CRCR Exam 2023
1. Which of the following statements are true of HFMA's Patient Financial Communications Best Practices? ANS The best practices were
... [Show More] developed specifi- cally to help patients understand the cost of services, their individual insurance benefits, and their responsibility for balances after insurance, if any.
2. The patient experience includes all of the following except ANS Recognition that revenue cycle processes must be patient-centric and efficient. This is espe- cially true in the areas of scheduling, registration, admitting, financial counseling and account resolution conversation with patients.
3. 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 ANS A critical tool to ensure compliance, essential and integral component, fosters an environment, (all of the above)
4. Specific to Medicare free-for-service patients, which of the following pay- ers have always been liable for payment? ANS Black lung service programs, veteran affairs program, working aged programs, ESRD, and disability
5. Provider policies and procedures should be in place to reduce the risk
of ethics violations. Examples include ANS financial misconduct, theft of property, applying policies in inconsistent manner (all of the above)
6. What is the intended outcome of collaborations made through an ACO delivery system for a population of patients? ANS To eliminate duplicate services, prevent medical errors and ensure appropriateness of care
7. What is the new terminology now employed in the calculation of net patient service revenues? ANS explicit price concessions and implicit price concessions
8. What are the two KPIs used to monitor performance related to the produc- tion and submission of claims to third party payers and patients (self-pay)? ANS - Elapsed days from discharge to final bill and elapsed days from final bill to claim/bill submission
9. What happens during the post-service stage? ANS Final coding of all services, preparation and submission of claims, payment processing and balance billing and resolution.
10. The following statements describe best practices established by the Med- icaid Debt Task Force. Select true statements. ANS educate patients, coordinate to avoid duplicate patient contacts, be consistent in key aspects of account resolution, follow best practices for communication
11. Which option is NOT a main HFMA Healthcare Dollars & Sense revenue cycle initiative? ANS Process Compliance
12. What is the objective of the HCAHPS initiative? ANS To provide a standardized method for evaluating patient's perspective on hospital care
13. Which option is NOT a department that supports and collaborates with the revenue cycle? ANS Assisted Living Services
14. Which option is NOT a continuum of care provider? ANS Health Plan Contract- ing
15. Which of the following are essential elements of an effective compliance program? ANS established compliance standards and procedures, oversight of per- sonnel by high-level personnel, reasonable methods to achieve compliance with standards, including monitoring systems and hotlines
16. 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. ANS Standard Unique Employer Identifier
17. 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 The Correct Coding Initiative(CCI)
18. What do business/organizational ethics represent? ANS Principles and stan- dards by which organizations operate
19. 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
20. Which of these statements describes the new methodology for the de- terminations of net patient service revenue? ANS Net 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.
21. What are KPIs? ANS Key Performance Indicators, which set standards for ac- counts receivable (A/R) and provide a method of measuring the collection and control of A/R
22. Which patient types are typically considered acute care patient types? ANS -
Observation, newborn, Emergency(ED)
23. Accurate identification of the patient is the first step in the scheduling process. Identifiers used in various combination to achieve accurate patient
identification include ANS Full legal name, date of birth, sex and social security number
24. Pre-registration is defined as ANS The collection of demographic information, insurance data, financial information, providing reminders, prep information, and identifying the potential need for financial assistance for scheduled patients.
25. Which of the following statements accurately describe the various Medicare benefit programs ANS Medicare part A provides benefits for inpatient hos- pital services, skilled nursing care and home health care; Medicare Part B covers outpatient and professional services; Medicare Part C or Medicare Advantage pl ANS are managed care pl ANS combining Part A and Part B coverages; and Medicare Part D is the prescription drug coverage benefit.
26. Which of the following statements about Medicaid eligibility is not true?-
ANS Medicaid categories are restricted to children, pregnant women, and elderly in nursing homes
27. Examples of managed care pl ANS include ANS HMO, PPO, EPO, POS, Concierge pl ANS, Medicare Advantage pl ANS, Direct contracting for specific ser- vices from specific providers (all of the above)
28. Patient Financial Communications best practices include all of the follow- ing activities except ANS Collecting payment or initiating the process to immediately remove the patient from the service schedule.
29. Which statement includes the required components of an accurate pric- ing determination ANS Insurance coverages and benefits, service or test involved, diagnosis and procedure codes, total estimated charges, adjudication calculations based on the patient's benefit package.
30. The value of a robust scheduling and pre-registration process includes all of the following except ANS Identification of patients who are likely to be "no shows".
31. Which patients are considered scheduled? ANS Recurring/Series Patients
32. Name the guideline that Medicare established to determine which diag- noses, signs, or symptoms are payable. ANS Local Coverage Determination
33. What is the purpose of insurance verification? ANS To ensure accuracy of the health plan information.
34. Which option is federally-aided, state-operated program to provide health and long-term care coverage? ANS Medicaid
35. Which option is NOT a specific managed care requirement? ANS Preferred Provider Organization
36. What is the first component of a pricing determination? ANS Verification of the patient's insurance eligibility and benefits.
37. What is the purpose of financial counseling? ANS To educate the patient on his/her health plan coverage and financial responsibility for healthcare services [Show Less]