the service Made up of physician's work, practice expenses, and malpractice insurance. Each of the 3 RVU components is multiplied by a factor known as the Geographic Practice Cost Fee for service - CORRECT ANSWERSCharge by the unit of service ex - charge or x-ray, cast, etc. Main problem - providers induce demand = non-essential care Package pricing or "bundled charges" - CORRECT ANSWERSnumber of related services in one price; reduces provider-induced demand becayse fees are inclusive of all inclusive of all bundled services. There is evidence that prosepectively set bundled fees reduced health care spending without compromising quality of care, bundled payments for Care Improvement (BCPI) initiative HMO - CORRECT ANSWERSHealth Management Organization HMO salaries its own providers Capitation (set amount of money) APC (reimbursement methodology) - CORRECT ANSWERSAmbulatory Payment Classification System Very similar to DRG, takes all of CPT and groups them together, and reimburse that APC. Similar to DRG, but outpatient APG (reimbursement methodology) - CORRECT ANSWERSAmbulatory Patient Group Medicaid version of grouping and reimbursement Revenue Codes - CORRECT ANSWERSDescriptions hospital service provided, tells an insurance company whether the procedure was performed in the emergency room, operating room, or another department Ex: 250 = pharmacy, 300 = lab, 360 = operating room DRG (reimbursement methodology) - CORRECT ANSWERSDiagnosis Related Group ICD-10 - CORRECT ANSWERSInternational Classification of Diseases version 10 Diagnoses Ex - primary hypertension = 100 E&M Codes - CORRECT ANSWERSEvaluation and Management Codes Doctors use various codes (1 to 5 to describe the amount of work covered in an appointment) HIM - CORRECT ANSWERSHealth Information Management Distribute/release of medical records, analyze information, coding - look at DRG and use that DRG or develop their own coding for patient stays to ensure reimbursement CMS - CORRECT ANSWERSCenters for Medicare and Medicaid US Federal agency that administers Medicare rules and payment. Also establishes the guidelines by which individual states administer Medicaid and children's Health Insurance Program (CHIP) HIPAA - CORRECT ANSWERSHealth Insurance Portability and Accountability Act created a set of uniform standards a nd had several main objectives; here are just a few: - to improve portability and continuity of health coverage when emoployees change jobs - ti combat waste, fraud and abuse in health insurance - to simplify the administration of health insurance - to protect the privacy and security of health information ARRA - CORRECT ANSWERSAmerican Reinvestment and Recovery Act Established, among other things, interim breach notification requirements and additional responsibilities for business associates to comply with the Security Rule and portions of the Privacy Rule or face penalties MSPQ - CORRECT ANSWERSMedicare Secondary Payer Questionnaire PPO - CORRECT ANSWERSPreferred provider organization Providers paid on FFS fee schdule MACRA - CORRECT ANSWERSMedical and CHIP Reauthorization Act PCS - CORRECT ANSWERSProceduraal Coding System Exact same as CPT for inpatient Ambulatory Surgery Center - CORRECT ANSWERSAmbulatory < 24 hours Freestanding (not affiliated with hospital) - flat reimbursement per procedure - billing form 1500 Affiliated with a hospital - reimbursement like hospital - billing for 1500 and UB-04 ACO - CORRECT ANSWERSAccountable Care Organization Formal alliance of people coming together for a common purpose. Created under the ACA, its purpose is to foster change in patient care so as to accelerate progress towards a three part aim: better care for individuals, better health for populations, and slower growth costs through improvements in care. HFMA - CORRECT ANSWERSHealthcare Financial Management Association Leading membership organization for health care financial management executives and leaders. Respected thought leader on top trends and issues facing the health care industry. DNFB - CORRECT ANSWERSDischarge Not Final Bill Finished service, but have not sent claim out Charity - CORRECT ANSWERSInability to pay and does not qualify for Medicaid assistance. Often based on a sliding scale discount amount up to a 100% discount based on the patient's financial status. Each provider determines the amount of the discounted or free care Bad Debt - CORRECT ANSWERSUnwillingness to pay the entire account or the balance of an account not paid by insurances ESRD - CORRECT ANSWERSEnd-Stage Renal Disease - A/R Days - CORRECT ANSWERSDays of Revenue in Receivables Measures how fast receivables are collected (Net Patients AR over period of months)/[(Net patient services Revenue)/(365)] MAR - CORRECT ANSWERSMeds Administration Record Used to track when IV, etc. starts and stop for reimbursement with CMS DME - CORRECT ANSWERSDurable Medical Equipment Medical equipment that is prescribed by a doctor for use in the home. Ex - walkers, wheelchair, hospital bed, respiratory supplies, CPAP Accounts Receivable (AR) - CORRECT ANSWERSrepresents money owed by third-party payers and patients to the provider for health care services ATB - CORRECT ANSWERSAged Trial Balance standard report that shows accounts receivable totals by financial class and aging (typically 30 day) from the moment the claim was submitted to the payer. Good indicator of how fast the organization is liquidating its assets Bad Debt Agency - CORRECT ANSWERSthird-party that focues on working self-pay claims including patient balances remaining after insurance has paid. Case Management (CM) - CORRECT ANSWERSmethod of managing the provision of health care with the goal of improving continuity and quality of care while lowering cost. Areas include: Bed management, case management, social work, discharge and utilization review CMI - CORRECT ANSWERSCase Mix Index The average DRG weight for all a hospital's Medicare volume. Financial department monitors case-mix index, and in an ideal world, hospital's CMI would be high as possible. a high CMI means the hospital performs big-ticket services and therefor receives more money per patient CDM - CORRECT ANSWERSCharge Description Master charge master is a file that contains a list of chargeable services and the respective charge for the procedures. Timeley and accurate CDM maintenance is crucial Charity Care - CORRECT ANSWERSinternal, hospital-specific policies by which a patient's health care charges are determined to be uncollectable after an investigation Clearinghouse - CORRECT ANSWERSCovered entity that processes or facilitates the processing of information received from another covered entity in a nonstandard format or containing nonstandard data content into standard data eleents or a standard transaction Facilitates calims submissions, remittance processes and eligibility verification transactions among others Compliance - CORRECT ANSWERSCompliance issues heavily deal with Medicare and Medicaid and its responsibility of healthcare facility to follow through with burden of proof of knowing the statues and regulations that govern the federal programs Medical Necessity - CORRECT ANSWERSOutpatient MEdical necessity refers to the process of checking a patient's appointment or procedure information against the diagnosis to determine if services to be provided are medically necessary based on criteria laid out by the insurance carrier. OIG - CORRECT ANSWERSOffice of Inspector General Self polices the hospitals FERA - CORRECT ANSWERSFraud Enforcement and Recovery Act Amends False Claims Act to close loopholes and enhance government to successfully pursue entitites who improperly receive funds Roles of Chief Compliance Officer - CORRECT ANSWERSOversees high-level personnel. Reports directly to board of directors. Responsible for operational aspects NPI - CORRECT ANSWERSNational Provider Identifier unique identification number for covered healthcare providers. Covered healthcare providers and all health plans and healthcare clearinghouses will use the NPIs in the admin and financial transactions adopted under HIPPA Stop-Loss Coverage - CORRECT ANSWERSInsurance bought by a business that self-funds its worker's healthcare to limit how much it might pay Utilization Review - CORRECT ANSWERSReview conducted by professional healthcare personnel of the appropriateness of, quality of, and need for healthcare services provided to patients Internally-based hospital program and an insurer-based program which seeks to confirm that appropriate levels of care are provided based on the patient's condition. Capitation - CORRECT ANSWERSPayment method where the provider receives a flat fee every month for taking care of an individual enrolled in a managed healthcare plan. Also known as per member, per month payment and ensures paymen for as long as an individual is enrolled in the plan Two Midnight Rule - CORRECT ANSWERSAllows hospitals to account for total hospital time (including outpatient time directly preceding the inpatient admission) when determining if an inpatient admission order should be written based on the expectation that the beneficiary will stay in the hospital for two or more midnights receiving medically necessary care. In order for patient to be admitted as inpatient status, patient needs projecting stay in hospital for at least 2 midnights Acute - CORRECT ANSWERSHospital CDI - CORRECT ANSWERSClinical Documentation Integrity In charge of looking through physician documentation and making sure we are assigning the correct diagnoses to the patients. Looks for correctness and as much information as possible Looking at physician's ICD-10 Codes and DRGs specifically Embedded Partners - CORRECT ANSWERS3rd party that is seemingly unseen in Cerner's solutions Ex - Address verification, etc. are partners embedded into Cerner solutions UR - CORRECT ANSWERSUtilization Review An assessment of the appropriateness and economy of an admission to a healthcare facility or a continued hospitilization Patient Bill of Rights - CORRECT ANSWERSDeveloped to promote and ensure healthcare quality and value and protect consumers and workers in the HC system. 1. The right to information to assist patients in making informed decisions about their health plans, facilities and professionals 2. Right to a choice of healthcare proividers that is sufficient to ensure access to appropriate high quality healthcare 3. Right to access emergency health services when and where the need arises 4. RIght to fully participate in all decisions related to their healthcare 5. Right to considerate, respectful care from all members of the healthcare industry at all ties and under all circumstances 6. RIght to communicate with healthcare providers in confidence and to have confidentiality of their info etc. Discharge Process - CORRECT ANSWERSPhysician must write discharge order Case management discharge planning must be finalized Appropriate discharge instructions must be provided to the patient When patient leaves, registration system must be updated to reflect the correct date and time of discharge, and the correct disposition code EMPI - CORRECT ANSWERSEnterprise Master Patient Index Searching for patient? Medicare 60 days window - CORRECT ANSWERS*** [Show Less]
- Exam
- $13.45
- 0
- 146
CRCR EXAM 151 Questions with Answers 2023,100% CORRECT
CRCR EXAM 151 Questions with Answers 2023 835 Record - CORRECT ANSWERSA standard electronic message between a health plan and provider sending remitta... [Show More] nce data on a claim to the provider. 837 Record - CORRECT ANSWERSA standard electronic message between a provider and health plan sending data on a claim to the health plan. AAR - CORRECT ANSWERSAfter-hours activity report ABN - CORRECT ANSWERSAdvanced Beneficiary Notice ACC - CORRECT ANSWERSambulatory care center Access - CORRECT ANSWERSThe ability to receive hospital, physician or other medical services without regard to an individuals ability to pay. Accountable Care Organization (ACO) - CORRECT ANSWERSA coordinated group of healthcare providers (including physicians, hospitals, and other types of providers) organized to improve quality and lower the cost of care to a defined group of patients. Accounting Identity - CORRECT ANSWERSAlso known as the accounting equation; assets = liabilities + equity. Accounts Payable - CORRECT ANSWERSA current liability where funds are owed to suppliers. Accounts Payable Distribution - CORRECT ANSWERSAn account computer system report that details the amounts paid to vendors by date, purchase order, and expense classification. Accounts receivable (A/R) - CORRECT ANSWERSMoney owed to an organization for goods or services furnished. A/R Collection Period - CORRECT ANSWERSNumber of days in the accounting period divided by accounts receivable turnover. This ratio tells you the average time it takes to collect amounts due. A/R Turnover - CORRECT ANSWERSServices rendered on credit during the period divided by the A/R balance. This ratio tells you how many times you collect your AR in a given cycle. Accounts Receivable Aging - CORRECT ANSWERSA report that summarizes accounts receivable from different sources (such as Medicare or commercial insurance) by thirty day increments. Accreditation - CORRECT ANSWERSFormal process by which an agency or organization evaluates and recognizes a program as meeting certain predetermined criteria or standards. A formal process for certifying that providers and health plans meet predetermined standards. Accredited Standards Committee X12 (ASC X12) - CORRECT ANSWERSA committee of the American National Standards Institute (ANSI) responsible for the development and maintenance of electronic data interchange (EDI) standards for many industries. The ASC 'X12N' is the subcommittee of ASC X12 responsible for the EDI health insurance administrative transactions such as 837 Institutional Health Care Claim and 835 Professional Health Care Claim forms Accrual - CORRECT ANSWERSAn expense or a revenue that occurs before the business pays or receives cash. An accrual is the opposite of a deferral. Accrual Basis Accounting - CORRECT ANSWERSThe method of accounting that recognizes revenue when it is earned and matches expenses to the revenues they helped produce Accrued Payroll and Benefits - CORRECT ANSWERSAn estimate of salaries and associated benefit costs (such as payroll tax matching) earned by employees but not yet paid by the employer. Accumilated Depreciation - CORRECT ANSWERSA balance sheet account where the total amount of depreciation recognized as expense over time is compiled. ACS - CORRECT ANSWERSAmbulatory Care Services Activity Based Costing - CORRECT ANSWERSA technique to assign product costs based on links between activities that drive costs and the production of specific products. acuity - CORRECT ANSWERSA measure of the severity of an illness or the resources required to treat an illness or injury. acute care hospital - CORRECT ANSWERSA hospital where patients are treated for brief but severe episodes of illness, injury, trauma, or during recovery from surgery. Patients who require a stay up to 7 days and that focus on physical or mental condition requiring immediate intervention and constant medical attention, equipment, and personnel. AD - CORRECT ANSWERSadmitting diagnosis Administrative cost - CORRECT ANSWERSIn a health plan, those expenses not paid for medical costs on behalf of plan members; but instead associated with administrative functions such as sales, customer services, claims processing, and finance. Administrative Load Ratio - CORRECT ANSWERSIn a health plan, the percentage of total premiums collected expended for administrative costs. Administrative services only (ASO) - CORRECT ANSWERSContract where a third-party administrator or insurer provides administrative services to an employer for a fixed fee per employee. Services usually include claims processing but may also include such services as group billing, actuarial analysis, utilization review, and provider network development. admission - CORRECT ANSWERSFormal registration of a patient who is to be provided with medical care by the provider. Admitting diagnosis - CORRECT ANSWERSThe patient's condition determined by a physician at admission to an inpatient facility for admission and coded according to current diagnosis coding conventions. ADP - CORRECT ANSWERSAutomated Data Processing ADR - CORRECT ANSWERSAverage Daily Revenue ADRG - CORRECT ANSWERSAdjacent diagnosis-related group; alternative diagnosis related group. ADS - CORRECT ANSWERSAlternative delivery system ADSC - CORRECT ANSWERSAverage Daily Service Charge ADT - CORRECT ANSWERSadmission, discharge, transfer Advance Beneficiary Notice (ABN) - CORRECT ANSWERSDocument that acknowledges patient responsibility for payment if Medicare denies the claim. Advanced Practice Provider (APP) - CORRECT ANSWERSClinical nurse specialists (CNS), nurse practitioners (NPs) and Physician Assistants (PAs). AFDC - CORRECT ANSWERSAid to Families with Dependent Children AFDS - CORRECT ANSWERSAlternative financing and delivery systems Affiliation - CORRECT ANSWERSArrangement between organizations