CRCR EXAM 80 Questions with Answers 2023
Which of the following statements are true of HFMA's Patient Financial Communications Best Practices? -
... [Show More] CORRECT ANSWERSThe best practices were developed specifically to help patients understand the cost of services, their individual insurance benefits, and their responsibility for balances after insurance, if any.
The patient experience includes all of the following except: - CORRECT ANSWERSRecognition that revenue cycle processes must be patient-centric and efficient. This is especially true in the areas of scheduling, registration, admitting, financial counseling and account resolution conversation with patients.
Corporate compliance programs play an important role in protecting the integrity of operations and ensuring compliance with federal and state requirements. The code of conduct is: - CORRECT ANSWERSA critical tool to ensure compliance, essential and integral component, fosters an environment, (all of the above)
Specific to Medicare free-for-service patients, which of the following payers have always been liable for payment? - CORRECT ANSWERSBlack lung service programs, veteran affairs program, working aged programs, ESRD, and disability
Provider policies and procedures should be in place to reduce the risk of ethics violations. Examples include: - CORRECT ANSWERSfinancial misconduct, theft of property, applying policies in inconsistent manner (all of the above)
What is the intended outcome of collaborations made through an ACO delivery system for a population of patients? - CORRECT ANSWERSTo eliminate duplicate services, prevent medical errors and ensure appropriateness of care
What is the new terminology now employed in the calculation of net patient service revenues? - CORRECT ANSWERSexplicit price concessions and implicit price concessions
What are the two KPIs used to monitor performance related to the production and submission of claims to third party payers and patients (self-pay)? - CORRECT ANSWERSElapsed days from discharge to final bill and elapsed days from final bill to claim/bill submission
What happens during the post-service stage? - CORRECT ANSWERSFinal coding of all services, preparation and submission of claims, payment processing and balance billing and resolution.
The following statements describe best practices established by the Medicaid Debt Task Force. Select true statements. - CORRECT ANSWERSeducate patients, coordinate to avoid duplicate patient contacts, be consistent in key aspects of account resolution, follow best practices for communication
Which option is NOT a main HFMA Healthcare Dollars & Sense revenue cycle initiative? - CORRECT ANSWERSProcess Compliance
What is the objective of the HCAHPS initiative? - CORRECT ANSWERSTo provide a standardized method for evaluating patient's perspective on hospital care
Which option is NOT a department that supports and collaborates with the revenue cycle? - CORRECT ANSWERSAssisted Living Services
Which option is NOT a continuum of care provider? - CORRECT ANSWERSHealth Plan Contracting
Which of the following are essential elements of an effective compliance program? - CORRECT ANSWERSestablished compliance standards and procedures, oversight of personnel by high-level personnel, reasonable methods to achieve compliance with standards, including monitoring systems and hotlines
Annually, the OIG publishes a work plan of compliance issues and objects that will be focused on the throughout the following year. Identify which option is NOT a work plan task mentioned in this course. - CORRECT ANSWERSStandard Unique Employer Identifier
In order to promote the use of correct coding methods on a national basis and prevent payment errors due to improper coding, CMS developed what? - CORRECT ANSWERSThe Correct Coding Initiative(CCI)
What do business/organizational ethics represent? - CORRECT ANSWERSPrinciples and standards by which organizations operate
What is the intended outcome of collaborations made through an ACO delivery system? - CORRECT ANSWERSTo ensure appropriateness of care, elimination of duplicate services, and prevention of medical errors for a population of patients
Which of these statements describes the new methodology for the determinations of net patient service revenue? - CORRECT ANSWERSNet patient service revenue is defined a the total incurred charges, less the explicit price concession, less any applicable implicit price concession(s) as applied to the specific portfolio of accounts.
What are KPIs? - CORRECT ANSWERSKey Performance Indicators, which set standards for accounts receivable (A/R) and provide a method of measuring the collection and control of A/R
Which patient types are typically considered acute care patient types? - CORRECT ANSWERSObservation, newborn, Emergency(ED)
Accurate identification of the patient is the first step in the scheduling process. Identifiers used in various combination to achieve accurate patient identification include: - CORRECT ANSWERSFull legal name, date of birth, sex and social security number
Pre-registration is defined as: - CORRECT ANSWERSThe collection of demographic information, insurance data, financial information, providing reminders, prep information, and identifying the potential need for financial assistance for scheduled patients.
Which of the following statements accurately describe the various Medicare benefit programs: - CORRECT ANSWERSMedicare part A provides benefits for inpatient hospital services, skilled nursing care and home health care; Medicare Part B covers outpatient and professional services; Medicare Part C or Medicare Advantage plans are managed care plans combining Part A and Part B coverages; and Medicare Part D is the prescription drug coverage benefit.
