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CRCR Bundled EXAM Solutions Pack
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CRCR EXAM PREP 2023 MULTIPLE CHOICE GRADED A+
What are collection agency fees based on? - ANSWER-A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using t... [Show More] he gender rule or what other rule? - ANSWER-Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - ANSWER-Case rates What customer service improvements might improve the patient accounts department? - ANSWER-Holding staff accountable for customer service during performance reviews What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - ANSWER-Inform 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? - ANSWER-Bad debt adjustment What is the initial hospice benefit? - ANSWER-Two 90-day periods and an unlimited number of subsequent periods When does a hospital add ambulance charges to the Medicare inpatient claim? - ANSWER-If 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? - ANSWER-Post 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 - ANSWER-They are not being processed in a timely manner What is an advantage of a preregistration program? - ANSWER-It reduces processing times at the time of service What are the two statutory exclusions from hospice coverage? - ANSWER-Medically unnecessary services and custodial care What core financial activities are resolved within patient access? - ANSWER-Scheduling, insurance verification, discharge processing, and payment of point-of-service receipts What statement applies to the scheduled outpatient? - ANSWER-The services do not involve an overnight stay How is a mis-posted contractual allowance resolved? - ANSWER-Comparing 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? - ANSWER-Observation Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has received what? - ANSWER-Medically 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$? - ANSWER-When the patient is the insured What are non-emergency patients who come for service without prior notification to the provider called? - ANSWER-Unscheduled patients If the insurance verification response reports that a subscriber has a single policy, what is the status of the subscriber's spouse? - ANSWER-Neither enrolled not entitled to benefits Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act, establishes what? - ANSWER-Disclosure rules for consumer credit sales and consumer loans What is a principal diagnosis? - ANSWER-Primary reason for the patient's admission Collecting patient liability dollars after service leads to what? - ANSWER-Lower accounts receivable levels What is the daily out-of-pocket amount for each lifetime reserve day used? - ANSWER-50% 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? - ANSWER-Inpatient care What code indicates the disposition of the patient at the conclusion of service? - ANSWER-Patient discharge status code What are hospitals required to do for Medicare credit balance accounts? - ANSWER-They 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? - ANSWER-Patient Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include: - ANSWER-A valid CPT or HCPCS code With advances in internet security and encryption, revenue-cycle processes are expanding to allow patients to do what? - ANSWER-Access their information and perform functions on-line What date is required on all CMS 1500 claim forms? - ANSWER-onset date of current illness What does scheduling allow provider staff to do - ANSWER-Review appropriateness of the service request What code is used to report the provider's most common semiprivate room rate? - ANSWER-Condition code Regulations and requirements for coding accountable care organizations, which allows providers to begin creating these organizations, were finalized in: - ANSWER-2012 What is a primary responsibility of the Recover Audit Contractor? - ANSWER-To correctly identify proper payments for Medicare Part A & B claims How must providers handle credit balances? - ANSWER-Comply with state statutes concerning reporting credit balance Insurance verification results in what? - ANSWER-The accurate identification of the patient's eligibility and benefits What form is used to bill Medicare for rural health clinics? - ANSWER-CMS 1500 What activities are completed when a scheduled pre-registered patient arrives for service? - ANSWER-Registering 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? - ANSWER-HCPCS (Healthcare Common Procedure Coding system) What results from a denied claim? - ANSWER-The provider incurs rework and appeal costs Why does the financial counselor need pricing for services? - ANSWER-To calculate the patient's financial responsibility What type of provider bills third-party payers using CMS 1500 form - ANSWER-Hospital-based mammography centers How are disputes with nongovernmental payers resolved? - ANSWER-Appeal conditions specified in the individual payer's contract The important message from Medicare provides beneficiaries with information concerning what? - ANSWER-Right 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? - ANSWER-To 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? - ANSWER-Submit interim bills to the Medicare program. 