by which the named organizations remain independent but have influence on each other; affiliations may or may not be permanent and my not result in common ownership or control of the affiliates. After care - CORRECT ANSWERSServices following hospitalization or rehabilitation. Aging - CORRECT ANSWERSProcess wherein accounts receivable or accounts payable are scheduled, listed or arranged based on elapsed time from date of service or transaction. AHA - CORRECT ANSWERSAmerican Hospital Association AHP - CORRECT ANSWERSallied health professional AHRQ - CORRECT ANSWERSAgency for Healthcare Research and Quality Aid to Families with Dependent Children (AFDC) - CORRECT ANSWERSFederal funds for children in families that fall below state standards of need. In 1996, Congress abolished AFDC, the largest federal cash transfer program, and replaced it with the Temporary Assistance for Needy Families (TANF) block grant AIDS Drug Assistance Programs (ADAP) - CORRECT ANSWERSJoint federal-state sponsored programs that assist eligible HIV-positive patients that assist eligible HIV-positive patients in obtaining HIV medications. ALC - CORRECT ANSWERSalternate level of care All inclusive rate - CORRECT ANSWERSa fixed amount charged on a daily basis during a patient's hospitalization or a total rate charged for an entire stay allied health professionals - CORRECT ANSWERSHealthcare professionals who support the work of physicians and perform specific services ordered by the physician. Allied health professionals include nurses, technologists, technicians, therapists, dentists, optometrists, chiropractors, podiatrists, and others. Allowable Costs - CORRECT ANSWERSCosts that are allowed under the terms of the contract. Typically, allowable costs become relevant under certain types of cost-reimbursable contracts where the buyer reimburses the seller's allowable costs. If there are non-allowable costs in a contract, the buyer is not obligated to reimburse the seller for these. allowance for bad debts - CORRECT ANSWERSA contra asset account, related to accounts receivable, that holds the estimated amount of uncollectible accounts. Allowed amount - CORRECT ANSWERSThe maximum amount Medicare will pay for any given area for a covered service. ambulatory care - CORRECT ANSWERSServices that do not require an overnight hospital stay. Services rendered outside the impatient setting. Ambulatory Patient Groups (APGs) - CORRECT ANSWERSInstitutional outpatient reimbursement system based on the methodology developed by CMS; APCs/APGs are to outpatient visits/services what DRGs are to inpatient hospital admissions; the payments are based on categories or groupings of like or similar services requiring like or similar professional services and supply utilization. Ambulatory Payment Classification (APC) - CORRECT ANSWERSProspective payment system used to calculate reimbursement for outpatient care according to similar clinical characteristics and in terms of resources required. Ambulatory setting - CORRECT ANSWERSA type of health care setting where health servies are provided on an outpatinet basis. Ambulatory setting usually include physician's offices, clinics, and surgery centers AMCC - CORRECT ANSWERSAutomated multi-channel chemistry American National Standards Institute (ANSI) - CORRECT ANSWERSParent organization of the ASC X12 and the recognized coordinator and clearinghouse for information on United States and Canadian national standards. Ancillary Services - CORRECT ANSWERSSupportive services other than routine hospital services provided by the facility, such as x-ray films and laboratory tests. Anniversary - CORRECT ANSWERSThe beginning of a subscriber group's benefit year. ANSI - CORRECT ANSWERSAmerican National Standards Institute APC - CORRECT ANSWERSAmbulatory Payment Classification APG - CORRECT ANSWERSAmbulatory patient group APHP - CORRECT ANSWERSAcute partial hospitalization program APP - CORRECT ANSWERSAdvanced Practice Provider Appeal - CORRECT ANSWERSRequest by a provider or beneficiary to have coverage and/or payment determination reconsidered. AR - CORRECT ANSWERSaccounts receivable AS - CORRECT ANSWERSAdmission scheduling ASC - CORRECT ANSWERSAdministrative services contract; ambulatory surgical/surgery center ASF - CORRECT ANSWERSAmbulatory surgical facility ASO - CORRECT ANSWERSAdministrative Services Only Asset - CORRECT ANSWERSAnything of value that is owned Assignment - CORRECT ANSWERSAgreement in which a patient transfers to a provider the right to receive payment from a third party for the service the patient has received. Attending physician - CORRECT ANSWERSMedical staff member who is legally responsible for the care and treatment given to a patient. Attestation - CORRECT ANSWERSPhysician's report attesting to the principal diagnosis, secondary diagnosis, and names of the major procedures performed, which must be completed shortly before or shortly after the patient is discharged; signature of authorized representative affirming that information in a CMS enrollment application is true. Audit - CORRECT ANSWERSMethodical review and objective examination of services performed, verifying specific information as determined by the auditor or as established by general practice. Audit trail - CORRECT ANSWERSAccounting records that trace transactions from their source documents to the financial statements Average Daily Census (ADC) - CORRECT ANSWERSThe average inpatient census (excluding newborns) receiving care each day over a given period of time. Average length of stay (ALOS) - CORRECT ANSWERSAverage stay counted by days of all or a class of inpatients discharged over a given period, calculated by dividing the number of inpatient days by the number of discharges. BAA - CORRECT ANSWERSBusiness Associate Agreement Bad debt - CORRECT ANSWERSUnpaid customers' bills that are now very unlikely to ever be paid Balance billing - CORRECT ANSWERSBilling patients for charges in excess of the Medicare fee schedule. Balance Sheet - CORRECT ANSWERSA financial statement that reports assets, liabilities, and owner's equity on a specific date. Statement that lists the financial resources (assets), financial obligations (liabilities), and ownership rights (equity/fund balance) within the organization. Balanced Budget Act of 1997 (BBA) - CORRECT ANSWERSFederal legislation, passed by Congress and signed by President Clinton, that cut health care expenditures for Medicare and other government-sponsored programs to achieve a balanced budget Bankruptcy - CORRECT ANSWERSFederal system of marshaling the assets of a financially distressed person or organization and paying the creditors' on a pro rata basis. Batch control tasks - CORRECT ANSWERSFigures that ensure batch processing has been performed correctly by comparing output to the input totals, record or document counts, or cash totals. batch processing - CORRECT ANSWERSAccumulating transaction records into groups or batches for processing at a regular interval such as daily or weekly. The records are usually sorted into some sequence (such as numerically or alphabetically) before processing. BBA - CORRECT ANSWERSBalanced Budget Act of 1997 behavioral health - CORRECT ANSWERSHealthcare services, such as those provided by a psychiatrist, psychologist, social worker, hospital, or other facility duly licensed and qualified to treat mental health and chemical dependency conditions. Benchmarking - CORRECT ANSWERSProcess of identifying industry standards and best practices. Benchmarks - CORRECT ANSWERSIndustry standards for specific tasks or performance normally set by surveying groups and comparing data across groups. Beneficiary - CORRECT ANSWERSA person on behalf of which an insurance plan payment is made to a healthcare provider. Benefit days - CORRECT ANSWERSDays that a patient is eligible for covered services. benefit package - CORRECT ANSWERSThe set of services, such as physician visits, hospitalizations, prescription drugs, that are covered by an insurance policy or health plan. The benefit package will specify any cost-sharing requirements for services, limits on particular services, and annual or lifetime spending limits. Benefit payment - CORRECT ANSWERSA payment by an insurer based on the terms of an insurance policy on behalf of a plan beneficiary or member. Benefit year - CORRECT ANSWERSthe 12-month period for which health insurance benefits are calculated, not necessarily coinciding with the calendar year. Health insurance companies may update plan benefits and rates at the beginning of the benefit year. Billed charges - CORRECT ANSWERSThe amount the provider bills to the payer for a specific item or service such as a visit to a physician or an inpatient day at a healthcare facility; gross prices charged for healthcare services. Same as submitted charges Billing - CORRECT ANSWERSSubmission of a claim for payment for services rendered by a healthcare provider to the insured or to the patient. Billing and collection function - CORRECT ANSWERSAlso known as patient financial services or PFS, the function in a healthcare provider entity that compiles and submits claims to insurers or patients and collects amounts due for services. BIPA - CORRECT ANSWERSSCHIP benefits improvement and protection act of 2000 Bond issue - CORRECT ANSWERSThe selling of a number of small debt instruments to multiple lenders. Bottom up approach - CORRECT ANSWERSA budgeting system whereby budgets originate at the department or program level and then are aggregated and approved by senior managers break-even analysis - CORRECT ANSWERSa method of determining what sales volume must be reached before total revenue equals total costs and operate at a zero profit. BSR - CORRECT ANSWERSBill Summary Period Budgeting - CORRECT ANSWERSProcess of formulating a comprehensive management plan of operation that formally expresses both broad and specific objectives and sets standards for the evaluation of performance. Bundled Payments - CORRECT ANSWERScategory of payments made as lump sums to providers for all healthcare services delivered to a patient for a specific illness and/or over a specified time period; they include multiple services and may include multiple providers of care Bundling - CORRECT ANSWERSA method used by insurance companies that combines reimbursement for two or more medical services into one payment in full. If an insurance company doesn't feel a medical procedure should be paid individually, it will combine the payment of one item with another, thus reducing its total cost. Business Intelligence - CORRECT ANSWERSanalyzing large amounts of data for strategic decision making Bylaws - CORRECT ANSWERSOrganizational document for for-profit and not-for-profit organizations that supplements the articles of incorporation, establishes procedural rules not found in the articles of incorporation or enabling statute, and is not a public document. C and E - CORRECT ANSWERSConsultation and examination CAH - CORRECT ANSWERSCritical Access Hospital Calculation for adjusted discharge - CORRECT ANSWERSFor adjusted discharges or patient days; adjusted discharges (days) = inpatient discharges (days) x (1 = [gross outpatient revenue/gross inpatient revenue]) capital assets - CORRECT ANSWERSAssets of a permanent nature used in the production of income, such as land, buildings, machinery, and equipment; usually distinguishable under income tax law from "inventory," assets held for sale to customers in the ordinary course of the taxpayer's trade or business capital budget - CORRECT ANSWERSA budget that describes the expected capital acquisitions (equipment, buildings) for a business during a specific period of time. capital lease - CORRECT ANSWERSA contractual agreement allowing one party (the lessee) to use another party's asset (the lessor); accounted for like a debt-financed purchase by the lessee. A lease with or without the eventual opportunity to purchase the asset. Capital Structure Ratios - CORRECT ANSWERSFinancial rations that evaluate the mix of debt and equity in a business. Capitation - CORRECT ANSWERSSystem of payment used by managed care plans in which physicians and hospitals are paid a fixed, per capita amount for each patient enrolled over a stated period regardless of the type and number of services provided; reimbursement to the hospital on a per-member/per-month basis to cover costs for the members of the plan. Care purchaser - CORRECT ANSWERSIndividual or entity that contributes to the purchase of healthcare services Carrier - CORRECT ANSWERSInsurer of a group contract that agrees to underwrite (accept the risk) and to provide certain types of insurance coverage. Carve Out - CORRECT ANSWERSSet of health plan benefits that are contracted separately from the standard benefits package case management - CORRECT ANSWERSMethod of managing the provision of healthcare with the goal of improving continuity and quality of care while lowering cost. Case Manager - CORRECT ANSWERSClinical professional who works with patients, providers, families, and insurers to coordinate all the services deemed necessary to care for the patient in the best and lowest cost medically appropriate setting. Case Mix Index - CORRECT ANSWERSThe average relative weight of all cases treated at a given facility or by a given physician, which reflects the resource intensity or clinical severity (acuity) of a specific group in relation to the other groups in the classification system Case Rate - CORRECT ANSWERSPayment to a provider for all care for a specific service, such as a surgery or treatment of an illness. Cash - CORRECT ANSWERSAlso called currency. It is used to determine liquidity ratios and transact financial business. Cash is considered the most liquid of all assets. Cash Basis of Accounting - CORRECT ANSWERSContrasted with the accrual basis of accounting, this basis of accounting records revenues and expenses in the period in which expense payments are made or revenues are collected. Cash budget - CORRECT ANSWERSa detailed plan showing how cash resources will be acquired and used over a specific time period Categorical Eligibility - CORRECT ANSWERSEligibility for a benefit program based solely on one's demographic characteristics. Categorically needy - CORRECT ANSWERSPersons whose Medicaid eligibility is based on their family, age, or disability status. CCH - CORRECT ANSWERSCommerce Clearinghouse CCI - CORRECT ANSWERSCorrect Coding Initiative CCMU - CORRECT ANSWERSCritical care medical unit CCO - CORRECT ANSWERSChief Compliance Officer CCU - CORRECT ANSWERScardiac care unit CD - CORRECT ANSWERSchemical dependency ceiling - CORRECT ANSWERSDollar amount above which amounts would be disallowed or rejected. CELIP - CORRECT ANSWERSClaims Expansion and Line Item Processing. Medicare's expanded claim form necessary to perform medical reviews and capture savings at the line item level under the outpatient PPS system. Census - CORRECT ANSWERSCount of patients who at the time counted were duly registered in a provider's care, normally on an inpatient basis; Count of all people in the United States taken every ten years by the federal government; Listing of all eligible members who are to be covered by a plan. Centers for Medicare and Medicaid Services (CMS) - CORRECT ANSWERSa federal agency within the U.S. Department of Health and Human Services that is responsible for Medicare and Medicaid, among many other responsibilities. certificate - CORRECT ANSWERSDocument or benefits booklet issued to a covered individual and a group health insurance plan setting forth the benefits and requirements of that plan Certificate of Medical Necessity (CMN) - CORRECT ANSWERSSigned physician attestation document stating services provided under a specific course of treatment are medically necessary. CHAMPUS - CORRECT ANSWERSCivilian Health and Medical Program of the Uniformed Services. The Department of Defense administers this program, which pays for healthcare delivered by civilian health providers to retired members and dependents of active members for all military services in the U.S. CHAMPVA - CORRECT ANSWERSCivilian Health and Medical Program of the Veterans Administration Change in Net Assets - CORRECT ANSWERSThe amount of change in Net Assets recorded as a result of earnings during an accounting period. See also Net income Channeling - CORRECT ANSWERSProcedure used in managed care or point-of-service plans as a means of steering or encouraging patients to a specific network of providers through the use of incentives. Patients who use a network provider may be responsible for a lower co-payment and/or receive higher insurance benefits then if accessing an out-of-network provider. Charge - CORRECT ANSWERSThe dollar amount a provider sets for services rendered before negotiating any discounts. The charge can be different from the amount paid. charge-based reimbursement - CORRECT ANSWERSPayment to health care provider based on billed charges and not on a prospectively negotiated amount. Charge capture - CORRECT ANSWERSThe process of recording a charge for a service or item on a patient's account. Chargemaster - CORRECT ANSWERSA listing of all items for which revenue can be generated in a healthcare provider organization; also referred to as the CDM or charge description master. [Show Less]