Which of the following statements about Medicaid eligibility is not true? - CORRECT ANSWERSMedicaid categories are restricted to children, pregnant women, and elderly in nursing homes
Examples of managed care plans include: - CORRECT ANSWERSHMO, PPO, EPO, POS, Concierge plans, Medicare Advantage plans, Direct contracting for specific services from specific providers (all of the above)
Patient Financial Communications best practices include all of the following activities except: - CORRECT ANSWERSCollecting payment or initiating the process to immediately remove the patient from the service schedule.
Which statement includes the required components of an accurate pricing determination: - CORRECT ANSWERSInsurance coverages and benefits, service or test involved, diagnosis and procedure codes, total estimated charges, adjudication calculations based on the patient's benefit package.
The value of a robust scheduling and pre-registration process includes all of the following except: - CORRECT ANSWERSIdentification of patients who are likely to be "no shows".
Which patients are considered scheduled? - CORRECT ANSWERSRecurring/Series Patients
Name the guideline that Medicare established to determine which diagnoses, signs, or symptoms are payable. - CORRECT ANSWERSLocal Coverage Determination
What is the purpose of insurance verification? - CORRECT ANSWERSTo ensure accuracy of the health plan information.
Which option is federally-aided, state-operated program to provide health and long-term care coverage? - CORRECT ANSWERSMedicaid
Which option is NOT a specific managed care requirement? - CORRECT ANSWERSPreferred Provider Organization
What is the first component of a pricing determination? - CORRECT ANSWERSVerification of the patient's insurance eligibility and benefits.
What is the purpose of financial counseling? - CORRECT ANSWERSTo educate the patient on his/her health plan coverage and financial responsibility for healthcare services
EMTALA prohibits inquiries about health plan or liability payer information if the inquiry will delay examination or treatment. What other requirements apply to the Emergency Department registration work? - CORRECT ANSWERSPatients are initially triaged by medical personnel... , identification and verification of insurance eligibility... , No additional registration may occur (all of the above)
Typical activities which must be performed when an unscheduled patient arrives for service include: - CORRECT ANSWERSIdentification of patient in the MPI or initiation of a new MPI record, insurance verification of eligibility and benefits, managed care screening, medical necessity screening, price estimations and financial counseling to achieve the appropriate account resolution
Case managers are involved from admission with the discharge planning process. The purpose of discharge planning is: - CORRECT ANSWERSTo estimate how long the patient will be in the hospital, identify the expected outcome of the hospitalization and initiate any special requirements for services at or after the time of discharge
The chargemaster is basically a list of services, procedures, room accommodations, supplies, drugs, tests, etc, typically associated with the billing for services rendered to patients. Challenges typically associated with the chargemaster include: - CORRECT ANSWERSOmission of charges, obsolete or invalid codes, and the omission of required modifiers
Ultimately, the services provided in the healthcare system are reduced to standard codes. The primary types of coding systems currently used in healthcare are: - CORRECT ANSWERSICD-10-CM/ICD-10-PCS;CPT/HCPCS codes
There are four code sets that provide health plans with additional information as they process claims. Those code sets are: - CORRECT ANSWERSCondition codes, occurrence codes, occurrence span codes and value codes
Each type of service has unique billing rules which come into play during the provision of service. For the skilled nursing facility, care is covered if which of the following factors are present? - CORRECT ANSWERSThe patient required skilled services on a daily basis and those services can only be provided on an inpatient basis in a SNF.
DRG's are a system of classifying inpatients on the basis of diagnoses, procedures, and co-monitoring for purposes of payment to hospitals. Each DRG includes: - CORRECT ANSWERSA relative weight which is multiplied by the established base payment rate to calculate the reimbursement for a specific DRG. For exceptionally costly cases over a set dollar amount, an outlier payment is added to the calculated payment
PPO networks represent one form o discounting commonly used by commercial payers. The silent PPO represents: - CORRECT ANSWERSA discounting scheme whereby health plans apply generic PPO rates to discount a provider's claims, even though there is no contractual arrangement between the silent PPO and the provider.
The concept of timely filing of the claims is important to providers, payers and patients. Thus, providers are required to comply with timely claim filing rules. Which of the following statements are not true about timely filing limitations: - CORRECT ANSWERSPayers will waive timely filing denials for claims filed over a year from date of service
What does EMTALA require hospitals to do? - CORRECT ANSWERSTo provide a medical screening examination and stabilizing treatment to every person presenting at an ED and requesting medical evaluation or treatment
In what manner do case managers assist revenue cycle staff? - CORRECT ANSWERSProviding assistance with written appeals to health plans related to utilization and other care issues.
Why is it critical that a chargemaster is reviewed and updated regularly? - CORRECT ANSWERSTo ensure it supports and represents the services provided within the organization
What are claim edits? - CORRECT ANSWERSRules developed to verify the accuracy and completeness of claims based on each health plan's policies
Which statement is NOT a unique billing rule specific to providers? - CORRECT ANSWERSA patient may be balance billed for whatever amount the non-contracting physician charges above the health plan's reimbursement amount.
