CRCR Certification Exam 200+ Questions and Answers 2023 (Verified Answers
⦁ Overall aggregate payments made to a hospice are subject to a computed
... [Show More] "cap amount" calculated by ✔✔✔ The Medicare Administrative Contractor (MAC) atthe end of the hospice cap period
⦁ Which of the following is required for participation in Medicaid ✔✔✔
Meet In-come and Assets Requirements
⦁ In choosing a setting for patient financial discussions, organizations should first and foremost ✔✔✔ Respect the patients privacy
⦁ A nightly room charge will be incorrect if the patient's ✔✔✔ Tr✔✔✔fer 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 ✔✔✔ Purchase
qualifiedhealth benefit pl✔✔✔ regardless of insured's health status
⦁ A portion of the accounts receivable inventory which has NOT qualified for billing includes ✔✔✔ Charitable pledges
⦁ What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? ✔✔✔ 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 ✔✔✔ Patient bill of rights
⦁ The activity which results in the accurate recording of patient bed and level of care assessment, patient tr✔✔✔fer and patient discharge status on areal-time basis is known as ✔✔✔ Case management
⦁ Which statement is an EMTALA (Emergency Medical Treatment and Ac- tive Labor Act) violation? ✔✔✔ Registration staff may routinely contact managed arepl✔✔✔ 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 tr✔✔✔actions to identify the employer of an individual described ina tr✔✔✔action EIN's are
assigned by ✔✔✔ The Internal Revenue Service
⦁ Checks received through mail, cash received through mail, and lock box are all examples of ✔✔✔ Control points for cash posting
⦁ What are some core elements if a board-approved financial assistance policy? ✔✔✔ Eligibility, application process, and nonpayment collection activities
⦁ A recurring/series registration is characterized by ✔✔✔ The creation of oneregistration record for multiple days of service
⦁ With the advent of the Affordable Care Act Health Insurance Marketplaces and the exp✔✔✔ion of Medicaid in some states, it is more important than everfor hospitals to ✔✔✔ Assist patients in understanding their insurance coverage and their financial obligation
⦁ The purpose of a financial report is to ✔✔✔ Present financial information todecision makers
⦁ Patient financial communications best practices produce communica- tions that are ✔✔✔ Consistent, clear and tr✔✔✔parent
⦁ Medicare has established guidelines called the Local Coverage Determi- nations (LCD) and National Coverage Determinations (NCD) that establish
✔✔✔ -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 ✔✔✔ The Provider Reimbursement Review
Board
⦁ Concurrent review and discharge planning ✔✔✔ Occurs during service
⦁ Duplicate payments occur ✔✔✔ When providers re-bill claims based on nonpay-ment from the initial bill submission
⦁ An individual enrolled in Medicare who is dissatisfied with the govern- ment's claim determination is entitled to reconsideration of the decision.This type of appeal is known as ✔✔✔ A beneficiary appeal
⦁ Insurance verification results in which of the following ✔✔✔ The accurateidentification 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 ✔✔✔ Judicial review by afederal district court
⦁ Under EMTALA (Emergency Medical Treatment and Labor Act) regula- tions, the providermay not ask about a patient's insurance information if it would delay what? ✔✔✔ Medical screening and stabilizing treatment
⦁ Ambulance services are billed directly to the health plan for ✔✔✔ 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 anotherfacility
⦁ Key performance indicators (KPIs) set standards for accounts receiv- ables (A/R) and ✔✔✔ Provide a method of measuring the collection and control of A/R
⦁ he patient discharge process begins when ✔✔✔ The physician writes the dis-charge orders
⦁ The nightly room charge will be incorrect if the patient's ✔✔✔ Tr✔✔✔fer from ICUto the Medical/Surgical floor is not reflected in the registration system.