- Exam
- $14.45
- 0
- 168
CRCR EXAM 146 Questions with Answers,100% CORRECT
CRCR EXAM 146 Questions with Answers What are collection agency fees based on? - CORRECT ANSWERSA percentage of dollars collected Self-funded benefit... [Show More] plans may choose to coordinate benefits using the gender rule or what other rule? - CORRECT ANSWERSBirthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - CORRECT ANSWERSCase rates What customer service improvements might improve the patient accounts department? - CORRECT ANSWERSHolding staff accountable for customer service during performance reviews What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - CORRECT ANSWERSInform a Medicare beneficiary that Medicare may not pay for the order or service What type of account adjustment results from the patient's unwillingness to pay for a self-pay balance? - CORRECT ANSWERSBad debt adjustment What is the initial hospice benefit? - CORRECT ANSWERSTwo 90-day periods and an unlimited number of subsequent periods When does a hospital add ambulance charges to the Medicare inpatient claim? - CORRECT ANSWERSIf the patient requires ambulance transportation to a skilled nursing facility How should a provider resolve a late-charge credit posted after an account is billed? - CORRECT ANSWERSPost a late-charge adjustment to the account An increase in the dollars aged greater than 90 days from date of service indicate what about accounts - CORRECT ANSWERSThey are not being processed in a timely manner What is an advantage of a preregistration program? - CORRECT ANSWERSIt reduces processing times at the time of service What are the two statutory exclusions from hospice coverage? - CORRECT ANSWERSMedically unnecessary services and custodial care What core financial activities are resolved within patient access? - CORRECT ANSWERSScheduling, insurance verification, discharge processing, and payment of point-of-service receipts What statement applies to the scheduled outpatient? - CORRECT ANSWERSThe services do not involve an overnight stay How is a mis-posted contractual allowance resolved? - CORRECT ANSWERSComparing the contract reimbursement rates with the contract on the admittance advice to identify the correct amount What type of patient status is used to evaluate the patient's need for inpatient care? - CORRECT ANSWERSObservation Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has received what? - CORRECT ANSWERSMedically necessary inpatient hospital services for at least 3 consecutive days before the skilled nursing care admission When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - CORRECT ANSWERSWhen the patient is the insured What are non-emergency patients who come for service without prior notification to the provider called? - CORRECT ANSWERSUnscheduled patients If the insurance verification response reports that a subscriber has a single policy, what is the status of the subscriber's spouse? - CORRECT ANSWERSNeither enrolled not entitled to benefits Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act, establishes what? - CORRECT ANSWERSDisclosure rules for consumer credit sales and consumer loans What is a principal diagnosis? - CORRECT ANSWERSPrimary reason for the patient's admission Collecting patient liability dollars after service leads to what? - CORRECT ANSWERSLower accounts receivable levels What is the daily out-of-pocket amount for each lifetime reserve day used? - CORRECT ANSWERS50% of the current deductible amount What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as an RHC services? - CORRECT ANSWERSInpatient care What code indicates the disposition of the patient at the conclusion of service? - CORRECT ANSWERSPatient discharge status code What are hospitals required to do for Medicare credit balance accounts? - CORRECT ANSWERSThey result in lost reimbursement and additional cost to collect When an undue delay of payment results from a dispute between the patient and the third party payer, who is responsible for payment? - CORRECT ANSWERSPatient Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include: - CORRECT ANSWERSA valid CPT or HCPCS code With advances in internet security and encryption, revenue-cycle processes are expanding to allow patients to do what? - CORRECT ANSWERSAccess their information and perform functions on-line What date is required on all CMS 1500 claim forms? - CORRECT ANSWERSOnset date of current illness What does scheduling allow provider staff to do - CORRECT ANSWERSReview appropriateness of the service request What code is used to report the provider's most common semiprivate room rate? - CORRECT ANSWERSCondition code Regulations and requirements for coding accountable care organizations, which allows providers to begin creating these organizations, were finalized in: - CORRECT ANSWERS2012 What is a primary responsibility of the Recover Audit Contractor? - CORRECT ANSWERSTo correctly identify proper payments for Medicare Part A & B claims How must providers handle credit balances? - CORRECT ANSWERSComply with state statutes concerning reporting credit balance Insurance verification results in what? - CORRECT ANSWERSThe accurate identification of the patient's eligibility and benefits What form is used to bill Medicare for rural health clinics? - CORRECT ANSWERSCMS 1500 What activities are completed when a scheduled pre-registered patient arrives for service? - CORRECT ANSWERSRegistering the patient and directing the patient to the service area In addition to being supported by information found in the patient's chart, a CMS 1500 claim must be coded using what? - CORRECT ANSWERSHCPCS (Healthcare Common Procedure Coding system) What results from a denied claim? - CORRECT ANSWERSThe provider incurs rework and appeal costs Why does the financial counselor need pricing for services? - CORRECT ANSWERSTo calculate the patient's financial responsibility What type of provider bills third-party payers using CMS 1500 form - CORRECT ANSWERSHospital-based mammography centers How are disputes with nongovernmental payers resolved? - CORRECT ANSWERSAppeal conditions specified in the individual payer's contract The important message from Medicare provides beneficiaries with information concerning what? - CORRECT ANSWERSRight to appeal a discharge decision if the patient disagrees with the services Why do managed care plans have agreements with hospitals, physicians, and other healthcare providers to offer a range of services to plan members? - CORRECT ANSWERSTo improve access to quality healthcare If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days, what is the SNF permitted to do? - CORRECT ANSWERSSubmit interim bills to the Medicare program. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims after what happens? - CORRECT ANSWERSdays passes, but the claim then be withdrawn from the liability carrier What data are required to establish a new MPI entry? - CORRECT ANSWERSThe patient's full legal name, date of birth, and sex What should the provider do if both of the patient's insurance plans pay as primary? - CORRECT ANSWERSDetermine the correct payer and notify the incorrect payer of the processing error What do EMTALA regulations require on-call physicians to do? - CORRECT ANSWERSPersonally appear in the emergency department and attend to the patient within a reasonable time At the end of each shift, what must happen to cash, checks, and credit card transaction documents? - CORRECT ANSWERSThey must be balanced What will cause a CMS 1500 claim to be rejected? - CORRECT ANSWERSThe provider is billing with a future date of service Under Medicare regulations, which of the following is not included on a valid physician's order for services? - CORRECT ANSWERSThe cost of the test how are HCPCS codes and the appropriate modifiers used? - CORRECT ANSWERSTo report the level 1, 2, or 3 code that correctly describes the service provided If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? - CORRECT ANSWERSDiagnostic and clinically-related non-diagnostic charges provided on the Tuesday, Wednesday, Thursday, and Friday before admission What is a benefit of pre-registering patient's for service? - CORRECT ANSWERSPatient arrival processing is expedited, reducing wait times and delays What is a characteristic of a managed contracting methodology? - CORRECT ANSWERSProspectively set rates for inpatient and outpatient services What do the MSP disability rules require? - CORRECT ANSWERSThat the patient's spouse's employer must have less than 20 employees in the group health plan what organization originated the concept of insuring prepaid health care services? - CORRECT ANSWERSBlue Cross and blue Shield What is true about screening a beneficiary for possible MSP situations? - CORRECT ANSWERSIt is acceptable to complete the screening form after the patient has completed the registration process and been sent to the service department If the patient cannot agree to payment arrangements, what is the next option? - CORRECT ANSWERSWarn the patient that unpaid accounts are placed with collection agencies for further processing In services lines such as cardiology or orthopedics, what does the case-rate payment methodology allow providers to do? - CORRECT ANSWERSReceive a fixed for specific procedures What will comprehensive patient access processing accomplish? - CORRECT ANSWERSMinimize the need for follow-up on insurance accounts Through what document does a hospital establish compliance standards? - CORRECT ANSWERSCode of conduct How does utilization review staff use correct insurance information? - CORRECT ANSWERSTo obtain approval for inpatient days and coordinate services When is it not appropriate to use observation status? - CORRECT ANSWERSAs a substitute for an inpatient admission What is a serious consequence of misidentifying a patient in the MPI? - CORRECT ANSWERSThe services will be documented in the wrong record When a patient reports directly to a clinical department for service, what will the clinical department staff do? - CORRECT ANSWERSRedirect the patient to the patient access department for registration What process can be used to shorten claim turnaround time? - CORRECT ANSWERSSend high-dollar hard-copy claims with required attachments by overnight mail or registered mail How are patient reminder calls used? - CORRECT ANSWERSTo make sure the patient follows the prep instructions and arrives at the scheduled time for service If a patient declares a straight bankruptcy, what must the provider do? - CORRECT ANSWERSWrite off the account to the contractual adjustment account According to the Department of Health and Human Services guidelines, what is NOT considered income? - CORRECT ANSWERSSale of property, house, or car The situation where neither the patient nor spouse is employed is described to the patient using: - CORRECT ANSWERSA condition code What option is an alternative to valid long-term payment plans? - CORRECT ANSWERSBank loans What is an advantage of using a collection agency to collect delinquent patient accounts? - CORRECT ANSWERSCollection agencies collect accounts faster than hospital does What statement DOES NOT apply to revenue codes? - CORRECT ANSWERSrevenue codes identify the payer When a patient's illness results in an unusually high amount of medical bills not covered by insurance or other patient pay resources, what type of account is created - CORRECT ANSWERScatastrophic charity What happens when a patient receives non-emergent services from and out-of-network provider? - CORRECT ANSWERSPatient payment responsibility is higher Every patient who is new to the healthcare provider must be offered what? - CORRECT ANSWERSA printed copy of the provider's privacy notice How may a collection agency demonstrate its performance? - CORRECT ANSWERSCalculate the rate of recovery What is true of the information the provider supplies to indicate that an authorization for service has been received from the patient's primary payer? - CORRECT ANSWERSIt is posted on the remittance advice by the payer What standard claim forms are currently used by the healthcare industry to submit claims to third-party payers? - CORRECT ANSWERSThe UB-04 and the CMS 1500 Unless the patient encounter is an emergency, what is the efficient and effective procedure for obtaining information? - CORRECT ANSWERSObtain the required demographic and insurance information before services are rendered what protocol was developed through the Patient Friendly Billing Project? - CORRECT ANSWERSProvide information using language that is easily understood by the average reader What technique is acceptable way to complete the MSP screening for a facility situation? - CORRECT ANSWERSAsk if the patient's current services was accident related What is a valid reason for a payer to delay a claim? - CORRECT ANSWERSFailure to complete authorization requirements IF outpatient diagnostic services are provided within three days of the admission of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these charges - CORRECT ANSWERSThey must be combined with the inpatient bill and paid under the MS-DRG system What do large adjustments require? - CORRECT ANSWERSManager-level approval What items are valid identifiers to establish a patient's identification? - CORRECT ANSWERSPhoto identification, date of birth, and social security number What must a provider do to qualify an account as a Medicare bad debts? - CORRECT ANSWERSPursue the account for 120 days and then refer it to an outside collection agency What restriction does a managed care plan place on locations that must be used if the plan is to pay for the services provided? - CORRECT ANSWERSSite-of-service limitation What is an example of an outcome of the Patient Friendly Billing Project? - CORRECT ANSWERSRedesigned patient billing statements using patient-friendly language What statement describes the APC (Ambulatory payment classification) system? - CORRECT ANSWERSAPC rates are calculated on a national basis and are wage-adjusted by geographic region What is a benefit of insurance verification? - CORRECT ANSWERSPre-certification or pre-authorization requirements are confirmed What is an effective tool to help staff collect payments at the time of service? - CORRECT ANSWERSDevelop scripts for the process of requesting payments What is a benefit of electronic claims processing? - CORRECT ANSWERSProviders can electronically view patient's eligibility What does Medicare Part D provide coverage for? - CORRECT ANSWERSPrescription drugs What are some core elements of a board-approved financial policy - CORRECT ANSWERSCharity care, payment methods, and installment payment guidelines What circumstance would result in an incorrect nightly room charge? - CORRECT ANSWERSIf the patient's discharge, ordered for tomorrow, has not been charted What is NOT a typical charge master problem that can result in a denial? - CORRECT ANSWERSDoes not include required modifiers An individual's ability to obtain medical services on a timely and financially acceptable level - CORRECT ANSWERSAccess Usually contracted administrative services to a self-insured health plan - CORRECT ANSWERSAdministrative Services Only (ASO) The process whereby all health-related components of a case are managed by a designated health professional. Intended to ensure continuity of healthcare accessibility and services - CORRECT ANSWERSCase management A demand by an insured person for the benefits provided by the group contract - CORRECT ANSWERSClaim A typical insurance provision that determines the responsibility for primary payment when the patient is covered by more than one employer-sponsored health benefit program - CORRECT ANSWERSCoordination of benefits (COB) A reimbursement methodology whereby a provider agrees to provide service on a fee for service basis, but the fees are discounted by certain packages - CORRECT ANSWERSDiscounted fee-for-service Patient status regarding coverage for healthcare insurance benefits - CORRECT ANSWERSEligibility A healthcare insurance policy that has no deductible and covers the first dollar of an insured's expenses - CORRECT ANSWERSFirst dollar coverage A concept wherein the primary care physician provides all primary patient care and coordinates all diagnostic testing and specialty referrals required for a patient's medical care - CORRECT ANSWERSGatekeeping An insurance company that provides for the delivery or payment of healthcare services - CORRECT ANSWERSHealth plan Negotiated healthcare coverage within a framework of fee schedules, limitations, and exclusions that is offered by insurance companies or benevolent associations - CORRECT ANSWERSIndemnity insurance Healthcare services that are required to preserve or maintain a person's health status in accordance with medical practice standards - CORRECT ANSWERSMedically necessary Healthcare plan coverage allowed to covered persons for emergency situations outside of the prescribed geographic area of the HMO - CORRECT