CRCR Exam Prep Questions And
Answers on Flashcard 2023 Update
A+
HFMA - ANS-Healthcare Financial Management Association
Revenue Cycle Overview: What
... [Show More] are the 3 segments? - ANS-Pre-Service, Time of
Service, Post-Service
Scheduling is part of which segment of the Revenue Cycle? - ANS-Pre-service
Patient-Centric Revenue Cycle - ANS-1) Engaged Consumer
2) Engaged Patient
3) Satisfied Customer
Healthcare Dollars & Sense - ANS-1) Price Transparency
2) Patient Financial Communications
3) Medical Account Resolution
Need for Price Transparency - ANS-1) The type of service based on CPT or MS-DRG
code
2) The patients health plan
3) The patients benefit plan
Medical Account Resolution Best Practices - ANS-1) Educate patients
2) Clear/Concise/Correct clear bills
3) Establish and follow policies
4) Be consistent in account resolution
5) Coordinate to avoid duplication
6) Use good judgement when communicating
7) Start account resolution when statement is sent
8) Report back to credit bureau when account is resolved
HCAHPS - ANS-Hospital Consumer Assessment of Healthcare Providers and Systems
(Satisfaction Survey)
Patient Access Process - ANS-1) Insurance verification, pre-certification, preauthorization processes should be completed prior to patients scheduled visit.
2) An incorrect estimate or incorrect application of the health plan and benefit rules
resulting in debits and credits on the patients account after the insurance company has
processed the claim.
What is the objective of the HCAHPS Initiative? - ANS-To provide a standardized
method for evaluating patients perspective on hospital care.
Departments that support and collaborate with the revenue cycle - ANS-1) IT
2) Clinical Services
3) Finance
4) Health Plan Contracting
Physician order should include - ANS-1) Date
2) Valid diagnosis
3) Patients name
4) Physician name and signature
5) Description of test or test ordered
Continuum providers - ANS-1) Physician
2) Skilled Nursing Facility
3) Home Health Agency
4) Durable Medical Equipment
5) Hospice
6) Assisted Living
OIG stands for what? - ANS-Office of Inspector General
FCA stands for what? - ANS-False Claims Act
FERA stands for what? - ANS-Fraud Enforcement and Recovery Act 2009
What does FERA do for the Government? - ANS-Close loopholes , Enhance the ability
of the government, whistleblowers and reporting individuals to identify and successfully
pursue entities and individuals who improperly receive government funds.
Compliance Program is defined as - ANS-Systematic procedures instituted by an
organization to ensure that the provisions of the regulations imposed by a government
agency are being met." (2016)
Corporate Compliance Program Elements - ANS-1) Self reporting
2) Corporate culture
3) Full support
4) Oversight
5) Written procedures
6) Training and education
7) Hotline
8) Employment of excluded individuals
9) Standards compliance
10) Established compliance standards and procedures.
11) Written communication standards and procedures.
12) An effective plan to communicate to employees and agents.
13) Discretionary authority vested in persons unlikely to engage in criminal conduct.
14) Mechanisms for monitoring compliance, including independent evaluations.
15) Appropriate and consistent disciplinary measures and mechanisms for employees
violating procedures/ethics.
16) Implementation of an audit plan with the following elements:
- Clearly defined goals that identify the specific company practices to be audited
- Personnel who will conduct the audit
- Individuals to be interviewed
- Documents to be reviewed
- Steps to be taken to ensure protection by the attorney-client privilege
HIPAA - ANS-Health Insurance Portability and Accountability Act passed in 1996
BAA - ANS-Business Associate Agreement
HIPAA contains what 3 goals - ANS-1) Expand health coverage by improving the
portability and continuity of health insurance coverage in group and individual markets.
2) Give patients access to their health files and the right to request amendments or
make corrections.
3) Facilitate the electronic exchange of medical information with respect to financial and
administrative transactions carried out by health plans, healthcare clearinghouses, and
healthcare providers.
ABN definition - ANS-Advance Beneficiary Notice of Noncoverage
Medicare is secondary payor - ANS-1) Working Aged
2) Accident or other Liability
3) End Stage Renal Disease (ESRD)
4) Disability
CCI stands for - ANS-Correct Coding Initiative
OPPS - ANS-Outpatient Prospective Payment System
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? - ANS-CCI (Correct
Coding Initiative)
Examples of ethics violations which may occur that impact the revenue cycle include: -
ANS-1) Financial misconduct
2) Overcharging
3) Theft of property
4) Falsifying records to boost reimbursement
5) Miscoding claims
ACA stands for - ANS-Affordable Care Act 2010
The ACA includes provisions to: - ANS-1) Improve the quality of care.
2) Reform the healthcare delivery system.
3) Encourage pricing transparency and modernized financing systems.
4) Address the issues of waste, fraud, and abuse.
ACA reformations include: - ANS-1) Establishing regulations for the development and
financing of Accountable Care Organizations (ACOs).
2) Developing new approaches to payment and delivery systems through the Center for
Medicare and Medicaid Innovation.
ACO stands for - ANS-Accountable Care Organization
ACO is: - ANS-A delivery system of physicians, hospitals, and other healthcare
providers, who work collaboratively to manage and coordinate the care of a patient
population. The point of this collaboration is to ensure:
- Appropriateness of care
- Elimination of duplicate services
- Prevention of medical errors for a population of patients.
MSSP stands for - ANS-Medicare Shared Savings Program
Medicare Shared Savings Program does what? - ANS-The Medicare Shared Savings
Program facilitates coordination and cooperation among providers to improve care for
Medicare Fee-for-Service (FFS) beneficiaries and reduce unnecessary costs.
Hospital Readmission Reduction Program (HRRP) - ANS-CMS reduces payments to
hospitals with high rates of readmissions for:
- Heart Attack
- Heart Failure
- Pneumonia
- COPD
- Total hips
- Total knees
BPCI - ANS-Bundled Payments for Care Improvement
ASC 606 creates two types of adjustment to incurred charges: - ANS-- Explicit price
concessions represent the payments due from the payers
- Implicit price concessions are applied to the amounts that are expected to be paid by
patients.
What is the intended outcome of collaborations made through an ACO delivery system?
- ANS-To ensure appropriateness of care, elimination of duplicate services, and
prevention of medical errors for a population of patients.
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