⦁ The soft cost of a dissatisfied customer is ✔✔✔ 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 ✔✔✔ The opportunity to reducethe corporate compliance failures within the registration process
⦁ It is important to have high registration quality standards because ✔✔✔
Inac-curate or incomplete patient data will delay payment or cause denials
⦁ Telemed seeks to improve a patient's health by ✔✔✔ Permitting 2-way real timeinteractive 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 ✔✔✔ HMO
⦁ Identifying the patient, in the MPI, creating the registration record, com- pleting medical necessity screening, determining insurance eligibility and
benefits resolving managed care, requirements and completing financial ed- ucation/resolution are all ✔✔✔ The data collection steps for scheduling and pre-reg-istering a patient
⦁ Medicare Part B has an annual deductible, and the beneficiary is respon- sible for ✔✔✔ A co-insurance payment for all Part B covered services
⦁ The standard claim form used for billing by hospitals, nursing facilities, and other inpatient ✔✔✔ UB-04
⦁ Charges are the basis for ✔✔✔ Separation of fiscal responsibilities between thepatient and the health plan
⦁ All of the following are forms of hospital payment contracting EXCEPT
✔✔✔ -
Contracted Rebating
⦁ The most common resolution methods for credit balances include all of the following EXCEPT ✔✔✔ Designate the overpayment for charity care
⦁ Ambulance services are billed directly to the health plan for ✔✔✔ The portionof 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 ✔✔✔ 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 ✔✔✔ Medicareand Medicaid payments
⦁ The Correct Coding Initiative Program consists of ✔✔✔ Edits that are imple-mented 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 ✔✔✔ The actual physician reimburse-ment
⦁ Which department supports/collaborates with the revenue cycle? ✔✔✔
Infor-mation Technology
⦁ Medicare Part B has an annual deductible and the beneficiary is respon- sible for ✔✔✔ a co-insurance payment for all Part B covered services
⦁ The two types of claims denial appeals are ✔✔✔ Beneficiary and Provider
⦁ Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) ✔✔✔ Registration staff members routinely contact man- aged care pl✔✔✔ 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 ✔✔✔ Providing inpatient services in the RHC
⦁ The patient discharge process begins when ✔✔✔ The physician writes the dis-charge order
⦁ Departments that need to be included in charge master maintenance include all of the following EXCEPT ✔✔✔ Quality Assurance
⦁ The first thing a health plan does when processing a claim is ✔✔✔ Check if thepatient is a health plan beneficiary and what is the coverage
⦁ Vital to accurate calculations of a patient's self-pay amount is ✔✔✔
⦁ The most accurate way to validate patient information is to ✔✔✔ require clinicalstaff to verify information at each treatment encounter
⦁ In order for Regulation Z to apply, a hospital must ✔✔✔
⦁ All of the following are minimum requirements for new patients with no MPI number EXCEPT ✔✔✔ Address
⦁ A typical routine patient financial discussion would include ✔✔✔
Explainingthe 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
✔✔✔ Re-viewing 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 conduct- ed to ✔✔✔ Continually align technology with processes rather than technology dictatingprocesses
⦁ Scheduler instructions are used to prompt the scheduler to ✔✔✔
Complete thescheduling 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 ✔✔✔ These codes will be used to determine medicalnecessity 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? ✔✔✔ The accounts receivable level would beunderstated
⦁ The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as ✔✔✔ insurance verification and reimbursable charges
⦁ Unless the patient encounter is an emergency, it is more efficient and
effective to ✔✔✔ Collect all information after the patient has been discharged
⦁ Applying the contracted payment amount to the amount of total charges yields ✔✔✔ A pricing agreement
⦁ "Hard-coded" is the term used to refer to ✔✔✔ 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 ✔✔✔ Providers pay pennies on each dollar collected
⦁ Which of the following is usually covered on a Conditions of Admission form ✔✔✔ Release of information
⦁ The 501(r) regulations require not-for-profit providers (501(c)(3) organi- zations) to do which of the following activities. ✔✔✔ Complete a community needs
assessment and develop a discount program for patient balances after insurance payment
⦁ To be eligible for Medicaid, an individual must ✔✔✔ meet income and assetrequirements
⦁ Eliminating mail time and reducing data entry time, electronically mon- itoring the receipt of claims and online claim adjudication, more prompt payment are all benefits achieved by ✔✔✔ The electronic submission of claims usingelectronic tr✔✔✔fers
⦁ There are unique billing requirements based on ✔✔✔ The provider type
⦁ The unscheduled "direct" admission represents a patient who ✔✔✔ Is admit-ted from a physician's office on an urgent basis
⦁ In resolving medical accounts, a law firm may be used as ✔✔✔ A substitute fora collection agency
⦁ The legal authority to request and analyze provider claim documentation to ensure that ✔✔✔ The Office of the U.S. Inspector General (OIG)
⦁ The office of inspector general (OIG) publishes a compliance work plan-
✔✔✔ Annually
⦁ Room and bed charges are typically posted ✔✔✔ From the midnight census
⦁ All of the following information should be reviewed as part of schedule finalization EXCEPT ✔✔✔ The results of any and all test
⦁ Revenue cycle activities occurring at the point-of-service include all of
the following EXCEPT ✔✔✔ Providing charges to the third-party payer as they areincurred
⦁ HFMA's patient financial communications best practices specify that pts should be told about the ✔✔✔ The service providers that typically participate in the service, e.g. radiologists ,pathologists, etc.