ANSWERSOut-of-area benefits Cash payments made by the insured for services not covered by the health insurance plan - CORRECT ANSWERSOut-of-pocket payments The practice of reviewing requests for inpatient admission before the patient is admitted to ensure that the admission is medically necessary - CORRECT ANSWERSPre-admission review A restriction on payments for charges directly resulting from a pre-existing health conditions - CORRECT ANSWERSPre-existing condition limitation A cost containment practice that reduces a surgical patient's inpatient stay by requiring that pre-procedure testing and preparation are completed on an outpatient basis and the patient is admitted the same day as the procedure - CORRECT ANSWERSSame-day admission Large employers who assume direct responsibility or risk for paying employees' healthcare without purchasing health insurance - CORRECT ANSWERSSelf-insured Seeking, by legal or administrative means, reimbursement from another party that is primarily responsible for a patient's medical expenses - CORRECT ANSWERSSubrogation An employer, a union, or an association that contracts with an insurance company for the healthcare plan it offers to eligible employees - CORRECT ANSWERSSubscriber A healthcare professional who is recognized to have expertise in a specialty of medicine or surgery - CORRECT ANSWERSSub-specialist Provides services to employers or insurance companies for utilization review, claims payment and benefit design - CORRECT ANSWERSThird-part administrator (TPA) A general term used for the healthcare benefit payments - used to identify that for benefit plans there are three parties in the transaction - CORRECT ANSWERSThird-party reimbursement Health insurance plan reimbursement methodology that limits payment to the lower billed charges, the provider's customary charge, or the prevailing charge for the service in the community - CORRECT ANSWERSUsual, customary, and reasonable (UCR) Review conducted by professional healthcare personnel of the appropriateness of, quality of, and need for healthcare services provided to patients - CORRECT ANSWERSUtilization review The dollar amount a provider sets for services rendered before negotiating any discounts. The charge can be different from the amount paid - CORRECT ANSWERSCharge The definition of cost varies by party incurring the expense - CORRECT ANSWERSCost The total amount a provider expects to be paid by payers and patients for healthcare services - CORRECT ANSWERSPrice Individual or entity that contributes to the purchase of healthcare services - CORRECT ANSWERSCare purchaser An organization that negotiates or sets rates for provider services, collects revenue through premium payments or tax dollars, processes provider claims for service, and pays provider claims using collected premium or tax revenues - CORRECT ANSWERSPayer An entity, organization, or individual that furnishes a healthcare service - CORRECT ANSWERSProvider The portion of the total payment for medical services and treatment for which the patient is responsible, including copayments, coinsurance, and deductibles - CORRECT ANSWERSOut of pocket payment In health care, readily available information on the price of healthcare services that, together, with other information helps define the value of those services and enables patients and other care purchasers to identify, compare, and choose providers that offer the desired level of value - CORRECT ANSWERSPrice transparency The quality of a healthcare service in relation to the total price paid for the service by care purchasers - CORRECT ANSWERSValue What areas does the code of conduct typically focus on? Human resources. Privacy/confidentiality. - CORRECT ANSWERSQuality of care. Billing/coding. Conflicts of interest. Laws/regulations FERA - CORRECT ANSWERSFraud Enforcement and Recovery act ESRD - CORRECT ANSWERSEnd-stage renal disease. The patient has permanent kidney failure, is covered by a GHP, and has not yet completed the 30-month coordination period What is the purpose of a compliance program? - CORRECT ANSWERSMitigate potential fraud and abuse in the industry-specific key risk areas What is important about an effective corporate compliance program? - CORRECT ANSWERSA program that embodies many elements to create a program that is transparent, clearly articulated and emphasized at all employee levels as a seriously held personal and organizational responsibility, one that relies on full communication inside and outside the organization What is a CCO? - CORRECT ANSWERSChief compliance officer - they typically report directly to the board of directors/trustees as well as the chief executive officer, and has limited responsibilities for other operational aspects of the organization What are the situations where another payer may be completely responsible for payment? - CORRECT ANSWERSWork-related accidents, black lung program services, patient is enrolled in Medicare Advantage, Federal grant programs True or False - Under Medicare rules, certain outpatient services that are provided within three days of the admission date, by hospitals or by entities owned or controlled by hospitals, must be billed as part of an inpatient stay. - CORRECT ANSWERSTRUE The OIG has issued compliance guidance/model compliance plans for all of the following entities: hospices. - CORRECT ANSWERSphysician practices. ambulance providers Providers who are found to be in violation of CMS regulations are subject to: - CORRECT ANSWERSCorporate integrity agreements What MSP situation requires LGHP - CORRECT ANSWERSDisability [Show Less]
- Exam
- $14.45
- 0
- 239
CRCR/CRCR conclusion 16 Questions with Answers 2023,100% CORRECT
CRCR/CRCR conclusion 16 Questions with Answers 2023 CRCR 9 What is Revenue Cycle? - CORRECT ANSWERSall steps required to process a patient account fr... [Show More] om the request for service through closing the account with a 0 balance and purging it from the system Health Insurance Marketplace - CORRECT ANSWERSalso known as Health Insurance Exchange, where individuals and small businesses can compare and purchase qualified health benefit plans ACA - CORRECT ANSWERSAssociation of Credit and Collections Professionals International Medical Debt Task Force - CORRECT ANSWERSbest practice workflow that builds off of HFMAs previous Patient-Friendly Billing work and spans he patient centric revenue cycle. Improves efficiency of the revenue cycle and patient experience HCAHPS - CORRECT ANSWERSHospital Consumer Assessment of Healthcare Providers and Systems, provide a standardized method for evaluating patients' perspective on hospital care How many questions does the HCAHPS survey have? - CORRECT ANSWERS27 related to clinical care and patient engagement CMS - CORRECT ANSWERSCenter for Medicare and Medicaid Services ADT - CORRECT ANSWERSAdmit, discharge, and transfer system 3 HFMA RC initiatives - CORRECT ANSWERSPatients financial communication best practice Best practices for price transparency Medical account resolution CRCR conclusion advantages of outsourcing - CORRECT ANSWERScapitalizes on the economies of scale, limits internal staffing requirements, access to qualified staff, vendor absorbs some financial risk based on efficiency factor disadvantages of outsourcing - CORRECT ANSWERSineffective vendor results in increased cost, impact on customer service, legal impact if vendor represents themselves as provider employees, impact on direct control of accounts receivable prior to selecting a vendor providers should - CORRECT ANSWERStalk to vendors employees, sups management, contact current and past vendors, choose a vendor that is successful clauses for collection agencies - CORRECT ANSWERSannual renewal and cancellation clause, understanding that provider has ownership, trail period of 3-6 months, outlines who will pay the cost of legal action if needed, their job descriptions, the types of reports, a statement on how the vendor is going to protect the confidentiality What are the 6 performance strategies? - CORRECT ANSWERSCulture, process, communications, technology, metrics, people What is the measure of patient satisfaction - CORRECT ANSWERSThe Medicare's Hospital Consumer Assessment of Healthcare Provider and Systems What are the segments of the revenue cycle - CORRECT ANSWERSConsumer experience, patient experience, customer experience [Show Less]
- Exam
- $9.95
- 0
- 156
CRCR Part 4| 36 Questions with Answers 2023,100% CORRECT
CRCR Part 4| 36 Questions with Answers 2023 General Ledger Cash - CORRECT ANSWERSPetty cash used as payments for miscellaneous purchases Electron... [Show More] ic Funds Transfer (EFT) - CORRECT ANSWERSThe transfer of funds from payer to payee through the banking system. It is considered the quickest way to move money because it is possible to transfer funds between banks on the same day. Electronic Remittance Advice (ERA) - CORRECT ANSWERSA standardized healthcare claim payment format used to electronically send third-party payment details to healthcare providers. ERA Level 1 - CORRECT ANSWERSElectronic receipt of 835 data only. An ERA is received, the info is printed, and the printout is processed the same as a paper remittance. ERA Level 2 - CORRECT ANSWERSElectronic receipt of 835 dataset and electronic data entry. ERA data is received and entered into the computer electronically, then viewed in a terminal. ERA Level 3 - CORRECT ANSWERSElectronic receipt, data entry, reconciliation, posting, and closing of 835 data. ERA Level 4 - CORRECT ANSWERSTotal automation of receipt, data entry, payment posting, and adjustment processing of 835 data. Includes all of level 3 and linking of banking information to allow reconciliation of payments received electronically though a non-bank network, with funds received electronically. Credit Balances - CORRECT ANSWERSWhen payments and contractual adjustments posted to an account exceed the overall total charges. CMS-838 - CORRECT ANSWERSMedicare form used to report all Medicare credit-balance overpayment accounts on a quarterly basis. Technical Denials - CORRECT ANSWERSType of health plan denial based on missing or incomplete claim information. Clinical Denials - CORRECT ANSWERSType of health plan denial associated with the care or service provided. Underpayment denials - CORRECT ANSWERSWhen the health plan pays less than the agreed contract amount. Pre-service denials - CORRECT ANSWERSAssociated with Physicians, Patient Access, Financial Counselors, and Case Management. Examples include not obtaining pre-auth, insurance benefits not verified, incorrect data entry. Time-of-service Denials - CORRECT ANSWERSAssociated with Physicians, Patient Access, Case Management, Clinical Service departments, and HIM. Examples include New technology used without determining coverage, Charges bundled or unbundled incorrectly, Patient acuity level changes but the type of service not changed, admission notification not completed, or invalid coding Post-Service Denials - CORRECT ANSWERSAssociated with the Clinical Service departments, Patient Access, IT, and Patient Accounting Examples include late charges, duplicate claims, and untimely filing. Recovery Audit Contractors (RAC) - CORRECT ANSWERSMission is to protect Medicare from fraudulent and abusive billing. Beneficiary Appeal Type - CORRECT ANSWERSFiled by the Medicare beneficiary who is dissatisfied with the government's claim determination. Provider Appeal Type - CORRECT ANSWERSFiled by the provider. When the amount in question is between $1,000 and $10,000, a provider may request a hearing. If the amount is >$10k the provider may file the appeal with the Provider Reimbursement Review Board. Medicare Waiver of Liability - CORRECT ANSWERSIf the beneficiary nor the provider knew or reasonably could know the services were not covered, Medicare is liable for paying the claim. Liens - CORRECT ANSWERSA claim against real or personal property that secures payment of a debt or performance of some other act. Agreement Liens - CORRECT ANSWERSA creditor can protect his/her security interest by filing a financing statement under the Uniform Commercial Code (UCC), usually at the Secretary of State's Office. When personal property is used as collateral, the agreement is called a security interest. When the secured property is real estate, the agreement is called a mortgage. Judicial Liens - CORRECT ANSWERSResults when the creditor cannot collect via reasonable "pressuring" techniques (as defined by the Fair Debt Collection Practices Act). Statute Liens - CORRECT ANSWERSFour common Types: Employee's Lien is placed on the employer's personal property to secure payment of back wages. Landlord's lien is placed on the tenant's property to secure payment of back rent. Materialman's or Mechanic's lien is placed to secure compensation of contractors, suppliers, or repair workers. Tax lien existing in favor of the state or municipality upon lands of a person charged with taxes. Difference between Bad Debt and Financial Assistance - CORRECT ANSWERSthe first is an unwillingness to pay the entire account or the balance of an account not paid by insurance. The second is an inability to pay (also called Charity Care). FAP Requirements - CORRECT ANSWERSThe ACA required the IRS to issue rules to implement this program. These regulations are known as the IRS 501® rules, and apply only to non-profit providers as designated by section 501(c)3 status. IRS Code 501(c)3 - CORRECT ANSWERSRegulations that must be met by all hospitals to legally qualify as non-profit under the ACA Community Health Needs Assessment - CORRECT ANSWERSMust be conducted in order to qualify as a 501(c)(3) tax-exempt facility. It must identify the community's needs and must include input from community members. Must be made widely available to the public via a hospital facility's website Extraordinary Collections Actions (ECAs) - CORRECT ANSWERSMay not be pursued until after the hospital has taken reasonable efforts to determine the patient's eligibility for financial assistance. This section applies to hospitals as well as other entities, such as collection agencies, working on behalf of the hospital. Includes garnishments, liens, and selling debt to third parties. Consumer Credit Protection Act Title 1 - CORRECT ANSWERSTruth in Lending Act. If triggered, a hospital must disclose the details of a debt repayment plan with a patient. Consumer Credit Protection Act Title 3 - CORRECT ANSWERSRestrictions on Garnishment. Establishes maximum limits for wage garnishments, either 25% of a worker's disposable earnings per week, or the amount by which a worker's hourly wage exceeds 30x the federal minimum wage. Consumer Credit Protection Act Title 6 - CORRECT ANSWERSFair Credit Reporting Act. Affects those who "issue or use reports on consumers in connection with the approval of credit." This section limits the use of consumer credit reports. For example, collection accounts must be removed after seven years. Consumer Credit Protection Act Title 8 - CORRECT ANSWERSFair Debt Collection Practices Act (FDCPA). Governs the actions and practices a debt collector may take when pursuing a debtor. Chapter 7 Straight Bankruptcy - CORRECT ANSWERSA court proceeding that liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from his/her debt. Chapter 11 Debtor Reorganization - CORRECT ANSWERSPermits a debtor to work out a court-supervised plan with his/her creditor, usually in the nature of a composition (reduction in debt), an extension (more time to pay off the debt), or a receivership (involving the continuing management of the debtor's business or property. Chapter 13 Debtor Rehabilitation - CORRECT ANSWERSCourt proceeding that does not liquidate property nor discharge debts. Rather, serves to reorganize a debtor's holdings and instruct creditors to look to the debtor's future earnings for payment. Garnishment is a form of debtor rehabilitation. Telephone Consumer Protection Act (TCPA) - CORRECT ANSWERSDesigned to restrict auto-callers and automated messages by telemarketers. [Show Less]
- Exam
- $11.45
- 0
- 164
CRCR 2 - Pre-Service Financial Care -30 Quiz with Answers,100% CORRECT