Which of the following statements does not apply to billing during the COVID-19 public health emergency? - CORRECT ANSWERSTelemedicine claims are not payable if the patient conducts the telemedicine visit from home
Which concept is NOT a contracted payment model? - CORRECT ANSWERSStop-Loss Provision
Credit balances may be created by any of the following activities except: - CORRECT ANSWERSCredits to pharmacy charges posted before the claim final bills.
Which of the following statements represent common reasons for inpatient claim denials: - CORRECT ANSWERSFailure to obtain a required pre-authorization; failure to complete a continued stay authorization and service provided which were not medically necessary.
A 68 year old patient, a Medicare beneficiary, was in a car accident. A medical insurance claim was filed with the auto insurance carrier. Six months later this claim remains unpaid. How can the provider pursue payment from Medicare? - CORRECT ANSWERSThe provider must first bill the auto insurer; However, after a period of 120 days, if the claim remains unpaid, the provider may cancel the liability claim and bill Medicare
The difference between bad debt and financial assistance (charity) is: - CORRECT ANSWERSBad debt represents a refusal to pay, charity represents an inability to pay.
In order to qualify for financial assistance, a patient or guarantor should: - CORRECT ANSWERSProvide the following documents: prior year tax return, employment check stubs from the prior three months and bank statements from the prior three months
To comply with the requirements of Section 501(r) for tax-exempt hospitals chartered as 510(c)3 providers, the hospital must complete which of the following activities: - CORRECT ANSWERSA community needs assessment
The three types of bankruptcy as defined in the 1979 Bankruptcy Act are: - CORRECT ANSWERSChapter 7- Straight Bankruptcy, Chapter 11- Debtor Reorganization and Chapter 13- Debtor Rehabilitation
Which of the following medical debt collection practices are recommended as part of HFMA's Best Practices for medical account resolution: - CORRECT ANSWERSEstablish policies and ensure that they are followed
Organizations may opt to contract with or outsource to specific vendors for some or all components of revenue cycle processing. This practice has both advantages and disadvantages. Which of the following statements is not an advantage of utilizing an outsourcing vendor? - CORRECT ANSWERSThe need for legal review if the outside vendor's staff represents themselves as employees of the healthcare facility
Each hospital covered by the 501(r) regulations is required to develop a financial assistance policy. Which of the following elements is not a required element of the policy? - CORRECT ANSWERSThe notice that individuals eligible for financial assistance under this policy may be charged more than the amount generally billed (AGB) to insured patients
Sue Smith came into the hospital. Her insurance provider sent an EFT directly into the hospital's account at the bank. John, the hospital representatives, receives an electronic Level 2 ERA. What should he do next? - CORRECT ANSWERSManually match the ERA in the patient account
What is EFT - CORRECT ANSWERSThe electronic transfer of funds from payer to payee through the banking system
Which statement is false regarding credit balances? - CORRECT ANSWERSThere are no CMS hospital compliance requirements regarding credit balances
Which option is NOT a type of denial? - CORRECT ANSWERSContractual Adjustment
Which option is NOT a lien type? - CORRECT ANSWERSSubrogation
Based on what you have just read, which activity is not considered when initiating self-pay follow-up and account resolution activities? - CORRECT ANSWERSPatient Open Balance Billing
Which option is NOT a required component of a FAP? - CORRECT ANSWERSOut-of-network providers
Which option is NOT a bankruptcy type governed by th 1979 Bankruptcy Act? - CORRECT ANSWERSCreditor priority
Agency fees are: - CORRECT ANSWERSThe cost to the provider for collection agency monies offset by the return on baddebt accounts
The correct way to handle the retention and payment of agency fee is: - CORRECT ANSWERSFollow the contractual agreement between the agency and the provider as to how monies sent to the agency will be handled
Patient relations include: - CORRECT ANSWERSThe ability to sensitively deal with patients or individuals while managing collection efficiency
Collection agency reports should be provided: - CORRECT ANSWERSIn at least two formats regarding accounts assigned on a routine basis
Collection results are: - CORRECT ANSWERSAccurately calculated to demonstrate the actual recovery percentage rate
Which option is NOT a HFMA best practice? - CORRECT ANSWERSCoordinate the resolution of bad debt accounts with a law firm
Which function within the revenue cycle is NOT a good candidate for outsourcing? - CORRECT ANSWERSHealth Care Patient Services
What are the steps that the hospital needs to take to establish and ensure a successful vendor relationship? - CORRECT ANSWERSDistributes a RFP to solicit vendor capabilities, evaluate vendor's expertise to provide outsourcing services, visit vendor locations, perform vendor reference checks, talk with vendor clients, interview vendor employees to assess experience level [Show Less]