The disadvantages of outsourcing include all of the following EXCEPT:
a) The impact of customer service or patient relations
b) The impact of loss of
... [Show More] direct control of accounts receivable services
c) Increased costs due to vendor ineffectiveness
d) Reduced internal staffing costs and a reliance on outsourced staff - ANSWER-D
The Medicare fee-for service appeal process for both beneficiaries and providers
includes all of the following levels EXCEPT:
a) Medical necessity review by an independent physician's panel
b) Judicial review by a federal district court
c) Redetermination by the company that handles claims for
Medicare
d) Review by the Medicare Appeals Council (Appeals Council) - ANSWER-B
Business ethics, or organizational ethics represent:
a) The principles and standards by which organizations operate
b) Regulations that must be followed by law
c) Definitions of appropriate customer service
d) The code of acceptable conduct - ANSWER-A
A portion of the accounts receivable inventory which has NOT qualified for billing
includes:
a) Charitable pledges
b) Accounts created during pre-registration but not activated
c) Accounts coded but held within the suspense period
d) Accounts assigned to a pre-collection agency - ANSWER-A
Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are
Medicare established guideline(s) used to determine:
a) Medicare and Medicaid provider eligibility
b) Medicare outpatient reimbursement rates
c) Which diagnoses, signs, or symptoms are reimbursable
d) What Medicare reimburses and what should be referred to
Medicaid - ANSWER-C
Days in A/R is calculated based on the value of:
a) The total accounts receivable on a specific date
b) Total anticipated revenue minus expenses
c) The time it takes to collect anticipated revenue
d) Total cash received to date - ANSWER-C
Patients are contacting hospitals to proactively inquire about costs and fees prior to
agreeing to service. The problem for hospitals in providing such information is:
a) That hospitals don't want to establish a price without knowing if
the patient has insurance and how much reimbursement can be
expected
b) The fact that charge master lists the total charge, not net charges
that reflect charges after a payer's contractual adjustment
c) That hospitals don't want to be put in the position of
"guaranteeing" price without having room for additional charges
that may arise in the course of treatment
d) Their reluctance to share proprietary information - ANSWER-B
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:
a) Make sure that the attending staff can answer questions and
assist in obtaining required patient financial data
b) Have a patient financial responsibilities kit ready for the patient,
containing all of the required registration forms and instructions
c) Support that choice, providing that the discussion does not
interfere with patient care or disrupt patient flow
d) Decline such request as finance discussions can disrupt patient
care and patient flow - ANSWER-C
A comprehensive "Compliance Program" is defined as
a) Annual legal audit and review for adherence to regulations
b) Educating staff on regulations
c) Systematic procedures to ensure that the provisions of
regulations imposed by a government agency are being met
d) The development of operational policies that correspond to
regulations - ANSWER-C
Case Management requires that a case manager be assigned
a) To patients of any physician requesting case management
b) To a select patient group
c) To every patient
d) To specific cases designated by third party contractual agreement - ANSWER-B
Pricing transparency is defined as readily available information on the price of
healthcare services, that together with other information, help define the value of those
services and enable consumers to
a) Identify, compare, and choose providers that offer the desired
level of value
b) Customize health care with a personally chosen mix of providers
c) Negotiate the cost of health plan premiums
d) Verify the cost of individual clinicians - ANSWER-A
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
a) MSO
b) HMO
c) PPO
d) GPO - ANSWER-B
In a Chapter 7 Straight Bankruptcy filing
a) The court liquidates the debtor's nonexempt property, pays
creditors, and discharges the debtor from the debt
b) The court liquidates the debtor's nonexempt property, pays
creditors, and begins to pay off the largest claims first. All claims
are paid some portion of the amount owed
c) The court vacates all claims against a debtor with the
understanding that the debtor may not apply for credit without
court supervision
d) The court establishes a creditor payment schedule with the
longest outstanding claims paid first - ANSWER-A
The core financial activities resolved within patient access include:
a) Scheduling, pre-registration, insurance verification and managed
care processing
b) Scheduling, insurance verification, clinical discharge processing
and payment posting of point of service receipts
c) Scheduling, registration, charge entry and managed care
processing
d) Scheduling, pre-registration, registration, medical necessity
screening and patient refunds - ANSWER-A
Which of the following is NOT contained in a collection agency agreement?
a) A clear understanding that the provider retains ownership of any
outsourced activities
b) Specific language as to who will pay legal fees, if needed
c) An annual renewal clause
d) A mutual hold-harmless clause - ANSWER-D
Maintaining routine contact with the health plan or liability payer, making sure all
required information is provided and all needed approvals are obtained is the
responsibility of:
a) Patient Accounts
b) Managed Care Contract Staff
c) HIM staff
d) Case Management - ANSWER-D
What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment
from Medicare?