90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims after what happens? - ANSWER-120 days passes, but the claim then be withdrawn from the liability carrier What data are required to establish a new MPI entry? - ANSWER-The 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? - ANSWER-Determine the correct payer and notify the incorrect payer of the processing error What do EMTALA regulations require on-call physicians to do? - ANSWER-Personally 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? - ANSWER-They must be balanced What will cause a CMS 1500 claim to be rejected? - ANSWER-The 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? - ANSWER-The cost of the test how are HCPCS codes and the appropriate modifiers used? - ANSWER-To 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? - ANSWER-Diagnostic 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? - ANSWER-Patient arrival processing is expedited, reducing wait times and delays What is a characteristic of a managed contracting methodology? - ANSWER-Prospectively set rates for inpatient and outpatient services What do the MSP disability rules require? - ANSWER-That 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? - ANSWER-Blue Cross and blue Shield What is true about screening a beneficiary for possible MSP situations? - ANSWER-It 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? - ANSWER-Warn 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? - ANSWER-Receive a fixed for specific procedures What will comprehensive patient access processing accomplish? - ANSWER-Minimize the need for follow-up on insurance accounts Through what document does a hospital establish compliance standards? - ANSWER-Code of conduct How does utilization review staff use correct insurance information? - ANSWER-To obtain approval for inpatient days and coordinate services When is it not appropriate to use observation status? - ANSWER-As a substitute for an inpatient admission What is a serious consequence of misidentifying a patient in the MPI? - ANSWER-The 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? - ANSWER-Redirect the patient to the patient access department for registration What process can be used to shorten claim turnaround time? - ANSWER-Send high-dollar hard-copy claims with required attachments by overnight mail or registered mail How are patient reminder calls used? - ANSWER-To 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? - ANSWER-Write off the account to the contractual adjustment account According to the Department of Health and Human Services guidelines, what is NOT considered income? - ANSWER-Sale of property, house, or car The situation where neither the patient nor spouse is employed is described to the patient using: - ANSWER-A condition code What option is an alternative to valid long-term payment plans? - ANSWER-Bank loans What is an advantage of using a collection agency to collect delinquent patient accounts? - ANSWER-Collection agencies collect accounts faster than hospital does What statement DOES NOT apply to revenue codes? - ANSWER-revenue 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 - ANSWER-catastrophic charity What happens when a patient receives non-emergent services from and out-of-network provider? - ANSWER-Patient payment responsibility is higher Every patient who is new to the healthcare provider must be offered what? - ANSWER-A printed copy of the provider's privacy notice How may a collection agency demonstrate its performance? - ANSWER-Calculate 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? - ANSWER-It 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? - ANSWER-The UB-04 and the CMS 1500 Unless the patient encounter is an emergency, what is the efficient and effective procedure for obtaining information? - ANSWER-Obtain the required demographic and insurance information before services are rendered what protocol was developed through the Patient Friendly Billing Project? - ANSWER-Provide 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? - ANSWER-Ask if the patient's current services was accident related What is a valid reason for a payer to delay a claim? - ANSWER-Failure 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 - ANSWER-They must be combined with the inpatient bill and paid under the MS-DRG system What do large adjustments require? - ANSWER-Manager-level approval What items are valid identifiers to establish a patient's identification? - ANSWER-Photo identification, date of birth, and social security number What must a provider do to qualify an account as a Medicare bad debts? - ANSWER-Pursue 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? - ANSWER-Site-of-service limitation What is an example of an outcome of the Patient Friendly Billing Project? - ANSWER-Redesigned patient billing statements using patient-friendly language What statement describes the APC (Ambulatory payment classification) system? - ANSWER-APC rates are calculated on a national basis and are wage-adjusted by geographic region What is a benefit of insurance verification? - ANSWER-Pre-certification or pre-authorization requirements are confirmed What is an effective tool to help staff collect payments at the time of service? - ANSWER-Develop scripts for the process of requesting payments What is a benefit of electronic claims processing? - ANSWER-Providers can electronically view patient's eligibility What does Medicare Part D provide coverage for? - ANSWER-Prescription drugs What are some core elements of a board-approved financial policy - ANSWER-Charity care, payment methods, and installment payment guidelines [Show Less]
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CRCR Test Review 2023 with Complete Solutions
