CRCR Practice 141 Questions with Answers 2023
The 501(r) regulations require not-for-profit providers 501(c) (3) to do which of the following
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A. Complete a community needs assessment and develop a discount program for patient balances after insurance payment.
B. Pursue extraordinary collection activities with all patients eligible for financial assistance.
C. Implement a financial assistance program for uninsured and underinsured patients.
D. Discount all charges to self-pay patients to an amount generally billed to all other patients. - CORRECT ANSWERSA. Complete a community needs assessment and develop a discount program for patient balances after insurance payment
The accurate capture of charges remains critically important because:
A. Of the potential of fraud and abuse charges from erroneous billing.
B. Charges remain one of the few consistent indicators available to monitor resource use.
C. Charges are means of measuring physician productivity.
D. Charges provide the data used in activity based costing. - CORRECT ANSWERSB. Charges remain one of the few consistent indicators available to monitor resource use
The ACO investment model will test the use of pre-paid shared savings to:
A. Invest in treatment protocols that reduce costs to Medicare
B. Attract physicians to participate in the ACO payment system.
C. Raise quality ratings in designated hospitals.
D. Encourage new ACOs to form in rural and underserved areas. - CORRECT ANSWERSD. Encourage new ACOs to form in rural and underserved areas
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. Have a patient financial responsibilities kit ready for the patient, containing all of the required registration forms and instructions.
B. Make sure that the attending staff can answer questions and assist in obtaining required patient financial data.
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. - CORRECT ANSWERSC. Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow
Activities completed when the scheduled, pre-registered patient arrives for service includes:
A. Verifying insurance, activating the record and directing the patient to the service area.
B. Scanning the driver's license or other phot identification and directing the patient to the financial counselor.
C. Activating the record, obtaining signatures and finalizing financial issues.
D. Registering the patient and directing the patient to the service area. - CORRECT ANSWERSC. Activating the record, obtaining signatures and
The activity which results in the accurate recording of patient bed and level of care assessment, patient transfer and patient discharge status on a real-time basis is known as:
A. Utilization review
B. Case Management
C. Census Management
D. Patient through-put - CORRECT ANSWERSA. Utilization review
or
B. Case Management
An advantage of a pre-registration program is:
A. The markets value of such a program
B. The ability to eliminate no-show appointments.
C. The opportunity to reduce processing times at the time of service.
D. The opportunity to reduce corporate compliance failures within the registration process. - CORRECT ANSWERSC. The opportunity to reduce processing times at the time of service.
The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can:
A. Obtain price estimates for medical services
B. Negotiate the price of medical services with providers
C. Purchase qualified health benefit plans regardless of insured's health status
D. Meet federal mandates for insurance coverage and obtain the corresponding tax deduction - CORRECT ANSWERSC. Purchase qualified health benefit plans regardless of insured's health status.
All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT:
A. Offered in an outpatient setting
B. Medically unnecessary
C. Not delivered in a Medicare licensed care setting.
D. Services and procedures that are custodial in nature - CORRECT ANSWERSC. Not delivered in a Medicare licensed care setting
All of the following are reference resources used to help guide in the application for business ethics EXCEPT:
A. Consumer satisfaction reports
B. Mission & Value Statements
C. Code of Ethics / Code of Conduct
D. Compliance Office & Policies - CORRECT ANSWERSA. Consumer satisfaction reports
All of the following are steps in safeguarding collections EXCEPT:
A. Placing collections in a lock-box for posting review the next business day.
B. Posting the payment to the patient's account
C. Completing balancing activities
D. Issuing receipts - CORRECT ANSWERSA. Placing collections in a lock-box for posting review the next business day
All of the following are steps in verifying insurance EXCEPT:
A. Sequencing plans involved in a coordination of benefits (COB) situation.
B. The patient signing the statement of financial responsibility.
C. Identifying and documenting the patient's health plan benefits
D. Confirming the patient's eligibility for benefits - CORRECT ANSWERSB. The patient signing the statement of financial responsibility
All of the following information is used to identify a patient EXCEPT:
A. Date of Birth
B. Gender
C. Social Security Number
D. Address - CORRECT ANSWERSD. Address
All of the following information should be reviewed as part of schedule finalization EXCEPT:
A. The estimated patient financial obligations
B. The service to be provided
C. The arrival time and procedure time
D. The patient's preparation instructions - CORRECT ANSWERSA. The estimated patient financial obligations
Ambulance services are billed directly to the health plan for :
A. All pre-admission emergency transports
B. Transport deemed medically necessary by the attending paramedic-ambulance crew
C. 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
D. The portion of the bill outside of the patient's self-pay - CORRECT ANSWERSC. 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 the another facility
Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons on a monthly fee is known as a:
A. HMO
B. PPO
C. MSO
D. GPO - CORRECT ANSWERSA. HMO
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. 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 - CORRECT ANSWERSA. The Provider Reimbursement Review Board
Applying the contracted payment methodology to the total charges yields:
A. An estimated price
B. An anticipated health plan payment
C. A price justified revenue accrual
D. A pricing agreement - CORRECT ANSWERSA. An estimated price
Appropriate training for the patient financial counselling staff must cover all of the following EXCEPT:
A. Patient financial communications best practices specific to staff role
B. Financial assistance policies
C. Documenting the conversation in the medical record
D. Available patient financing options - CORRECT ANSWERSC. Documenting the conversation in the medical record
The basis for qualification in Medicaid is typically:
A. The Federal Poverty Guidelines
B. Financial need as demonstrated by the prior two-years federal income tax fillings
C. The patient's score on the Internal Revenue Service's Personal Wealth and Spending indicator
D. Bank statements for the previous 18 months - CORRECT ANSWERSA. The Federal Poverty Guidelines
Because 501(r) regulations focus on identifying potentially eligible financial assistance patients, hospitals must:
A. Capture their experience with such patients to properly budget
B. Hold financial conversations with patients as soon as possible
C. Build the necessary processes to handle the potentially lengthy payment schedules
D. Expedite payment processing of normal accounts receivables to protect cash flow - CORRECT ANSWERSB. Hold financial conversations with patients as soon as possible
Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implementation, identifying and processing accounts and:
A. Obtain the patients income tax statements from the prior 2 years
B. Having the account triaged for any partial payment possibilities
C. Monitor compliance
D. Assist in arranging for a commercial bank loan - CORRECT ANSWERSC. Monitor compliance
The benefit of a Medicare Advantage Plan is:
A. It is a less costly plan compared to traditional Medicare
B. Patients may retain a primary care physician and see another physician for a second opinion at no charge
C. Patients generally have their entire Medicare-covered healthcare through the plan and do not need to worry about "Part A" or "Part B' benefits
D. Patients receive significant discounting on services contracted by the federal government - CORRECT ANSWERSC. Patients generally have their entire Medicare-covered healthcare through the plan and do not need to worry about "Part A" or "Part B" benefits
A benefit period begins:
A. With admission as an inpatient
B. Upon the day the coverage premium is paid
C. The first day in which a patient is furnished extended care services in the period the patient is entitled to hospital insurance
D. Immediately once authorization for treatment is provided by the health plan - CORRECT ANSWERSC. The first day in which a patient is furnished extended care services in the period the patient is entitled to hospital insurance
The best practice in billing is to generate bills and financial information that is:
A. Timely and specifies the patient's next steps
B. Clear, concise, correct and patient-friendly
C. Comprehensive and all-inclusive
D. Direct in summarizing charges and in requesting prompt payment - CORRECT ANSWERSB. Clear, concise, correct and patient-friendly
Case management requires that a case manager be assigned:
A. To a select group of resource intensive patient cases
B. To every patient
C. To specific cases designated by third-party contractual agreement
D. To patients of any physician requesting case management - CORRECT ANSWERSB. To every patient
Claims edits are:
A. Rules developed to verify the accuracy of claims based on each health plan's policies
B. The specific reimbursement areas of a claim that are denied by the health plan
C. Special addendums to the claim allowing the provider to submit additional documentation