CRCR 2 - Pre-Service Financial Care -30 Quiz with Answers While the highest level of differentiation among patients is scheduled patient vs unschedule... [Show More] d patient, a variety of patient types are routinely identified in both the acute and non-acute settings. Which patient types are typically considered acute care patients? (Pre-Test2) - CORRECT ANSWERSObservation, newborn, emergency (ED) Accurate identification of the patient is the first step in the scheduling process. Identifiers used in various combination to achieve accurate patient identification include? (Pre-Test2) - CORRECT ANSWERSFull legal name, date of birth, sex and social security number Pre-registration is defined as: (Pre-Test2) - CORRECT ANSWERSThe collection of demographic information, insurance data, financial information, providing reminders, prep information, and identifying the potential need for financial assistance for scheduled patients. Medicare has unique features not found in other health plan programs. It is government sponsored and financed through taxes and general revenue funds. Which of the following statements accurately describe the various Medicare benefit programs: (Pre-Test2) - CORRECT ANSWERSMedicare Part A provides benefits for inpatient hospital services, skilled nursing care and home health care; Medicare Part B covers outpatient and professional services; Medicare Part C or Medicare Advantage plans are managed care plans combining Part A and Part B coverages; and Medicare part D is the prescription drug coverage benefit. Which of the following statements about Medicaid eligibility is NOT true? (Pre-Test2) - CORRECT ANSWERSMedicaid categories are restricted to children, pregnant women and elderly in nursing homes. Examples of managed care plans include: (Pre-Test2) - CORRECT ANSWERSAll of the above Patient Financial Communications best practices include all of the following activities except: (Pre-Test2) - CORRECT ANSWERSCollecting payment or initiating the process to immediately remove the patient from the service schedule. Which statement includes the required components of an accurate pricing determination? (Pre-Test2) - CORRECT ANSWERSInsurance coverage and benefits, service or test involved, diagnosis and procedure codes, total estimated charges, adjudication calculations based on the patient's benefit package. The value of a robust scheduling and pre-registration process includes all of the following except: (Pre-Test2) - CORRECT ANSWERSIdentification of patients who are likely to be "no shows". Which patients are considered scheduled? (KC2.1) - CORRECT ANSWERSRecurring/Series Patients Name the guideline that Medicare established to determine which diagnoses, signs, or symptoms are payable. (KC2.2) - CORRECT ANSWERSLocal Coverage Determinations (LCD) What is the purpose of insurance verification? (KC2.3) - CORRECT ANSWERSTo ensure accuracy of the health plan information. The attempt to reduce costs through contractual agreements with providers is best described as: (KC2.4) - CORRECT ANSWERSManaged Care Plans The nation's oldest and largest family of private health benefits companies: (KC2.4) - CORRECT ANSWERSBlue Cross/Blue Shield Health plans that cover almost all services without authorization requirements are: (KC2.4) - CORRECT ANSWERSCommercial Indemnity Plans Plans where the costs of medical care are borne by the employer on a pay-as-you-go basis are called: (KC2.4) - CORRECT ANSWERSSelf-Insured Plans Plans responsible for providing Federal health services to Native Americans: (KC2.4) - CORRECT ANSWERSIndian Health Service (IHS) Which option is a federally-aided, state-operated program to provide health and long-term care coverage? (KC2.5) - CORRECT ANSWERSMedicaid Which most appropriately describes an HMO plan? (KC2.5) - CORRECT ANSWERSA health plan that provides comprehensive healthcare services, within a designated population, on a pre-payment basis. Which most appropriately describes a CDHP plan? (KC2.5) - CORRECT ANSWERSSubscriber agrees to a high initial deductible, in return for lower premiums. Which most appropriately describes a POS plan? (KC2.5) - CORRECT ANSWERSMembers can refer themselves outside the plan and still get some coverage. Which most appropriately describes a PPO plan? (KC2.5) - CORRECT ANSWERSA group of medical providers is identified to furnish services at lower than usual fees. What is the first step in determining a surgical case price estimate for an uninsured patient? (KC2.6) - CORRECT ANSWERSVerify the patient is not eligible for Medicaid. After verifying the patient is not eligible for Medicaid, what is the next step in determining a surgical case price estimate for an uninsured patient? (KC2.6) - CORRECT ANSWERSObtain total charges for hospital portion of case and identify network status of additional providers. In determining a surgical case price estimate for an uninsured patient, would it be appropriate to apply the organization's self-pay discount BEFORE or AFTER obtaining total charges for hospital portion of case and identifying network status of additional providers? (KC2.6) - CORRECT ANSWERSAFTER What is the first component of a pricing determination? (KC2.6) - CORRECT ANSWERSVerification of the patient's insurance eligibility and benefits. After greeting the patient and introducing yourself, what is the next step in financial counseling for an uninsured patient's surgery case? (KC2.7) - CORRECT ANSWERSExplain organization's financial care approach and patient's financial responsibility There are six steps in in financial counseling for an uninsured patient's surgery case. The first two steps are listed below. What is the third step? 1. Greet patient and give your name 2. Explain organization's financial care approach and patient's financial responsibility (KC2.7) - CORRECT ANSWERSReview patient's heath plan benefits and status Select the response that lists the steps in financial counseling for an uninsured patient's surgery case in the correct order. (KC2.7) - CORRECT ANSWERS1. Greet patient and give your name 2. Explain organization's financial care approach and patient's financial responsibility 3. Review patient's heath plan benefits and status 4. Review anticipated charges and patients anticipated liability 5. Ask patient to resolve liability by reviewing payment options 6. For uninsured, explain financial assistance options What is the purpose of financial counseling? - CORRECT ANSWERSTo educate the patient on his/her health plan coverage and financial responsibility for healthcare services [Show Less]
- Exam
- $10.95
- 0
- 161
CRCR EXAM 74 Questions with Answers 2023,100% CORRECT
CRCR EXAM 74 Questions with Answers 2023 HFMA patient financial communications best practices call for annual training for all staff EXCEPT - CORRECT AN... [Show More] SWERSA. Patient access B. Customer service representatives **C. Nursing D. Staff who engage in patient financial communications discussions What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? - CORRECT ANSWERSMedical necessity documentation B. The CMS 1500 Part B attachment C. Correct Part A and B procedural codes **D. Revenue codes The most common resolution methods for credit balances include all of the following EXCEPT - CORRECT ANSWERSA. Designate the overpayment for charity care B. Determine the correct primary payer and notify incorrect payer of overpayment C. Submit the corrected claim to the payer incorporating credits D. Either send a refund or complete a takeback form as directed by the payer. Net Accounts Receivable is - CORRECT ANSWERSA. The total bad debt B. Total debt owed by an entity **C. The amount an entity is reasonably confident of collecting from overall accounts receivable D. The total claims amount billed to health plans For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions - CORRECT ANSWERSA. May take place between the patient and discharge planning **B. Should take place between the patient or guarantor and properly trained provider representatives C. Are optional D. Are focused on verifying required third-party payer information Scheduled procedures routinely include - CORRECT ANSWERSA. Physician's office contact information B. Physician notification that scheduling is complete C. The scheduler's name and contact information **D. Patient preparation instructions ICD-10-CM and ICD-10-PCS code sets are modifications of - CORRECT ANSWERSA. DRGs B. CPT codes C. ICD 9 codes **D. The international ICD-10 codes as developed by the WHO (World Health Organization) The Medicare Bundled Payments for Care Initiative (BCPI) is designed to - CORRECT ANSWERSA. Prevent duplicate billing B. "Stretch" the impact of patient self-pay by squeezing costs down through a lump-sum payment to providers **C. Align incentives between hospitals, physicians, and non-physician providers in order to better coordinate patient care D. Drive down physician fees by forcing physicians to share equitably in one payment Which of the following is required for participation in Medicaid - CORRECT ANSWERSA. Be free of chronic conditions B. Meet a minimum yearly premium C. Obtain a supplemental health insurance policy **D. Meet income and assets requirements A four digit number code established by the National Uniform Billing Committee (NUBC) that categorizes/classifies a line item in the charge master is known as - CORRECT ANSWERSA. CPT codes B. ICD-10 Procedural codes C. HCPCs codes **D. Revenue codes Checks received through mail, cash received through mail, and lock box are all examples of - CORRECT ANSWERSA. Payment methods being phased out for more secure payment method option **B. Control points for cash posting C. Payment methods in which the majority of fraud occurs D. Highly fraud prone processes If further treatment can only be provided in a hospital setting, the patient's condition cannot be evaluated and/or treated within 24 hours, or if there is not an anticipation of improvement in the patient's condition within 24 hours, the patient - CORRECT ANSWERSA. Will remain in observation for up to 72 hours after which the patient is admitted as an inpatient B. Will have his/her case reviewed by the attending physician, a consulting physician and the primary care physician and a future course of care will then be determined C. Will be discharged and if needed, designated to a priority one outpatient status **D. Will be admitted as an inpatient Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare established guideline(s) used to determine - CORRECT ANSWERSA. Medicare and Medicaid provider eligibility **B. What Medicare reimburses and what should be referred to Medicaid C. Which diagnoses, signs, or symptoms are reimbursable D. Medicare outpatient reimbursement rates The ACO Investment model will test the use of pre-paid shared savings to - CORRECT ANSWERS**A. Encourage new ACOs to form in rural and underserved areas B. Attract physicians to participate in the ACO payment system C. Raise quality ratings in designated hospital D. Invest in treatment protocols that reduce costs to Medicar The consumers' right to revoke consent to receive auto-dialed calls and text messages is regulated by - CORRECT ANSWERSA. The Patient Protection and Affordable Care Act (PPACA) **B. The Telephone Consumer Protection Act (TCPA) C. The Interstate-Commerce Commission D. Health Insurance Protection and Portability Act (HIPAA) Medicare has established guidelines called Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish - CORRECT ANSWERSA. Provider and physician reimbursement for specific diagnoses and tests B. Prospective Medicare patient financial responsibilities for a given diagnosis C. Reasonable and customary prices for services in a given area **D. What services or healthcare items are covered under Medicare The best practice in billing is to generate bills that are - CORRECT ANSWERSA. Direct in summarizing charges and in requesting prompt payment B. Comprehensive and all-inclusive **C. Clear, concise, correct, and patient-friendly D. Timely and specifies the patient's next steps Appropriate training for patient financial counseling staff must cover all of the following EXCEPT - CORRECT ANSWERSA. Available patient financing options **B. Documenting the conversation in the medical record C. Financial assistance policies D. Patient financial communications best practices specific to staff role For scheduled patients, which of the following are NOT important revenue cycle activities in the time-of-service stage? - CORRECT ANSWERSA. Pre-registration record is activated, consents are signed, and co-payment are collected B. Pre-processed patients are directed to a designated "express arrival" desk C. Positive patient identification is completed, and the patient is given an armband **D. Final bill is presented for payment All of the following are steps in verifying insurance EXCEPT - CORRECT ANSWERSA. Identifying and documenting the patient's health plan benefits B. Confirming the patient's eligibility for benefits C. The patient signing the statement of financial responsibility **D. Sequencing plans involved in a coordination of benefits (COB) situation Medicare beneficiaries may appeal - CORRECT ANSWERSA. For a waiver from pre-authorization of treatment for specified chronic conditions B. Only payment issues seriously affecting the patient's access to care C. Virtually any issue related to the provision and payment of services **D. For reclassification of ongoing services not covered by Medicare as a Medicare Chronic Care Exemption What is the Continuum of Care? - CORRECT ANSWERSA. The clinical treatment course selected by the attending physician **B. The coordination and linkage of resources needed to avoid the duplication of services and the facilitation of a seamless movement among care settings C. All clinical services provided in a hospital D. Post- inpatient treatment This directive was developed to promote and ensure healthcare quality and value and also to protect consumers and workers in the healthcare system. This directive is called - CORRECT ANSWERS**A. Patient bill of rights B. Medicare patient and staff safety standards C. Joint Commission for Accreditation of Healthcare Organizations (JCAHO) safety standards D. Payer quality monitoring Claims with dates of service received later than one calendar year beyond the date of service, will be - CORRECT ANSWERSA. The full responsibility of the patient **B. Denied by Medicare C. The provider's responsibility but can be deemed charity care D. Fully paid with interest Applying the contracted payment amount to the amount of total charges yields - CORRECT ANSWERSA. A pricing agreement **B. An estimated price for the patients responsibility C. A service cost guarantee D. A price justified revenue accrual Identifying the patient in the MPI, creating the registration record, completing medical necessity screening, determining insurance eligibility and benefits, resolving managed care requirements, and completing financial education/resolution are all - CORRECT ANSWERS**A. The data collection steps for scheduling and pre-registering a patient B. The steps mandated for billing Medicare Part A C. Registration steps that must be completed before any medical services are provided D. The process of closing an account Eliminating mail time and reducing data entry time; electronically monitoring the receipt of claims and online claim adjudication; more prompt payment are all benefits achieved by - CORRECT ANSWERS**A. The electronic submission of claims using electronic transactions B. Regular chargemaster description maintenance C. Accurate and complete documentation of medical record by coders D. Well-trained Patient Access and Contract Management staff Which department supports/collaborates with the revenue cycle? - CORRECT ANSWERS**A. Information Technology B. Continuum of Care C. Software Applications D. Hospice The Truth in Lending Act establishes - CORRECT ANSWERSA. Consumer disclosure requirements to obtain credit B. Repayment and interest rate schedules C. Conditions under which a non-profit entity may extend credit **D. Disclosure rules for consumer credit sales and consumer loans The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physicians to do all of the following EXCEPT - CORRECT ANSWERS**A. Obtain higher compensation for physicians B. Embrace new reimbursement models C. Drive significant improvements in the areas of quality and the patient experience D. Improve outcomes Insurance verification results in which of the following? - CORRECT ANSWERSA. The resolution of managed care and billing requirements **B. The accurate identification of the patient's eligibility C. The consistent formatting of the patient's name and identification number D. The identification of physician fee schedule amounts and the NPI (National Provider Identifier) numbers Medicare Part A benefits provide coverage for - CORRECT ANSWERSA. Physician office visits B. All medical services for eligible beneficiaries over the age of 70 **C. Inpatient hospital services, skilled nursing care, and home health care D. Medical services for indigents and those living below the poverty level What type of account adjustment results from the patient's unwillingness to pay a self-pay balance? - CORRECT ANSWERS**A. Bad debt adjustment B. Charity adjustment C. Administrative adjustment D. Contractual adjustment Medicare Part B has an annual deductible, and the beneficiary is responsible for - CORRECT ANSWERSA. Physicians office fees B. Prescriptions C. Tests outside of an inpatient setting **D. A co-insurance payment for all Part B covered services The Two Midnight Rule allows hospitals to account for total hospital time including - CORRECT ANSWERSA. Costs outside of what is regular and customary occurring within the first 48 hours of inpatient care B. Attending physician "on-call" time C. Off site ancillary services **D. Outpatient time directly preceding the inpatient admission Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with - CORRECT ANSWERS**A. The Provider Reimbursement Review Board B. The Department of Health and Human Services Provider