Important revenue cycle activities in the pre-service stage include; - ANSWER-Obtaining or updating patient and guarantor information In the pre-service... [Show More] stage, the cost of the scheduled service is identified and the patient's health plan and benefits are used to calculate; - ANSWER-The amount the patient may be expected to pay after insurance. Demographic and health plan edit failures are identified and resolved within the Patient Access area. Census activity is processed, Discharges are completed and correctly coded. These activities are considered - ANSWER-Point-of-service revenue cycle activities. HFMA best practices call for patient financial discussions to be reinforced; - ANSWER-With a written statement of the conversation HFMA's patient financial communications best practices specify that patients should be told about the types of services provided and; - ANSWER-Who participates in providing the service, e.g. surgeons, radiologists, etc. The process of evaluating compliance with financial assistance policies involves; - ANSWER-The annual observation, monitoring, and tracking of results for all best practices. The account resolution clock begins when - ANSWER-The first statement is sent to the patient The soft cost of a dissatisfied customer is - ANSWER-The customer passing on information about their negative experience to potential patients or through social media channels The hard cost of a dissatisfied customer is - ANSWER-loss of future revenue When there is a request for service, scheduling staff must first - ANSWER-Confirm the patients key identification information A standardized form informing patients about the conditions that must be agreed to as part of the agreement for the hospital to provide care is called - ANSWER-Conditions of admission Hospitals need which of the following information sets to assess a patients financial status - ANSWER-Demographic, Income, Assets, and Expenses For new patients with no MPI number - ANSWER-A new medical record will be created by the provider Which option is a government sponsored program that is financed through taxes and general revenue funds - ANSWER-Medicare An increase in the dollars aged greater than 90 days from date of service indicates that accounts are - ANSWER-Not resolved in a timely manner In many states, people covered under the Medicaid program are required to join managed care plans focusing on preventive healthcare - ANSWER-Medicaid Advantage Price is defined as; - ANSWER-The amount actually paid by the health plan and/or the patient for a specific service 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; - ANSWER-The fact that chargemaster lists the total charge, not net charges that reflect charges after a payer's contractual adjustment 19) Time of the patient portion earlier in the cycle and increases patient satisfaction because; - ANSWER-There is clarity for the patient about what is owed. Because case managers are well positioned to document the clinical reasons for treatment, they are; - ANSWER-Of great assistance to revenue cycle staff working on written appeals for denials 21) The best practice in billing is to generate bills and financial information that is: - ANSWER-Clear, concise, correct, and patient-friendly. 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; - ANSWER-Identify, compare, and choose providers that offer the desired level or value. The 501 (r) regulations require not-for-profit providers 501 (c)(3) to do which of the following activities: - ANSWER-Implement a financial assistance program for uninsured and underinsured patients. Net Accounts Receivable is - ANSWER-The amount an entity is reasonably confident of collecting from overall accounts receivable [Show Less]
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CRCR Certification Exam Latest Updated
Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - ANSWER-The Medicare Administrative Contractor (MAC) at ... [Show More] the end of the hospice cap period Which of the following is required for participation in Medicaid - ANSWER-Meet Income and Assets Requirements In choosing a setting for patient financial discussions, organizations should first and foremost - ANSWER-Respect the patients privacy A nightly room charge will be incorrect if the patient's - ANSWER-Transfer 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 - ANSWER-Purchase qualified health benefit plans regardless of insured's health status A portion of the accounts receivable inventory which has NOT qualified for billing includes: - ANSWER-Charitable pledges What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? - ANSWER-Revenue 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 - ANSWER-Patient 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 - ANSWER-Case management Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? - ANSWER-Registration 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 - ANSWER-The Internal Revenue Service Checks received through mail, cash received through mail, and lock box are all examples of - ANSWER-Control points for cash posting What are some core elements if a board-approved financial assistance policy? - ANSWER-Eligibility, application process, and nonpayment collection activities A recurring/series registration is characterized by - ANSWER-The 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 - ANSWER-Assist patients in understanding their insurance coverage and their financial obligation The purpose of a financial report is to: - ANSWER-Present financial information to decision makers Patient financial communications best practices produce communications that are - ANSWER-Consistent, clear and transparent Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish - ANSWER-What 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 - ANSWER-The Provider Reimbursement Review Board Concurrent review and discharge planning - ANSWER-Occurs during service Duplicate payments occur: - ANSWER-When 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 - ANSWER-A beneficiary appeal Insurance verification results in which of the following - ANSWER-The 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: - ANSWER-Judicial 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? - ANSWER-Medical screening and stabilizing treatment Ambulance services are billed directly to the health plan for - ANSWER-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 Key performance indicators (KPIs) set standards for accounts receivables (A/R) and - ANSWER-Provide a method of measuring the collection and control of A/R he patient