CRCR SECTION 3 exam 2023 with 100% correct answers

Document Content and Description Below

CRCR SECTION 3 exam 2023 with 100% correct answers What does EMTALA require hospitals to do? ✔Ans✔ to provide a medical screening examination and stabilizing treatment to every person presenti... ng at an ED and requesting medical evaluation or treatment What is the first critical step for all patients arriving for service, scheduled or unscheduled? ✔Ans✔ verifying the patient's identification with a combination of two identifiers from a valid information source Admission process forms include: ✔Ans✔ consent to treatment, conditions of admission, privacy notice, important message from Medicare, advance directives and medical power of attorney, patient bill of rights EMTALA prohibits inquires about health care or liability payer information if the inquiry will delay examination or treatment. What other requirements apply to the Emergency Department registration work? ✔Ans✔ patients are initially triaged by medical personnel and a "quick" registration initiated to allow electronic order entry and documentation, identification and verification of insurance eligibility and benefits once the medical screening has been completed, no additional registration may occur until the patient is stabilized Typical activities which must be performed when an unscheduled patient arrives for a service include: ✔Ans✔ identification 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 estimation 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: ✔Ans✔ to 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 Charge master include: ✔Ans✔ omission 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: ✔Ans✔ ICD-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: ✔Ans✔ condition 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: ✔Ans✔ the patient required skilled services on a daily basis and those services can only be provided on a inpatient basis in a SNF DRG's are system of classifying inpatients on the basis of diagnoses, procedures, and co-morbidities for purposes of payment to hospitals. Each DRG includes: ✔Ans✔ a 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 outliner payment is added to the calculated payment PPO networks represent one form of discounting commonly used by commercial payers. The silent PPO represents: ✔Ans✔ a 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 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? ✔Ans✔ payers will waive timely filing denials for claims filed over a year from date of service [Show More]

Last updated: 2 years ago

Preview 1 out of 6 pages