⦁ The core financial activities resolved within patient access include ✔✔✔
-
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 ✔✔✔ The patient's home care coverage
⦁ Which option is a benefit of pre-registering a patient for services
✔✔✔ Thepatient arrival process is expedited, reducing wait times and delays
⦁ Days in A/R is calculated based on the value of ✔✔✔ The total accounts receiv-able on a specific date
⦁ Case Management requires that a case manager be assigned ✔✔✔ To a selectpatient group
⦁ Which of the following is required for participation in Medicaid? ✔✔✔
Meetincome and assets requirements
⦁ All of the following are steps in safeguarding collections EXCEPT ✔✔✔
Issuingreceipts
⦁ The Electronic Remittance Advice (ERA) data set is ✔✔✔ A standardized formthat 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 ✔✔✔ Services and procedures that are custodial in nature
⦁ Medicare beneficiaries remain in the same "benefit period" ✔✔✔ Until the ben-eficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days
⦁ It is important to calculate reserves to ensure ✔✔✔ Stable financial operationsand accurate financial reporting
⦁ A claim is denied for the following reasons, EXCEPT ✔✔✔ The submitted claimdoes not have the physici✔✔✔ signature
⦁ HFMA best practices call for patient financial discussions to be rein-
forced ✔✔✔ By changing policies to programs
⦁ Patients should be informed that costs presented in a price estimate may ✔✔✔ Vary from estimates, depending on the actual services performed
⦁ The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physici✔✔✔ to do all of the following EXCEPT ✔✔✔ Obtainhigher compensation for physici✔✔✔
⦁ Charges as the most appropriate measurement of utilization enables
✔✔✔ Ac-curacy of expense and cost capture
⦁ Once the EMTALA requirements are satisfied ✔✔✔ The remaining registrationprocessing 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 ✔✔✔ Support that choice, providing that the discussion does not interfere withpatient care or disrupt patient flow
⦁ In Chapter 7 straight bankruptcy filling ✔✔✔ The court liquidates the debtor'snonexempt property, pays creditors, and discharges the debtor from the debt
⦁ Chapter 13 Bankruptcy, debtor rehabilitation is a court proceeding
✔✔✔ That reorganizes a debtor's holdings and instructs creditors to look to the debtors' futureearnings for payment
⦁ This concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits ✔✔✔ Claims processing
⦁ The importance of Medical records being maintained by HIM is that the patient records ✔✔✔ Are the primary source for clinical data required for reimburse-ment
⦁ When there is a request for service, the scheduling staff member must confirm the patient's unique identification information to ✔✔✔ Ensure that she/heaccesses the correct information in the historical database
⦁ Maintaining routine contact with the health plan or liability payer, mak- ing sure all required information is provided and all needed approvals are obtained is the responsibility of ✔✔✔ Case Management
⦁ Key Performance Indicators (KPIs) set standards for accounts receiv-
ables (A/R) and ✔✔✔ Provide 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 ✔✔✔ Potentially tr✔✔✔ferred to the patient
⦁ Pricing tr✔✔✔parency is defined as readily available information on the price of healthcare services, that together with other information, help definethe value of those services and enable consumers to ✔✔✔ Identify, compare, andchoose providers that offer the desired level of value