a) Revenue codes
b) Correct Part A and B procedural codes
c) The CMS 1500 Part B attachment
d) Medical necessity documentation - ANSWER-A
Before classifying and subsequently writing off an account to financial assistance or bad
debt, the hospital must establish policy, define appropriate criteria, implement
procedures for identifying and processing accounts:
a) Monitor compliance
b) Have the account triaged for any partial payment possibilities
c) Assist in arranging for a commercial bank loan
d) Obtain the patients income tax statements from the prior 2 years - ANSWER-A
For routine scenarios, such as patients with insurance coverage or a known ability to
pay, financial discussions:
a) Are optional
b) Should take place between the patient or guarantor and properly
trained provider representatives
c) May take place between the patient and discharge planning
d) Are focused on verifying required third-party payer information - ANSWER-B
The purpose of a financial report is to:
a) Provide a public record, if reqluested
b) Present financial information to decision makers
c) Prepare tax documents
d) Monitor expenses - ANSWER-B
Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act)
violation?
a) Registration staff may routinely contact managed are plans for
prior authorizations before the patient is seen by the on-duty
physician
b) Initial registration activities may occur so long as these activities
do not delay treatment or suggest that treatment with not be
provided to uninsured individuals
c) Co-payments may be collected at the time of service once the
medical screening and stabilization activities are completed
d) Signage must be posted where it can be easily seen and read by
patients - ANSWER-A
A claim is denied for the following reasons, EXCEPT:
a) The health plan cannot identify the subscriber
b) The frequency of service was outside the coverage timeline
c) The submitted claim does not have the physicians signature
d) The subscriber was not enrolled at the time of service - ANSWER-C
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
a) A court appointed federal mediator
b) The Department of Health and Human Services Provider Relations
Division
c) The Office of the Inspector General
d) The Provider Reimbursement Review Board - ANSWER-D
Charges, as the most appropriate measurement of utilization, enables
a) Generation of timely and accurate billing
b) Managing of expense budgets
c) Accuracy of expense and cost capture
d) Effective HIM planning - ANSWER-???Number 24???
Ambulance services are billed directly to the health plan for
a) All pre-admission emergency transports
b) 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 another facility
c) The portion of the bill outside of the patient's self-pay
d) Transports deemed medically necessary by the attending
paramedic-ambulance crew - ANSWER-C
An individual enrolled in Medicare who is dissatisfied with the government's claim
determination is entitled to reconsideration of the decision. This type of appeal is
known as
a) A beneficiary appeal
b) A Medicare supplemental review
c) A payment review
d) A Medicare determination appeal - ANSWER-A
The nuanced data resulting from detailed ICD-10 coding allows senior leadership to
work with physicians to do all of the following EXCEPT:
a) Drive significant improvements in the areas of quality and the
patient experience
b) Embrace new reimbursement models
c) Improve outcomes
d) Obtain higher compensation for physicians - ANSWER-D
Duplicate payments occur:
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 the payer's coordination of benefits is not captured
correctly at the time of patient registration
d) 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 - ANSWER-a
The Affordable Care Act legislated the development of Health Insurance Exchanges,
where individuals and small businesses can
a) Purchase qualified health benefit plans regardless of insured's
health status
b) Obtain price estimates for medical services
c) Negotiate the price of medical services with providers
d) Meet federal mandates for insurance coverage and obtain the
corresponding tax deduction - ANSWER-A
The most common resolution methods for credit balances include all of the following
EXCEPT:
a) Designate the overpayment for charity care
b) Submit the corrected claim to the payer incorporating credits
c) Either send a refund or complete a takeback form as directed by
the payer
d) Determine the correct primary payer and notify incorrect payer of
overpayment - ANSWER-A
EFT (electronic funds transfer) is
a) An electronic claim submission
b) The record of payments in the hospital's accounting system
c) An electronic confirmation that a payment is due
d) An electronic transfer of funds from payer to payee - ANSWER-D
Revenue cycle activities occurring at the point-of-service include all of the following
EXCEPT:
a) The monitoring of charges
b) The provision of case management and discharge planning
services
c) Providing charges to the third-party payer as they are incurred
d) The generation of charges - ANSWER-C
Medicare beneficiaries remain in the same "benefit period"
a) Up to hospitalization discharge
b) Until the beneficiary is "hospitalization and/or skilled nursing
facility-free" for 60 consecutive days
c) Each calendar year
d) Up to 60 days - ANSWER-B
Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and
a) Provide evidence of financial status
b) Provide a method of measuring the collection and control of A/R
c) Establish productivity targets
d) Make allowance for accurate revenue forecasting - ANSWER-B
Recognizing that health coverage is complicated and not all patients are able to navigate
this terrain, HFMA best practices specify that
a) The patient accounts staff have someone assigned to research
coverage on behalf of patients
b) Patients should be given the opportunity to request a patient
advocate, family member, or other designee to help them in these
discussions
c) Patient coverage education may need to be provided by the
health plan
d) A representative of the health plan be included in the patient
financial responsibilities discussion - ANSWER-B
When there is a request for service, the scheduling staff member must confirm the
patient's unique identification information to
a) Check if there is any patient balance due
b) Verify the patient's insurance coverage if the patient is a returning
customer
c) Confirm that physician orders have been received
d) Ensure that she/he accesses the correct information in the
historical database - ANSWER-D
Once the price is estimated in the pre-service stage, a provider's financial best practice
is to
a) Explain to the patient their financial responsibility and to
determine the plan for payment
b) Allow the patient time to compare prices with other providers
c) Lock-in the prices
d) Have another employee double check the price estimate - ANSWER-A
What type of account adjustment results from the patient's unwillingness to pay a self-
pay balance?
