CRCR EXAM 74 Questions with Answers 2023
HFMA patient financial communications best practices call for annual training for all staff EXCEPT - CORRECT
... [Show More] ANSWERSA. 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]