⦁ All of the following are potential causes of credit balances EXCEPT
✔✔✔ Apatient's choice to build up a credit against future medical bills
⦁ A comprehensive "Compliance Program" is defined as ✔✔✔ Systematic pro-cedures to ensure that the provisions of regulations imposed by a government agency are being met
⦁ An originating site is ✔✔✔ The location of the patient at the time the service isprovided
⦁ Local Coverage Determinations (LCD) and National Coverage Determi- nations (NCD) are Medicare established guideline(s) used to determine
✔✔✔ - Which 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 ✔✔✔ Will be admitted as an inpatient
⦁ The benefit of Medicare Advantage Plan is ✔✔✔ Patients 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 ✔✔✔
Accuratebilling
⦁ Claims with dates of service received later than one calendar year beyond the date of service, will be ✔✔✔ Denied by Medicare
⦁ A portion of the accounts receivable inventory which has NOT qualified for billing includes ✔✔✔ Charitable pledges
⦁ The standard claim form used for billing by hospitals, nursing facilities, and other in-patient ✔✔✔ UB-04
⦁ Once the price is estimated in the pre-service stage, a provider's finan- cial best practice is to ✔✔✔ Explain to the patient their financial responsibility and todetermine the plan for payment
⦁ Internal controls addressing coding and reimbursement changes are
put in place to guard against ✔✔✔ Compliance fraud by upcoding
⦁ Health Plan Contracting Departments do all of the following EXCEPT
✔✔✔ -
Establish 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 ✔✔✔ Should take place between thepatient or guarantor and properly trained provider representatives
⦁ What type of account adjustment results from the patient's unwilling- ness to pay a self-pay balance? ✔✔✔ Bad debt adjustment
⦁ Most major health pl✔✔✔ including Medicare and Medicaid, offer
✔✔✔ Elec-tronic and/or web portal verification
⦁ The important Message from Medicare provides beneficiaries informa- tion concerning their ✔✔✔ Right to appeal a discharge decision if the patient dis- agrees with the plan
⦁ Under EMTALA (Emergency Medical Treatment and Labor Act) regula- tions, the provider may not ask about a patient's insurance information if it would delay what? ✔✔✔ Medical 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 ✔✔✔ Monitor compliance
⦁ Medicare will only pay for tests and services that ✔✔✔ Medicare determinesare "reasonable and necessary"
⦁ The physician who wrote the order for an inpatient service and is in charge of the patients ✔✔✔ The attending physician
⦁ When primary payment is received, the actual reimbursement ✔✔✔ Is com- pared to the expected reimbursement, the remaining contractual adjustments areposted, and secondary claims are submitted
⦁ The ICD-10 codes set and CPT/HCPCS code sets combines provide
✔✔✔ Thespecificity and coding needed to support reimbursement claims
⦁ In a self-insured (or self-funded) plan, the costs of medical care are
✔✔✔ -
Borne by the employer on a pay-as-you-go basis
⦁ Indemnity pl✔✔✔ usually reimburse ✔✔✔ A certain percentage of the chargesafter the patient meets the policy's annual deductible
⦁ The first and most critical step in registering a patient, whether sched- uled or unscheduled, is ✔✔✔ Verifying the patient's identification
⦁ When Recovery Audit Contractors (RAC) identify improper payments as over payments, the ✔✔✔ Send 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 ✔✔✔ Support that choice, providing that the discussiondoes not interfere with patient care or disrupt patient flow