a) Charity adjustment
b) Bad debt adjustment
c) Contractual adjustment
d) Administrative adjustment - ANSWER-B
All of the following are conditions that disqualify a procedure or service from being paid
for by Medicare EXCEPT
a) Medically unnecessary
b) Not delivered in a Medicare licensed care setting
c) Offered in an outpatient setting
d) Services and procedures that are custodial in nature - ANSWER-D
All of the following are forms of hospital payment contracting EXCEPT
a) Contracted Rebating
b) Per Diem Payment
c) Fixed Contracting
d) Bundled Payment - ANSWER-A
Overall aggregate payments made to a hospice are subject to a computed "cap amount"
calculated by:
a) The Center for Medicare and Medicaid Services (CMS)
b) Each state's Medicaid plan
c) Medicare
d) The Medicare Administrative Contractor (MAC) at the end of the
hospice cap period - ANSWER-D
With the advent of the Affordable Care Act Health Insurance Marketplaces and the
expansion of Medicaid in some states, it is more important than ever for hospitals to
a) Reschedule the visit for non-payment of a prior balance
b) Strictly limit charity care and bad-debt
c) Collect patient's self-pay and deductibles in the first encounter
d) Assist patients in understanding their insurance coverage and
their financial obligation - ANSWER-D
A nightly room charge will be incorrect if the patient's
a) Discharge for the next day has not been charted
b) Condition has not been discussed during the shift change report
meeting
c) Pharmacy orders to the ICU have not been entered in the
pharmacy system
d) Transfer from ICU (intensive care unit) to the Medical/Surgical
floor is not reflected in the registration system - ANSWER-D
Which of the following is required for participation in Medicaid?
a) Meet income and assets requirements
b) Meet a minimum yearly premium
c) Be free of chronic conditions
d) Obtain a health insurance policy - ANSWER-A
HFMA best practices call for patient financial discussions to be reinforced
a) By issuing a new invoice to the patient
b) By copying the provider's attorney on a written statement of
conversation
c) By obtaining some type of collateral
d) By changing policies to programs - ANSWER-B
A Medicare Part A benefit period begins:
a) With admission as an inpatient
b) The first day in which an individual has not been a hospital
inpatient not in a skilled nursing facility for the previous 60 days
c) Upon the day the coverage premium is paid
d) Immediately once authorization for treatment is provided by the
health plan - ANSWER-A
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
a) Will remain in observation for up to 72 hours after which the
patient is admitted as an inpatient
b) Will be admitted as an inpatient
c) Will be discharged and if needed, designated to a priority one
outpatient status
d) 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 - ANSWER-B
It is important to have high registration quality standards because
a) Incomplete registrations will trigger exclusion from Medicare
participation
b) Incomplete registrations will raise satisfaction scores for the
hospital
c) Inaccurate registration may cause discharge before full treatment
is obtained
d) Inaccurate or incomplete patient data will delay payment or
cause denials - ANSWER-D
Medicare will only pay for tests and services that
a) Constitute appropriate treatment and are fairly priced
b) Have solid documentation
c) Can be demonstrated as necessary
d) Medicare determines are "reasonable and necessary" - ANSWER-D
Room and bed charges are typically posted
a) From case management reports generated for contracted payers
b) Through the case management daily resource report
c) At the end of each business day
d) From the midnight census - ANSWER-D
The process of creating the pre=registration record ensures
a) Ability to pursue extraordinary collection activities
b) Early and productive communication with a third-party payer
c) Accurate billing
d) That access staff will have the compete and valid information
needed to finalize any remaining pre-access activities - ANSWER-C
Once the EMTALA requirements are satisfied [Show Less]