discharge process begins when - ANSWER-The physician writes the discharge orders The nightly room charge will be incorrect if the patient's - ANSWER-Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system. The soft cost of a dissatisfied customer is - ANSWER-The customer passing on info about their negative experience to potential pts or through social media channels An advantage of a pre-registration program is - ANSWER-The opportunity to reduce the corporate compliance failures within the registration process It is important to have high registration quality standards because - ANSWER-Inaccurate or incomplete patient data will delay payment or cause denials Telemed seeks to improve a patient's health by - ANSWER-Permitting 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 - ANSWER-HMO 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 - ANSWER-The data collection steps for scheduling and pre-registering a patient Medicare Part B has an annual deductible, and the beneficiary is responsible for - ANSWER-A co-insurance payment for all Part B covered services The standard claim form used for billing by hospitals, nursing facilities, and other inpatient - ANSWER-UB-04 Charges are the basis for - ANSWER-Separation of fiscal responsibilities between the patient and the health plan All of the following are forms of hospital payment contracting EXCEPT - ANSWER-Contracted Rebating The most common resolution methods for credit balances include all of the following EXCEPT: - ANSWER-Designate the overpayment for charity care Ambulance services are billed directly to the health plan for - ANSWER-The 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 - ANSWER-A clean claim The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to - ANSWER-Medicare and Medicaid payments The Correct Coding Initiative Program consists of - ANSWER-Edits 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 - ANSWER-The actual physician reimbursement Which department supports/collaborates with the revenue cycle? - ANSWER-Information Technology Medicare Part B has an annual deductible and the beneficiary is responsible for - ANSWER-a co-insurance payment for all Part B covered services The two types of claims denial appeals are - ANSWER-Beneficiary and Provider Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) - ANSWER-Registration 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 - ANSWER-Providing inpatient services in the RHC The patient discharge process begins when - ANSWER-The physician writes the discharge order Departments that need to be included in charge master maintenance include all of the following EXCEPT - ANSWER-Quality Assurance The first thing a health plan does when processing a claim is - ANSWER-Check 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 - ANSWER- The most accurate way to validate patient information is to - ANSWER-require clinical staff to verify information at each treatment encounter In order for Regulation Z to apply, a hospital must - ANSWER- All of the following are minimum requirements for new patients with no MPI number EXCEPT - ANSWER-Address A typical routine patient financial discussion would include - ANSWER-Explaining 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 - ANSWER-Reviewing 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 - ANSWER-Continually align technology with processes rather than technology dictating processes Scheduler instructions are used to prompt the scheduler to - ANSWER-Complete 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 - ANSWER-These 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? - ANSWER-The accounts receivable level would be understated The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as - ANSWER-insurance verification and reimbursable charges Unless the patient encounter is an emergency, it is more efficient and effective to - ANSWER-Collect all information after the patient has been discharged Applying the contracted payment amount to the amount of total charges yields - ANSWER-A pricing agreement "Hard-coded" is the term used to refer to - ANSWER-Codes 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 - ANSWER-Providers pay pennies on each dollar collected Which of the following is usually covered on a Conditions of Admission form - ANSWER-Release of information The 501(r) regulations require not-for-profit providers (501(c)(3) organizations) to do which of the following activities. - ANSWER-Complete a community needs assessment and develop a discount program for patient balances after insurance payment To be eligible for Medicaid, an individual must - ANSWER-meet 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 - ANSWER-The electronic submission of claims using electronic transfers There are unique billing requirements based on - ANSWER-The provider type The unscheduled "direct" admission represents a patient who: - ANSWER-Is admitted from a physician's office on an urgent basis In resolving medical accounts, a law firm may be used as: - ANSWER-A substitute for a collection agency The legal authority to request and analyze provider claim documentation to ensure that - ANSWER-The Office of the U.S. Inspector General (OIG) The office of inspector general (OIG) publishes a compliance work plan - ANSWER-Annually Room and bed charges are typically posted - ANSWER-From the midnight census All of the following information should be reviewed as part of schedule finalization EXCEPT: - ANSWER-The results of any and all test Revenue cycle activities occurring at the point-of-service include all of the following EXCEPT: - ANSWER-Providing 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 - ANSWER-The service providers that typically participate in the service, e.g. radiologists ,pathologists, etc. The core financial activities resolved within patient access