D. Triggers in the health plan claim adjudication system that disallows reimbursement - CORRECT ANSWERSA. Rules developed to verify the accuracy of claims based on each health plan's policies
Claims with dates of service received later than one year beyond the date of service, will be:
A. Denied by Medicare
B. The full responsibility of the patient
C. The provider's responsibility but can be deemed charity care
D. Fully paid with interest - CORRECT ANSWERSA. Denied by Medicare
A "Compliance Program" is defined as:
A. Educating staff on regulations
B. The development of operational policies that correspond to regulations
C. Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met
D. Annual legal audit and review for adherence to regulations - CORRECT ANSWERSC. Systematic procedures to ensure that provisions of regulations imposed by government agency are being met
The concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits:
A. Billing
B. Account resolution
C. Claims Processing
D. Third-party invoicing - CORRECT ANSWERSC. Claims processing
Concurrent review and discharge planning:
A. Occurs during service
B. Is performed by the health plan during the time of service
C. Is a significant part of quality and is performed by the clinical treatment team
D. Is performed at discharge with the patient - CORRECT ANSWERSC. Is a significant part of quality and is preformed by the clinical treatment team
A decision of whether a patient should be admitted as an inpatient or become an outpatient observation patient requires medical judgments based on all of the following EXCEPT:
A. The patient's medical history
B. The safe-guarding against medical error
C. Current medical needs
D. The Medical predictability of something adverse happening - CORRECT ANSWERSB. The safe-guarding against medical error
The disadvantages of outsourcing include all the following EXCEPT:
A. Increased costs due to vendor ineffectiveness
B. Possible staff job cuts due to vendor efficiencies
C. The impact of customer service or patient relations
D. The impact of direct control of accounts receivable - CORRECT ANSWERSB. Possible staff job cuts due to vendor efficiencies
During the pre-registration, a search for the patient's MPI is initiated using which of the following data sets?
A. Patient's full legal name and address
B. Patient's full legal name and health plan group numbers
C. Patient's full legal name and date of birth or the patient's Social security number
D. Patient's Social Security number and home address - CORRECT ANSWERSC. Patient's full legal name and date of birth or the patient's Social Security number
Each time a patient is transferred:
A. Any additional charges must be explained to the patient
B. The attending physician must sign-off on the transfer request
C. The patient must give consent
D. A transfer request must be made to staff responsible for bed assignments - CORRECT ANSWERSD. A transfer request must be made to staff responsible for bed assignments
The enhanced data-mining opportunities that results from the more detailed coding under ICD-10 allow senior leadership to work with physicians to do all of the following EXCEPT:
A. Improve outcomes
B. Obtain higher compensation for physicians
C. Embrace new reimbursement models
D. Drive significant improvements in areas of quality and the patient experience - CORRECT ANSWERSB. Obtain higher compensation for physicians
Failure to take the appropriate precautions with a bankruptcy account, to identify and isolate the debtor's accounts from further collection activity:
A. Provides evidence of unauthorized extraordinary collections activity
B. Could be in violation of a court's order
C. May violate the provisions of the patient protection regulations
D. Could potentially create under "write-offs" - CORRECT ANSWERSB. Could be in violation of a court's order
The first thing a health plan does when processing a claim is:
A. Review to make sure the claim is complete
B. Verify if the provider(s) is(are) in network or not
C. Check if the patient is covered
D. Confirm if deductibles and con-insurance requirements have been met - CORRECT ANSWERSC. Check if the patient is covered
For Medicare patients, an important component of the pre-registration process is:
A. Obtaining clear physician's orders
B. Verifying Medicare eligibility
C. Clear authorization for all services covered in Part A
D. The effective completion of the Medicare Secondary Payer (MSP) screening process - CORRECT ANSWERSD. The effective completion of the Medicare Secondary Payer (MSP) screening process
For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions:
A. 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 information - CORRECT ANSWERSB. Should take place between the patient or guarantor and properly trained provider representatives
For scheduled patients, important revenue cycle activities in the time-of-service stage DO NOT include:
A. Pre-registration record is activated, consents are signed, and co-payments are collected
B. Positive patient identification is completed, and the patient is given an armband
C. Obtaining or updating patient and guarantor information
D. Pre-processed patients report to a designated "express arrival" desk - CORRECT ANSWERSC. Obtaining or updating patient and guarantor information
A four digit number code established by the National Uniform Billing (NUBC) that categorizes/classifies a line item in the chargemaster is known as:
A. HCPCs codes
B. ICD-10 Procedural codes
C. CPT codes
D. Revenue codes - CORRECT ANSWERSD. Revenue codes
The fundamental approach in managing denials is:
A. To create billing "double-check" processes
B. To analyze the type and sources of denials and consider process changes to eliminate further denials
C. To standardize and centralize all billing activity to focus on compliance with contractual agreements
D. to review all claims processing for compliance with contractual agreements - CORRECT ANSWERSB. To analyze the type and sources of denials and consider process changes to eliminate further denials
The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statues and regulations pertaining to:
A. Patient financial obligations for the entire cost of treatment
B. Unregulated market activity for third-party payers
C. Medicare and Medicaid payments
D. Commercial third-party payers - CORRECT ANSWERSC. Medicare and Medicaid payments
Health Information Management (HIM) is responsible for:
A. All patient medical records
B. The maintenance of all software applications
C. The maintenance of the entire technology infrastructure
D. Clean claims being filed - CORRECT ANSWERSA. All patient medical records
Health Plan Contracting Departments do all the following EXCEPT:
A. Reimbursement rate setting
B. Review all managed care contracts for accuracy and load contract terms into the patient accounting system
C. Review payment schemes to ensure that the health plan and provider understand how reimbursements must be calculated
D. Review contracts to ensure the appeals process for denied claims is clearly specified - CORRECT ANSWERSA. Reimbursement rate setting
HFMA best practices call for patient financial discussions to be reinforced:
A. By obtaining some type of collateral
B. With a written statement of the conversation
C. By issuing a new invoice to the patient
D. Ny copying the provider's attorney on a written statement of the conversation - CORRECT ANSWERSB. With a written statement of the conversation
HFMA best practice specify that, In an Emergency Department setting:
A. Financial conversations are inappropriate
B. Financial conversations be brief and focused on obtaining third-party payer information
C. Financial conversations be focused on obtaining basic demographic data needed to create the patient account
D. No patient financial discussions should occur before a patient is screened and stabilized - CORRECT ANSWERSD. No patient financial discussions should occur before a patient is screened and stabilized
HFMA best practices stipulate that a reasonable attempt should be made to have the financial responsibilities discussion:
A. As early as possible, before a financial obligation is Incurred
B. During the registration process
C> Before scheduling of services
D. No later than the evening of the day of admission - CORRECT ANSWERSA. As early as possible, before a financial obligation is incurred
HFMA patient financial communications best practices call for annual training for all staff EXCEPT:
A. Staff who engage in patient financial communications discussions
B. Patient access
C. Nursing
D. Customer service representatives - CORRECT ANSWERSC. Nursing
HIPPA contains all of the following goals EXCEPT:
A. To expand health coverage by improving the portability and continuity of health insurance coverage in group and individual markets
B. To ensure proper coding across the continuum of care
C. To give patients access to their health files and the right to request amendments or make corrections
D. To facilitate the electronic exchange of medical information with respect to financial and administrative transactions carried out by health plans, healthcare clearing houses, and healthcare providers - CORRECT ANSWERSB. To ensure proper coding across the continuum of care
HIPAA has adopted Employer Identification Numbers (EINs) to be used in standard transactions to identify the employer of an individual described transaction. EINs are created and assigned by:
A. The Social Security Administration
B. The United States Department of the Treasury
C. The United States Department of Labor
D. The Internal Revenue Service - CORRECT ANSWERSD. The Internal Revenue Service
HIPAA privacy rules require covered entitles to take all of the following actions EXCEPT:
A. Develop written policies and procedures including a description of staff who have access to protected information
B. Define protected health information and access thereto by individuals, health plans, and business associates
C. Ensure that a privacy officer is hired/designated
D. Use only designated software platforms to secure patient data - CORRECT ANSWERSD. Use only designated software platforms to secure patient data
Hospitals can only convert an inpatient case to observation if the hospital utilization review committee determines this status before the patient is discharged and:
A. With the consent of the third-party payer's medical director that and observation setting will be more appropriate
B. After any billing
C. Before closing the patient's account
D. Prior to billing, that an observation setting will be more appropriate - CORRECT ANSWERSD. Prior to billing, that an observation setting will be more appropriate
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