Relations Division C. A court appointed federal mediator D. The Office of the Inspector General A recurring/series registration is characterized by - CORRECT ANSWERSA. The creation of one registration record per diagnosis per visit B. The creation of multiple registrations for multiple services **C. The creation of one registration record for multiple days of service D. The creation of multiple patient types for one date of service The advantages to using a third-party collection agency include all of the following EXCEPT - CORRECT ANSWERSA. Providers pay pennies on each dollar collected **B. Collection agencies can establish a complete documentation record that may be critical in litigation activities C. ollection agencies may collect appropriately assigned accounts faster than the provider D. Collection agencies have tools and technologies that are effective in pursuing aged self-pay accounts Most major health plans including Medicare and Medicaid, offer - CORRECT ANSWERS**A. Electronic and/or web portal verification B. A grace period for obtaining verification within 72 hours of treatment C. Toll free verification hot lines, staffed around the clock D. Patient "verification of benefits" cards All of the following are steps in safeguarding collections EXCEPT - CORRECT ANSWERSA. Placing collections in a lock-box for posting review the next business day B. Posting the payment to the patient's account **C. Issuing receipts D. Completing balancing activities The first and most critical step in registering a patient, whether scheduled or unscheduled, is - CORRECT ANSWERSA. Having the patient initial the HIPAA privacy statement **B. Verifying the patient's identification C. Verifying insurance to activate the patient medical record D. Check the schedule for treatment availability Hospitals can only convert an inpatient case to observation if the hospital utilization review committee determines this status before the patient is discharged and - CORRECT ANSWERSA. Before closing the patient's account B. After any billing **C. Prior to billing, that an observation setting will be more appropriate D. With the consent of the third-party payer's medical director that an observation setting will be more appropriate The most effective payment plan programs - CORRECT ANSWERSA. Are rigorous in patient follow-up **B. Screen patients to determine if they are capable of paying C. Do not allow missed payments D. Are turned over to a collection agency Each patient is assigned a unique number, commonly called the - CORRECT ANSWERSA. Medical case number **B. Master Patient Index (MPI) number C. Patient Identifier D. Patient Classification A claim for reimbursement submitted to a third-party payer that has all the information and documentation required for the payer to make a decision on it is known as - CORRECT ANSWERS**A. An authorized request for repayment B. A correct claim C. A clean claim D. Payer accepted billing Health Plan Contracting Departments do all of the following EXCEPT - CORRECT ANSWERSA. Review payment schemes to ensure that the health plan and provider understand how reimbursements must be calculated B. Review contracts to ensure the appeals process for denied claims is clearly specified **C. Establish a global reimbursement rate to use with all third-party payers D. Review all managed care contracts for accuracy for loading contract terms into the patient accounting system Duplicate payments occur - CORRECT ANSWERS**A. When providers re-bill claims based on nonpayment from the initial bill submission B. When service departments do not process charges with the organization's suspense days C. When there are other healthcare claims in process and the anticipated deductibles and co-insurance amounts still show open but will be met by the in-process claims D. When the payer's coordination of benefits is not captured correctly at the time of patient registration In a self-insured (or self-funded) plan, the costs of medical care are - CORRECT ANSWERSA. Created by a combination of employer and employee contributions B. Mandated by the Affordable Care Act for small businesses unable to obtain commercial coverage C. Backed-up by stop-loss insurance against a catastrophic claim **D. Borne by the employer on a pay-as-you-go basis The result of accurate census balancing on a daily basis is - CORRECT ANSWERS**A. The overall accuracy of resource planning B. Improved ability to plan nursing staff support services C. The increased efficiency in treatment D. The correct recording of room charges Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - CORRECT ANSWERS**A. The Medicare Administrative Contractor (MAC) at the end of the hospice cap period B. Each state's Medicaid plan C. Medicare D. The Center for Medicare and Medicaid Services (CMS) Internal controls addressing coding and reimbursement changes are put in place to guard against - CORRECT ANSWERSA. Denials **B. Compliance fraud by "upcoding" C. Underpayments D. Charge master error Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the provider may not ask about a patient's insurance information if it would delay what? - CORRECT ANSWERSA. Admission to observation status **B. Medical screening and stabilizing treatment C. Transfer to another facility D. Complete course of treatment Medicare patients are NOT required to produce a physician's order to receive which of these services? - CORRECT ANSWERS**A. Screening mammography, flu vaccine or pneumonia vaccine B. Diagnostic mammography, flu vaccine or pneumonia vaccine C. Screening mammography, flu vaccine or B-12 shots D. Diagnostic mammography, flu vaccine or B-12 shots In order for Regulation Z to apply, a hospital must - CORRECT ANSWERSA. Meet all five of the conditions specified by Regulation Z **B. Make available to all creditors, patient financial information obtained in the credit application process C. Have a credit granting mechanism in place D. Obtain credit insurance in the event of a debtor credit default In a Chapter 7 Straight Bankruptcy filing - CORRECT ANSWERSA. The court establishes a creditor payment schedule with the longest outstanding claims paid first B. The court liquidates the debtor's nonexempt property, pays creditors, and begins to pays off the largest claims first. All claims are paid some portion of the amount owed. **C. The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt D. The court vacates all claims against a debtor with the understanding that the debtor may not apply for credit without court supervision The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to - CORRECT ANSWERSA. Patient financial obligations for the entire cost of treatment **B. Medicare and Medicaid payments C. Commercial third-party payers D. Unregulated market activity for third-party payers Revenue cycle activities occurring at the point-of-service include all of the following EXCEPT - CORRECT ANSWERSA. The provision of case management and discharge planning services B. The monitoring of charges **C. Providing charges to the third-party payer as they are incurred D. The generation of charges In resolving medical accounts, a law firm may be used as - CORRECT ANSWERSA. An independent broker of patient financial assistance from banks B. An independent auditor of a Financial Assistance Policy C. Legal counsel to patients regarding financing options **D. A substitute for a collection agency Health Information Management (HIM) is responsible for - CORRECT ANSWERSA. The maintenance of all software applications B. Clean claims being filed C. The maintenance of the entire technology infrastructure **D. All patient medical records The soft cost of a dissatisfied customer is - CORRECT ANSWERSA. Potentially negative treatment outcomes leading to expanding length-of-stay **B. The customer passing on information about their negative experience to potential patients or through social media channels C. Lowered quality outcomes for the dissatisfied patient D. The "cost" of staff providing extra attention in trying to perform service recovery A routine patient financial discussion would include - CORRECT ANSWERSA. Gathering the patient's banking information B. Determining and notifying the patient of their ineligibility for financial assistance due to existing insurance coverage **C. Explaining the benefits identified through verifying the patient's insurance D. Refunding an overpayment Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act)? - CORRECT ANSWERSA. Initial registration activities only take place when they do not delay treatment and there is no suggestion that treatment will not be provided to uninsured people **B. Registration staff members routinely contact managed care plans for prior authorizations before the patient is seen by the on-duty physician C. Signage is posted where it can be easily seen and read by patients D. Copayments are collected at the time of service once the medical screening and stabilization activities are completed The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as - CORRECT ANSWERSA. Patient self-pay identification **B. Insurance verification of reimbursable charges C. Price estimation D. Accounts resolution The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) initiative was launched to - CORRECT ANSWERSA. Provide data for building shared savings reimbursement for quality procedures. B. Create a national database on physician quality. **C. Provide a standardized method for evaluating patients' perspective on hospital care. D. Gather national data on overall trust in the nation's health care system. The importance of medical records being maintained by HIM is that the patient records - CORRECT ANSWERSA. Are the evidence cited in quality review **B. Are the primary source for clinical data required for reimbursement by health plans and liability payer C. Are evidence used in assessing the quality of care D. Are the strongest evidence and defense in the event of a Medicare audit Improving the overall patient experience requires revenue cycle leadership and staff to simultaneously be - CORRECT ANSWERS**A. Clear on policies and consistent in applying the policies B. Responsive and flexible C. Careful in screening patient demands D. Monitoring the costs and charges the patient incurs HFMA's patient financial communications best practices specify that patients should be told about the types of services provided and - CORRECT ANSWERSA. The price of service to their covering health plan B. A satisfaction survey regarding clinical service providers C. An explanation of why a specific service is not provided **D. The service providers that typically participate in the service, e.g., radiologists, pathologists, etc. When billing Rural Health Clinic services on a UB-04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521). Although codes are collapsed into a single revenue code, it is still important to list the appropriate CPT codes as part - CORRECT ANSWERS**A. This insures that the full and proper amount is remitted promptly B. Failure to include the CPT codes will trigger a denial C. These codes will be used to determine medical necessity and useful in determining what happened during the encounter D. This is a required compliance protocol The Two Midnight Rule allows hospitals to account for total hospital time when determining if an inpatient admission order should be written based on - CORRECT ANSWERSA. A beneficiary needing a minimum of 48 hours of care **B. The expectation that the beneficiary will stay in the hospital for two or more midnights receiving medically necessary care C. The expectation that the beneficiary will receive all medically necessary care within a 48 hour period D. The beneficiary receiving medically necessary care and the hospital receiving all required pre-authorizations During pre-registration, a search for the patient's MPI number is initiated using which of the following data sets? - CORRECT ANSWERS**A. Patient's full legal name and date of birth or the patient's Social Security number B. Patient's full legal name and address C. Patient's Social Security number and home address D. Patient's full legal name and health plan group numbers Patient financial communications best practices produce communications that are - CORRECT ANSWERSA. Current and report the status of a patient's claim **B. Consistent, clear and transparent C. Timely, comprehensive and specifying next steps D. Timely and remind patients of their financial responsibilities HIPAA has adopted Employer Identification Numbers (EINs) to be used in standard transactions to identify the employer of an individual described in a transaction. EINs are created and assigned by - CORRECT ANSWERSA. The United States Department of the Treasury B. The United States Department of Labor **C. The Internal Revenue Service D. The Social Security Administration The most accurate way to validate patient information is to - CORRECT ANSWERSA. Require clinical staff to verify information at each treatment encounter **B. Request that the patient provide certain, specific demographic data at each encounter C. Read it slowly to the patient noting any corrections D. Provide a hard-copy of demographic data to the patient for review, update and signature In choosing a setting for patient financial discussions, organizations should first and foremost - CORRECT ANSWERSA. Hold the discussion in a business office B. Assess locations for comfort C. Select a public location where the discussion will appear common-place **D. Select locations that protect the patient's privacy [Show Less]
- Exam
- $12.95
- 0
- 567
CRCR Certification Exam 372 Questions with Answers 2023,100% CORRECT
CRCR Certification Exam 372 Questions with Answers 2023 The disadvantages of outsourcing include all of the following EXCEPT: a) The impact of customer... [Show More] service or patient relations b) The impact of loss of direct control of accounts receivable services c) Increased costs due to vendor ineffectiveness d) Reduced internal staffing costs and a reliance on outsourced staff - CORRECT ANSWERSd) Reduced internal staffing costs and a reliance on outsourced staff The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: a) Medical necessity review by an independent physician's panel b) Judicial review by a federal district court c) Redetermination by the company that handles claims for Medicare d) Review by the Medicare Appeals Council (Appeals Council) - CORRECT ANSWERSb) Judicial review by a federal district court Business ethics, or organizational ethics represent: a) The principles and standards by which organizations operate b) Regulations that must be followed by law c) Definitions of appropriate customer service d) The code of acceptable conduct - CORRECT ANSWERSa) The principles and standards by which organizations operate A portion of the accounts receivable inventory which has NOT qualified for billing includes: a) Charitable pledges b) Accounts created during pre-registration but not activated c) Accounts coded but held within the suspense period d) Accounts assigned to a pre-collection agency - CORRECT ANSWERSa) Charitable pledges Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare established guideline(s) used to determine: a) Medicare and Medicaid provider eligibility b) Medicare outpatient reimbursement rates c) Which diagnoses, signs, or symptoms are reimbursable d) What Medicare reimburses and what should be referred to Medicaid - CORRECT ANSWERSc) Which diagnoses, signs, or symptoms are reimbursable Days in A/R is calculated based on the value of: a) The total accounts receivable on a specific date b) Total anticipated revenue minus expenses c) The time it takes to collect anticipated revenue d) Total cash received to date - CORRECT ANSWERSc) The time it takes to collect anticipated revenue Patients are contacting hospitals to proactively inquire about costs and fees prior to agreeing to service. The problem for hospitals in providing such information is: a) That hospitals don't want to establish a price without knowing if the patient has insurance and how much reimbursement can be expected b) The fact that charge master lists the total charge, not net charges that reflect charges after a payer's contractual adjustment c) That hospitals don't want to be put in the position of "guaranteeing" price without having room for additional charges that may arise in the course of treatment d) Their reluctance to share proprietary information - CORRECT ANSWERSb) The fact that charge master lists the total charge, not net charges that reflect charges after a payer's contractual adjustment Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite discharge, the HFMA best practice is to: a) Make sure that the attending staff can answer questions and assist in obtaining required patient financial data b) Have a patient responsibilities kit ready for the patient, containing all of the required registration forms and instructions c) Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow d) Decline such request as finance discussions can disrupt patient care and patient flow - CORRECT