⦁ Overall aggregate payments made to a hospice are subject to a comput- ed "cap amount" calculated by ✔✔✔ Each state's Medicaid plan
⦁ Medicare patients are NOT required to produce a physician order to receive which of these services ✔✔✔ Screening Mammography, flu vaccine or pneu-monia vaccine
⦁ EFT (electronic funds tr✔✔✔fer) is ✔✔✔ An electronic tr✔✔✔fer of funds from payerto payee
⦁ The importance of medical records being maintained by HIM is that the patient records ✔✔✔ Are the primary source for clinical data required for reimburse- ment by health pl✔✔✔ and liability payers
⦁ Days in A/R is calculated based on the value of ✔✔✔ The time it takes to collectanticipated revenue
⦁ To maximize the value derived from customer complaints, all consumer complaints should be ✔✔✔ Responded to within two business days
⦁ A scheduled inpatient represents an opportunity for the provider to do which of the following? ✔✔✔ Complete registration and insurance approval before service
⦁ In the pre-service stage, the requested service is screened for medical necessity, health ✔✔✔ Pre-authorization are obtained
⦁ Hospitals need which of the following information sets to assess a patient's financial status ✔✔✔ Patient and guarantor's income, expenses and assets
⦁ Patients are contacting hospitals to proactively inquire about costs and fees prior to ✔✔✔ The 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 tr✔✔✔actions to identify the employer of an individual describedin a tr✔✔✔action EIN's are assigned by ✔✔✔ The Internal Revenue Service
⦁ The HCAHPS (hospital consumer assessment of healthcare providers and systems) initiative ✔✔✔ Provide a standardized method for evaluating patient'sperspective on hospital care.
⦁ A large number of credit balances are not the result of overpayments but of ✔✔✔ Posting errors in the patient accounting system
⦁ A Medicare Part A benefit period begins ✔✔✔ With admission as an inpatient
⦁ Chapter 13 Bankruptcy, debtor rehabilitation, is a court proceeding
✔✔✔ That reorganizes a debtor's holdings and instructs creditors to look to the debtor's futureearnings for payment
⦁ Which of the following in NOT included in the Standardized Quality Measures ✔✔✔ Cost of services
⦁ The disadvantages of outsourcing include all of the following EXCEPT
✔✔✔-
✔✔✔ Reduced internal staffing costs and a reliance on outsourced staff
⦁ Improving the overall patient experience requires revenue cycle leader- ship and staff to simultaneously be ✔✔✔ Clear on policies and consistent in applyingthe policies
⦁ Because 501(r) regulations focus on identifying potential eligible fi- nancial assistants patients hospitals must ✔✔✔ Hold financial conversations withpatients as soon as possible
⦁ Which of the following is NOT contained in a collection agency agree- ment? ✔✔✔ A mutual hold-harmless clause
⦁ HFMA best practices stipulate that a reasonable attempt should be made to have the financial ✔✔✔ As early as possible, before a financial obligationis incurred
⦁ Recognizing that health coverage is complicated and not all pts are able to navigate this terrain, HFMA best practices specify that ✔✔✔ Patients 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 ✔✔✔ Final 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 ✔✔✔ The serviceproviders that typically participate in the service, e.g., radiologists, pathologists, etc.