include: - ANSWER-Scheduling, 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 - ANSWER-The patient's home care coverage Which option is a benefit of pre-registering a patient for services - ANSWER-The patient arrival process is expedited, reducing wait times and delays Days in A/R is calculated based on the value of - ANSWER-The total accounts receivable on a specific date Case Management requires that a case manager be assigned - ANSWER-To a select patient group Which of the following is required for participation in Medicaid? - ANSWER-Meet income and assets requirements All of the following are steps in safeguarding collections EXCEPT - ANSWER-Issuing receipts The Electronic Remittance Advice (ERA) data set is : - ANSWER-A 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 - ANSWER-Services and procedures that are custodial in nature Medicare beneficiaries remain in the same "benefit period" - ANSWER-Until the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days It is important to calculate reserves to ensure - ANSWER-Stable financial operations and accurate financial reporting A claim is denied for the following reasons, EXCEPT: - ANSWER-The submitted claim does not have the physicians signature HFMA best practices call for patient financial discussions to be reinforced - ANSWER-By changing policies to programs Patients should be informed that costs presented in a price estimate may - ANSWER-Vary 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: - ANSWER-Obtain higher compensation for physicians [Show Less]
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CRCR Multiple Choice Questions and Answers with Complete Solutions
The disadvantages of outsourcing include all of the following EXCEPT: a) The impact of customer service or patient relations b) The impact of loss of dir... [Show More] ect control of accounts receivable services c) Increased costs due to vendor ineffectiveness d) Reduced internal staffing costs and a reliance on outsourced staff - ANSWER-D 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) - ANSWER-B 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 - ANSWER-A 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 - ANSWER-A 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 - ANSWER-C 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 - ANSWER-C 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 - ANSWER-B 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 financial 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 - ANSWER-C 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 - ANSWER-C 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 - ANSWER-B 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 - ANSWER-A 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 - ANSWER-B 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 - ANSWER-A 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 - ANSWER-A 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 - ANSWER-D 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 - ANSWER-D 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 - ANSWER-A 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 - ANSWER-A 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 - ANSWER-B The purpose of a financial report is to: a) Provide a public record, if reqluested b) Present financial information to decision makers c) Prepare tax documents d) Monitor expenses - ANSWER-B 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 - ANSWER-A 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 - ANSWER-C 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 - ANSWER-D 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 - ANSWER-???Number 24??? 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 - ANSWER-C 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 - ANSWER-A 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 - ANSWER-D 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 - ANSWER-a 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 - ANSWER-A The most common resolution methods for credit balances include all of 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 - ANSWER-A 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 - ANSWER-D Revenue cycle activities occurring at the point-of-service include all of 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 - ANSWER-C 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 - ANSWER-B 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 - ANSWER-B 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 - ANSWER-B 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 - ANSWER-D 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 - ANSWER-A 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 - ANSWER-B 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 - ANSWER-D All of the following are forms of hospital payment contracting EXCEPT a) Contracted Rebating b) Per Diem Payment c) Fixed Contracting d) Bundled Payment - ANSWER-A 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 - ANSWER-D 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 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 - ANSWER-D 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 - ANSWER-D 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 - ANSWER-A 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 - ANSWER-B 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 - ANSWER-A 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 - ANSWER-B 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 - ANSWER-D 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" - ANSWER-D 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 - ANSWER-D 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 - ANSWER-C Once the EMTALA requirements are satisfied [Show Less]
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