ANSWERSc) Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow A comprehensive "Compliance Program" is defined as a) Annual legal audit and review for adherence to regulations b) Educating staff on regulations c) Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met d) The development of operational policies that correspond to regulations - CORRECT ANSWERSc) Systematic procedures to ensure that the provisions of regulations imposed by a government 10. Case Management requires that a case manager be assigned a) To patients of any physician requesting case management b) To a select patient group c) To every patient d) To specific cases designated by third party contractual agreement - CORRECT ANSWERSb) To a select patient group Pricing transparency is defined as readily available information on the price of healthcare services, that together with other information, help define the value of those services and enable consumers to a) Identify, compare, and choose providers that offer the desired level of value b) Customize health care with a personally chosen mix of providers c) Negotiate the cost of health plan premiums d) Verify the cost of individual clinicians - CORRECT ANSWERSa) Identify, compare, and choose providers that offer the desired level of value Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a monthly fee is known as a a) MSO b) HMO c) PPO d) GPO - CORRECT ANSWERSb) HMO In a Chapter 7 Straight Bankruptcy filing a) The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt b) The court liquidates the debtor's nonexempt property, pays creditors, and begins to pay off the largest claims first. All claims are paid some portion of the amount owed c) The court vacates all claims against a debtor with the understanding that the debtor may not apply for credit without court supervision d) The court establishes a creditor payment schedule with the longest outstanding claims paid first - CORRECT ANSWERSa) The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt 14. The core financial activities resolved within patient access include: a) Scheduling, pre-registration, insurance verification and managed care processing b) Scheduling, insurance verification, clinical discharge processing and payment posting of point of service receipts c) Scheduling, registration, charge entry and managed care processing d) Scheduling, pre-registration, registration, medical necessity screening and patient refunds - CORRECT ANSWERSa) Scheduling, pre-registration, insurance verification and managed care processing 15. Which of the following is NOT contained in a collection agency agreement? a) A clear understanding that the provider retains ownership of any outsourced activities b) Specific language as to who will pay legal fees, if needed c) An annual renewal clause d) A mutual hold-harmless clause - CORRECT ANSWERSd) A mutual hold-harmless clause 16. Maintaining routine contact with the health plan or liability payer, making sure all required information is provided and all needed approvals are obtained is the responsibility of: a) Patient Accounts b) Managed Care Contract Staff c) HIM staff d) Case Management - CORRECT ANSWERSd) Case Management What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? a) Revenue codes b) Correct Part A and B procedural codes c) The CMS 1500 Part B attachment d) Medical necessity documentation - CORRECT ANSWERSa) Revenue codes Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implement procedures for identifying and processing accounts: a) Monitor compliance b) Have the account triaged for any partial payment possibilities c) Assist in arranging for a commercial bank loan d) Obtain the patients income tax statements from the prior 2 years - CORRECT ANSWERSa) Monitor compliance For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: a) Are optional b) Should take place between the patient or guarantor and properly trained provider representatives c) May take place between the patient and discharge planning d) Are focused on verifying required third-party payer information - CORRECT ANSWERSb) Should take place between the patient or guarantor and properly trained provider representatives The purpose of a financial report is to: a) Provide a public record, if requested b) Present financial information to decision makers c) Prepare tax documents d) Monitor expenses - CORRECT ANSWERSb) Present financial information to decision makers Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? a) Registration staff may routinely contact managed are plans for prior authorizations before the patient is seen by the on-duty physician b) Initial registration activities may occur so long as these activities do not delay treatment or suggest that treatment with not be provided to uninsured individuals c) Co-payments may be collected at the time of service once the medical screening and stabilization activities are completed d) Signage must be posted where it can be easily seen and read by patients - CORRECT ANSWERSa) Registration staff may routinely contact managed are plans for prior authorizations before the patient is seen by the on-duty physician A claim is denied for the following reasons, EXCEPT: a) The health plan cannot identify the subscriber b) The frequency of service was outside the coverage timeline c) The submitted claim does not have the physicians signature d) The subscriber was not enrolled at the time of service - CORRECT ANSWERSc) The submitted claim does not have the physicians signature Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with a) A court appointed federal mediator b) The Department of Health and Human Services Provider Relations Division c) The Office of the Inspector General d) The Provider Reimbursement Review Board - CORRECT ANSWERSd) The Provider Reimbursement Review Board Charges, as the most appropriate measurement of utilization, enables a) Generation of timely and accurate billing b) Managing of expense budgets c) Accuracy of expense and cost capture d) Effective HIM planning - CORRECT ANSWERSa) Generation of timely and accurate billing Ambulance services are billed directly to the health plan for a) All pre-admission emergency transports b) Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility c) The portion of the bill outside of the patient's self-pay d) Transports deemed medically necessary by the attending paramedic-ambulance crew - CORRECT ANSWERSc) The portion of the bill outside of the patient's self-pay An individual enrolled in Medicare who is dissatisfied with the government's claim determination is entitled to reconsideration of the decision. This type of appeal is known as a) A beneficiary appeal b) A Medicare supplemental review c) A payment review d) A Medicare determination appeal - CORRECT ANSWERSa) A beneficiary appeal The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physicians to do all of the following EXCEPT: a) Drive significant improvements in the areas of quality and the patient experience b) Embrace new reimbursement models c) Improve outcomes d) Obtain higher compensation for physicians - CORRECT ANSWERSd) Obtain higher compensation for physicians Duplicate payments occur: a) When providers re-bill claims based on nonpayment from the initial bill submission b) When service departments do not process charges with the organization's suspense days c) When the payer's coordination of benefits is not captured correctly at the time of patient registration d) When there are other healthcare claims in process and the anticipated deductibles and co- insurance amounts still show open but will be met by the in-process claims - CORRECT ANSWERSa) When providers re-bill claims based on nonpayment from the initial bill submission The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can a) Purchase qualified health benefit plans regardless of insured's health status b) Obtain price estimates for medical services c) Negotiate the price of medical services with providers d) Meet federal mandates for insurance coverage and obtain the corresponding tax deduction - CORRECT ANSWERSa) Purchase qualified health benefit plans regardless of insured's health status The most common resolution methods for credit balances include all the following EXCEPT: a) Designate the overpayment for charity care b) Submit the corrected claim to the payer incorporating credits c) Either send a refund or complete a takeback form as directed by the payer d) Determine the correct primary payer and notify incorrect payer of overpayment - CORRECT ANSWERSa) Designate the overpayment for charity care EFT (electronic funds transfer) is a) An electronic claim submission b) The record of payments in the hospital's accounting system c) An electronic confirmation that a payment is due d) An electronic transfer of funds from payer to payee - CORRECT ANSWERSd) An electronic transfer of funds from payer to payee Revenue cycle activities occurring at the point-of-service include all the following EXCEPT: a) The monitoring of charges b) The provision of case management and discharge planning services c) Providing charges to the third-party payer as they are incurred d) The generation of charges - CORRECT ANSWERSc) Providing charges to the third-party payer as they are incurred Medicare beneficiaries remain in the same "benefit period" a) Up to hospitalization discharge b) Until the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days c) Each calendar year d) Up to 60 days - CORRECT ANSWERSb) Until the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and a) Provide evidence of financial status b) Provide a method of measuring the collection and control of A/R c) Establish productivity targets d) Make allowance for accurate revenue forecasting - CORRECT ANSWERSb) Provide a method of measuring the collection and control of A/R Recognizing that health coverage is complicated and not all patients are able to navigate this terrain, HFMA best practices specify that a) The patient accounts staff have someone assigned to research coverage on behalf of patients b) Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions c) Patient coverage education may need to be provided by the health plan d) A representative of the health plan be included in the patient financial responsibilities discussion - CORRECT ANSWERSb) Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions When there is a request for service, the scheduling staff member must confirm the patient's unique identification information to a) Check if there is any patient balance due b) Verify the patient's insurance coverage if the patient is a returning customer c) Confirm that physician orders have been received d) Ensure that she/he accesses the correct information in the historical database - CORRECT ANSWERSd) Ensure that she/he accesses the correct information in the historical database Once the price is estimated in the pre-service stage, a provider's financial best practice is to a) Explain to the patient their financial responsibility and to determine the plan for payment b) Allow the patient time to compare prices with other providers c) Lock-in the prices d) Have another employee double check the price estimate - CORRECT ANSWERSa) Explain to the patient their financial responsibility and to determine the plan for payment What type of account adjustment results from the patient's unwillingness to pay a self-pay balance? a) Charity adjustment b) Bad debt adjustment c) Contractual adjustment d) Administrative adjustment - CORRECT ANSWERSb) Bad debt adjustment All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT a) Medically unnecessary b) Not delivered in a Medicare licensed care setting c) Offered in an outpatient setting d) Services and procedures that are custodial in nature - CORRECT ANSWERSd) Services and procedures that are custodial in nature All of the following are forms of hospital payment contracting EXCEPT a) Contracted Rebating b) Per Diem Payment c) Fixed Contracting d) Bundled Payment - CORRECT ANSWERSa) Contracted Rebating Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by: a) The Center for Medicare and Medicaid Services (CMS) b) Each state's Medicaid plan c) Medicare d) The Medicare Administrative Contractor (MAC) at the end of the hospice cap period - CORRECT ANSWERSd) The Medicare Administrative Contractor (MAC) at the end of the hospice cap period With the advent of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is out than ever for hospitals to a) Reschedule the visit for non-payment of a prior balance b) Strictly limit charity care and bad-debt c) Collect patient's self-pay and deductibles in the first encounter d) Assist patients in understanding their insurance coverage and their financial obligation - CORRECT ANSWERSd) Assist patients in understanding their insurance coverage and their financial obligation A nightly room charge will be incorrect if the patient's a) Discharge for the next day has not been charted b) Condition has not been discussed during the shift change report meeting c) Pharmacy orders to the ICU have not been entered in the pharmacy system d) Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system - CORRECT ANSWERSd) Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system Which of the following is required for participation in Medicaid? a) Meet income and assets requirements b) Meet a minimum yearly premium c) Be free of chronic conditions d) Obtain a health insurance policy - CORRECT ANSWERSa) Meet income and assets requirements HFMA best practices call for patient financial discussions to be reinforced a) By issuing a new invoice to the patient b) By copying the provider's attorney on a written statement of conversation c) By obtaining some type of collateral d) By changing policies to programs - CORRECT ANSWERSb) By copying the provider's attorney on a written statement of conversation A Medicare Part A benefit period begins: a) With admission as an inpatient b) The first day in which an individual has not been a hospital inpatient not in a skilled nursing facility for the previous 60 days c) Upon the day the coverage premium is paid d) Immediately once authorization for treatment is provided by the health plan - CORRECT ANSWERSa) With admission as an inpatient If further treatment can only be provided in a hospital setting, the patient's condition cannot be evaluated and/or treated within 24 hours, or if there is not an anticipation of improvement in the patient's condition with 24 hours, the patient a) Will remain in observation for up to 72 hours after which the patient is admitted as an inpatient b) Will be admitted as an inpatient c) Will be discharged and if needed, designated to a priority one outpatient status d) Will have his/her case reviewed by the attending physician, a consulting physician and the primary care physician and a future course of care will then be determined - CORRECT ANSWERSb) Will be admitted as an inpatient It is important to have high registration quality standards because a) Incomplete registrations will trigger exclusion from Medicare participation b) Incomplete registrations will raise satisfaction scores for the hospital c) Inaccurate registration may cause discharge before full treatment is obtained d) Inaccurate or incomplete patient data will delay payment or cause denials - CORRECT ANSWERSd) Inaccurate or incomplete patient data will delay payment or cause denials Medicare will only pay for tests and services that a) Constitute appropriate treatment and are fairly priced b) Have solid documentation c) Can be demonstrated as necessary d) Medicare determines are "reasonable and necessary" - CORRECT ANSWERSd) Medicare determines are "reasonable and necessary" Room and bed charges are typically posted a) From case management reports generated for contracted payers b) Through the case management daily resource report c) At the end of each business day d) From the midnight census - CORRECT ANSWERSd) From the midnight census The process of creating the pre-registration record ensures a) Ability to pursue extraordinary collection activities b) Early and productive communication with a third-party payer c) Accurate billing d) That access staff will have the compete and valid information needed to finalize any remaining pre-access activities - CORRECT ANSWERSc) Accurate billing Once the EMTALA requirements are satisfied a) Third-party payer information should be collected from the patient and the payer should be notified of the ED visit b) The patient then assumes full liability for services unless a third-party is notified or the patient applies for financial assistance with the first 48 hours c) The remaining registration processing is initiated at the bedside or in a registration area d) An initial registration record is completed so that the proper coding can be initiated - CORRECT ANSWERSc) The remaining registration processing is initiated at the bedside or in a registration area This directive was developed to promote and ensure healthcare quality and value and also, to protect consumers and workers in the healthcare system. This directive is called a) Payer quality monitoring b) Medicare patient and staff