⦁ Successful account resolution begins with ✔✔✔ Collecting all
deductibles andcopayments 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 ✔✔✔ Patientsshould be given the opportunity to request a patient advocate, family member, orother designee to help them in these discussions
⦁ In the balance resolution process, providers should ✔✔✔ Ask the patient if he or she would like to receive information about payment options and supportivefinancial assistance programs
⦁ Business ethics, or organizational ethics represent ✔✔✔ The principles andstandards by which organizations operate
⦁ Which option is a government-sponsored health care program that is financed through taxes and general revenue funds ✔✔✔ Medicare
⦁ 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 ✔✔✔ HMO
⦁ In a Chapter 7 Straight Bankruptcy filing ✔✔✔ The court liquidates the debtor'snonexempt 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 ✔✔✔ Ensure that she/he accesses the correct information in thehistorical 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 ✔✔✔ Revenue codes
⦁ Appropriate training for patient financial counseling staff must cover all of the following EXCEPT ✔✔✔ Documenting the conversation in the medical records
⦁ The ACO investment model will test the use of pre-paid shared savings to ✔✔✔ Encourage 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 ✔✔✔ Send a demand letterto the provider to recover the over payment amount
⦁ The purpose of the ACA mandated Community Health Needs Assess-
ment is ✔✔✔ To identify significant health needs, prioritize those needs and identifyresources to address them
⦁ A balance sheet is ✔✔✔ A statement of assets, liabilities, and capital for anorganization at a specified point in time
⦁ Hospitals can only convert an inpatient case to observation if the hos- pital utilization review committee determines this status before the patient is discharged and ✔✔✔ Prior 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? ✔✔✔ Patient'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 ✔✔✔ A good resource when developing written appeals of denials
⦁ The Truth in Lending Act establishes ✔✔✔ Disclosure rules for consumer creditsales and consumer lo✔✔✔
⦁ What is Continuum of Care? ✔✔✔ The coordination and linkage of resourcesneeded 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 ✔✔✔ Use 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 ✔✔✔ A beneficiary needing a minimum of 48 hours of care
⦁ Since passage of the Affordable Care Act Health Insurance Market- places and the exp✔✔✔ion of Medicaid in some states, it is more important than ever for hospitals to ✔✔✔ Assist patients in understanding their insurance cov-erage and their financial obligation
⦁ HFMA patient financial communications best practices call for annual training for all staff EXCEPT ✔✔✔ Nursing
⦁ The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as ✔✔✔ Insurance verification of reim-bursable charges
⦁ Net Accounts Receivable is ✔✔✔ The amount an entity is reasonably confidentof collecting from overall accounts receivable.
⦁ ED patients should be informed that their ability to pay ✔✔✔ Will not interferewith treatment of any emergency medical conditions
⦁ Providers are advised that it is best to establish patient financial respon- sibility and assistance policies and make sure they are followed internally and by ✔✔✔ Business affiliates
⦁ Incorrect data gathering can cause all of the following EXCEPT
✔✔✔ Theinability to discuss quality with physici✔✔✔
⦁ All Hospitals are required to establish a written financial assistance policy that applies to ✔✔✔ All emergency and medically necessary care
⦁ All of the following are reference resources used to help guide in the application of business ethics EXCEPT ✔✔✔ Consumer satisfaction reports
⦁ Each patient is assigned a unique number, commonly called the ✔✔✔
MasterPatient Index (MPI) number
⦁ HIPAA contains all of the following goals EXCEPT ✔✔✔ To ensure propercoding across the continuum of care
⦁ Which of the following is NOT included in the Standardized Quality Measures? ✔✔✔
⦁ Account Receivable (A/R) Aging reports ✔✔✔ Divide accounts receivable into30, 60, 90 ,120 days past due categories
⦁ Patients expect value for their healthcare dollar, including greater tr✔✔✔-parency of ✔✔✔ Quality and price information
⦁ The impact of denials on the revenue cycle includes all of the following EXCEPT ✔✔✔ Patient outcomes
⦁ Examples of ethics violations that impact the revenue cycle include all of the following EXCEPT ✔✔✔ Seeking payment options for patient self-pay
⦁ Scheduled procedures routinely include ✔✔✔ Patient preparation instructions
⦁ ICD-10-CM and ICD-10-PCS codes sets are modifications of ✔✔✔ The Inter-national ICD-10 codes as developed by the WHO (World Health Organization)
⦁ The result of accurate census balancing on a daily basis is ✔✔✔ The correctrecording of room charges
⦁ All of the following are steps in verifying insurance EXCEPT ✔✔✔ The patientsigning the statement of financial responsibility
⦁ Health Information Management (HIM) is responsible for ✔✔✔ All patient med-ical 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 pl✔✔✔ this form is called ✔✔✔ The 1500
⦁ Which of the following is NOT a factor in self-pay follow-up? ✔✔✔ The type ofpatient (inpatient, out-patient)
⦁ The Office of Inspector General (OIG) was created ✔✔✔ Detect and preventfraud, waste, and abuse [Show Less]