safety standards c) Joint Commission for Accreditation of Healthcare Organizations (JCAHO) safety d) Patient bill of rights - CORRECT ANSWERSd) Patient bill of rights A scheduled inpatient represents an opportunity for the provider to do which of the following? a) Refer the patient to another location with the health system b) Comply with EMTALA (Emergency Medical Treatment and Labor Act) requirements before service c) Complete registration and insurance approval before service d) Register the patient after he or she is placed in a bed on that service unit. - CORRECT ANSWERSc) Complete registration and insurance approval before service The first and most critical step in registering a patient, whether scheduled or unscheduled, is a) Having the patient initial the HIPAA privacy statement b) Verifying insurance to activate the patient medical record c) Verifying the patient's identification d) Check the schedule for treatment availability - CORRECT ANSWERSc) Verifying the patient's identification The legal authority to request and analyze provider clam documentation to ensure that IPPS services were reasonable and necessary is given to a) Recovery Audit Contractors (RAC) b) The Office of the U.S. Inspector General (OIG) c) All health plans d) State insurance commissioners - CORRECT ANSWERSb) The Office of the U.S. Inspector General (OIG) An advantage of a pre-registration program is a) The opportunity to reduce processing times at the time of service b) The ability to eliminate no-show appointments c) The opportunity to reduce the corporate compliance failures within the registration process d) The marketing value of such a program - CORRECT ANSWERSc) The opportunity to reduce the corporate compliance failures within the registration process Claims with dates of service received later than one calendar year beyond the date of service, will be a) Denied by Medicare b) The provider's responsibility but can be deemed charity care c) Fully paid with interest d) The full responsibility of the patient. - CORRECT ANSWERSa) Denied by Medicare This concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits a) Third-party invoicing b) Account resolution c) Claims processing d) Billing - CORRECT ANSWERSc) Claims processing The ACO investment model will test the use of pre-paid shared savings to a) Raise quality ratings in designated hospitals. b) Encourage new ACOs to form in rural and underserved areas c) Attract physicians to participate in the ACO payment system d) Invest in treatment protocols that reduce costs to Medicare - CORRECT ANSWERSb) Encourage new ACOs to form in rural and underserved areas Chapter 13 Bankruptcy, debtor rehabilitation, is a court proceeding a) That establishes a payment priority order to creditors' claims b) That classifies the debtor as eligible for government financial assistance for housing, medical treatment and food as debts are paid c) That creates a clear court-supervised payment accountability plan going forward d) That reorganizes a debtor's holdings and instructs creditors to look to the debtor's future earnings for payment - CORRECT ANSWERSd) That reorganizes a debtor's holdings and instructs creditors to look to the debtor's future earnings for payment HFMA's patient financial communication best practices specify that patients should be told about the types of services provided and a) A satisfaction survey regarding clinical service providers b) The price of service to their covering health plan c) The service providers that typically participate in the service, e.g., radiologists, pathologists, etc. d) An expiration of why a specific service is not provided - CORRECT ANSWERSc) The service providers that typically participate in the service, e.g., radiologists, pathologists, etc. The important Message from Medicare provides beneficiaries information concerning their: a) Understanding of billing issues and the deductibles and/or co-insurance due for the current visit b) Right to refuse to use lifetime reserve days for the current stay c) Right to appeal a discharge decision if the patient disagrees with the plan d) Obligation to reimburse the hospital for any services not covered by the Medicare program - CORRECT ANSWERSc) Right to appeal a discharge decision if the patient disagrees with the plan All of the following are potential causes of credit balances EXCEPT: a) Duplicate payments b) Primary and secondary payers both paying as primary c) Inaccurate upfront collections based on incorrect liability estimates d) A patient's choice to build up a credit against future medical bills - CORRECT ANSWERSd) A patient's choice to build up a credit against future medical bills Medicare Part B has an annual deductible, and the beneficiary is responsible for a) A co-insurance payment for all Part B covered services b) Physician's office fees c) Tests outside of an inpatient setting d) Prescriptions - CORRECT ANSWERSa) A co-insurance payment for all Part B covered services The importance of medical records being maintained by HIM is that the patient records a) Are the primary source for clinical data required for reimbursement by health plans and liability payers b) Are the strongest evidence and defense in the event of a Medicare audit c) Are evidence used in assessing the quality of care d) Are the evidence cited in quality review - CORRECT ANSWERSa) Are the primary source for clinical data required for reimbursement by health plans and liability payers A decision on whether a patient should be admitted as an inpatient or become an outpatient observation patient requires medical judgments based on all of the following EXCEPT: a) The patient's home care coverage b) Current medical needs c) The likelihood of an adverse event occurring to the patient d) The patient's medical history - CORRECT ANSWERSa) The patient's home care coverage Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish a) Provider and physician reimbursement for specific diagnoses and tests b) Prospective Medicare patient financial responsibilities for a given diagnosis c) Reasonable and customary prices for services in a given area d) What services or healthcare items are covered under Medicare - CORRECT ANSWERSd) What services or healthcare items are covered under Medicare What are some core elements if a board-approved financial assistance policy? a) Payment requirements, staffing hours, and admission policies b) Case management, payment methods, and discharge policies c) Deposit requirements, pre-registration calling hours, and charity care policy d) Eligibility, application process, and nonpayment collection activities - CORRECT ANSWERSd) Eligibility, application process, and nonpayment collection activities The ICD-10 codes set and CPT/HCPCS code sets combines provide a) Pricing floors for services b) The financial data required for activity-based costing c) Patients an overview of services covered by their health insurance plan d) The specificity and coding needed to support reimbursement claims - CORRECT ANSWERSd) The specificity and coding needed to support reimbursement claims A recurring/series registration is characterized by a) A creation of multiple registrations for multiple services b) The creation of one registration record for multiple days of service c) The creation of multiple patient types for one date of service d) The creation of one registration record per diagnosis per visit - CORRECT ANSWERSb) The creation of one registration record for multiple days of service Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the provider may not ask about a patient's insurance information if it would delay what? a) Complete course of treatment b) Medical screening and stabilizing treatment c) Admission to observation status d) Transfer to another facility - CORRECT ANSWERSb) Medical screening and stabilizing treatment In resolving medical accounts, a law firm may be used as: a) An independent auditor of a financial assistance policy b) Legal counsel to patients regarding financing options c) An independent broker of patient financial assistance from banks d) A substitute for a collection agency - CORRECT ANSWERSd) A substitute for a collection agency The unscheduled "direct" admission represents a patient who: a) Is admitted from a physician's office on an urgent basis b) Arrives at the hospital via ambulance for treatment in the emergency room c) Is an ambulatory patient who collapses in the hospital lobby d) Arrives on the medical helicopter for trauma services - CORRECT ANSWERSa) Is admitted from a physician's office on an urgent basis In the balance resolution process, providers should: a) Stress to the patient that serious consequences may result from refusal to pay b) Remind the patient of their legal responsibility to pay the balance due c) Ask the patient if he or she would like to receive information about payment options and supportive financial assistance programs d) Tag the patients record for possible financial assistance for bad debt - CORRECT ANSWERSc) Ask the patient if he or she would like to receive information about payment options and supportive financial assistance programs Which of the following in NOT included in the Standardized Quality Measures a) Clinical outcomes b) Patient perceptions c) Health care processes d) Cost of services - CORRECT ANSWERSd) Cost of services In the pre-service stage, the requested service is screened for medical necessity, health plan coverage and benefits are verified and: a) Billing authorization is signed by the patient b) The patient signs the consents for treatment c) The patient signs a statement attesting an understanding and acceptance of payment policies d) Pre-authorization are obtained - CORRECT ANSWERSd) Pre-authorization are obtained Improving the overall patient experience requires revenue cycle leadership and staff to simultaneously be: a) Clear on policies and consistent in applying the policies b) Careful in screening patient demands c) Monitoring the costs and charges the patient incurs d) Inquisitive, responsive and flexible - CORRECT ANSWERSa) Clear on policies and consistent in applying the policies Hospitals need which of the following information sets to assess a patient's financial status: a) Income, expenses, debt b) Patient and guarantor's income, expenses and assets c) Income, expenses and capacity to take on more debt d) Assets liquidity, Income, expenses, credit worthiness - CORRECT ANSWERSb) Patient and guarantor's income, expenses and assets For scheduled patients, important revenue cycle activities I the Time of Service stage DO NOT INCLUDE: a) Pre-registration record is activated, consents are signed, and co-payment is collected b) Positive patient identification is completed, and patient is given an armband c) Final bill is presented for payment d) Preprocessed patients may report to a designated "express" desk - CORRECT ANSWERSc) Final bill is presented for payment [Show Less]
- Exam
- $15.45
- 1
- 191
CRCR Part 4|41 Questions with Answers 2023,100% CORRECT
CRCR Part 4|41 Questions with Answers 2023 The liens types - CORRECT ANSWERSagreement, judicial process, statue The third party payer follow up a... [Show More] nd account resolution activities include - CORRECT ANSWERSelectronic work list after untimely non payments, comparison of actual and expected reimbursement, adjustment posts, submitting secondary claims if necessary liability payers - CORRECT ANSWERSworkers' compensation, auto insurance, premises medical coverage for property cases home owners based on policy what can be done with unpaid clean third party claims - CORRECT ANSWERSbecome the patient responsibility after some days work flow payment cycle - CORRECT ANSWERSclean claim cycle should be determined for all major health plans if timely payments not received a electronic work list should be maded What is Medicares work flow payment cycle for clean claims - CORRECT ANSWERS14 days impact payment turn around techniques for third party include - CORRECT ANSWERSuse electronic claims submission, send hard copy claims via over night mail, send high dollar hard copy claims via registered mail with attachments, closely monitor payment timeliness and back logs of major health plans Name the statutory liens - CORRECT ANSWERSemployee, landlord, material-man & mechanic, tax subrogation - CORRECT ANSWERSupon being billed the healthcare plan may process the claim for reimbursement and subsequently pursue payment from the liability payer financial assistance policy key elements - CORRECT ANSWERSstatement of mission & financial assistance, payment, in & out patient deposit requirements, payment methods, payment arrangements & bad debt guidelines What is done with a remaining open balanced after all insurance payments have been received and posted - CORRECT ANSWERSpatient responsibility what can be an open balance - CORRECT ANSWERSdeductible, co-payment, co-insurance what is fundamental requirement for correctly identifying charity and bad debt accounts - CORRECT ANSWERSa board approved financial assistance policy inability to pay - CORRECT ANSWERSfinancial assistance unwillingness to pay the entire account - CORRECT ANSWERSbad debt the Affordable Care Act requires the IRS - CORRECT ANSWERSto issues rules to implement the FAP section of the ACA The IRS rules for the FAP sections of the ACA are called - CORRECT ANSWERSIRS 501 (r) The 501 (r) rules apply to - CORRECT ANSWERSnon-profit providers as made the 501 (c) 3 status What are the activities when initiating self-pay follow up and account resolution - CORRECT ANSWERSpresumptive financial assistance determination, financial profile, poverty guidelines HFMA's Best practices - CORRECT ANSWERSmake bills patient friendly, establish policies & ensure that they are followed, be consistent, coordinate account resolution activities with business affiliates, exercise sound business judgement when choosing account resolution methods, start the account resolution when the first statement is sent, report back to credit bureaus when account is resolved, track consumer complaints evaluation criteria demonstrates reputation expectations - CORRECT ANSWERSdocumented experience working in financial areas of health care agency fees - CORRECT ANSWERSthe cost to the provider for collection agency monies offset by the return on bad debt accounts how to handle the retention and payment of agency fees - CORRECT ANSWERSfollow contractual agreement between agency and provider as to how monies sent to the agency will be handled patient relations include - CORRECT ANSWERSto sensitively deal with patients or individuals while managing collection efficiency Collection agencies should include - CORRECT ANSWERSat least 2 formats regarding accounts assigned on a routine basis collection results are - CORRECT ANSWERSaccurately calculated to demonstrate the actual recovery percentage rate What are the advantages in using a third party collection agency - CORRECT ANSWERShave tools and technologies that are good in payment of self pay accounts, collect faster, complete documentation record may be critical in litigation activities, provide additional benefits to the provider through feedback eval of accounts and staff training, incentive to patients to pay accounts timely to provider to avoid agency transfer What is the selection of the collection agency similar to - CORRECT ANSWERSa business partner or the hiring of a vendor for specific services Consumer credit protection Act Title I - CORRECT ANSWERSTruth in Lending Act Consumer credit protection Act Title III - CORRECT ANSWERSRestrictions on Garnishment Consumer credit protection Act Title VI - CORRECT ANSWERSFair Credit Reporting Act Consumer credit protection Act Title VIII - CORRECT ANSWERSFair Debt Collection Practices Act The 1979 key chapters - CORRECT ANSWERSChapter 7, 11 and 13 Chapter 7 - CORRECT ANSWERSstraight bankruptcy or liquidation Chapter 11 - CORRECT ANSWERSDebtor reorganization Chapter 13 - CORRECT ANSWERSdebtor rehabilitation Governs the types of bankruptcy and its impact on patient's financial responsibility to the hospital - CORRECT ANSWERSThe 1979 Bankruptcy Act Federal Acts have been passed - CORRECT ANSWERSto ensure consumers are treated fairly in the credit and debt collection transactions Failure to follow these various acts could - CORRECT ANSWERSresult in large fines and bad publicity Advantages to outsourcing - CORRECT ANSWERScapitalizes on the economies of scale, limits internal staffing requirements, access to qualified staff, absorbs some financial risk based on "efficiency factor Disadvantages to outsourcing - CORRECT ANSWERSineffective vendor results in increased costs, impact on customer service, legal impact if vendor represents themselves as provider employees, impact on direct control of accounts receivable [Show Less]
- Exam
- $12.45
- 0
- 215
Purchase the bundle to get the full access instantly
- 3 Million+ Study Documents
- 100% Money Back Guarantee
- Immediate Download Access
Add To Cart
Reviews 0
Bundle Details
$40.45
- Trusted by 800,000+ Students
- 24/7 Money Back Guarantee
- Download is directly available
141
0
Seller Details
