CRCR 4 - Post-Service Financial Care - Quiz Combo: (Pre-Tests, KCs, Quizzes): Solved: Questions & Answers

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Credit balances may be created by any of the following activities except: (Ans- Credits to pharmacy charges posted before the claim final bills. Which of the following statements represent common ... reasons for inpatient claim denials? (Ans- Failure to obtain a required pre-authorization; failure to complete a continued stay authorization and services provided which were not medically necessary. A 68-year-old patient, a Medicare beneficiary, was in a car accident. A medical insurance claim was filed with the auto insurance carrier. Six months later this claim remains unpaid. How can the provider pursue payment from Medicare? (Ans- The provider must first bill the auto insurer; however, after a period of 120 days, if the claim remains unpaid, the provider may cancel the liability claim and bill Medicare. The difference between bad debt and financial assistance (charity) is: (Ans- Bad debt represents a refusal to pay; charity represents an inability to pay. In order to qualify for financial assistance, a patient or guarantor should: (Ans- Provide the following documents: prior year tax return, employment check stubs from the prior three months and bank statements from the prior three months. To comply with the requirements of Section 501(r) for tax-exempt hospitals chartered as 510(c)3 providers, the hospital must complete with of the following activities: (Ans- A community needs assessment. The three types of bankruptcy as defined in the 1979 Bankruptcy Act are: (Ans- Chapter 7 - Straight Bankruptcy, Chapter 11 - Debtor Reorganization, and Chapter 13 - Debtor Rehabilitation Which of the following medical debt collection practices are recommended as part of HFMA's Best Practices for medical account resolution: (Ans- Establish policies and ensure that they are followed. Organizations may opt to contract with or outsource to specific vendors for some or all components of revenue cycle processing. This practice has both advantages and disadvantages. Which of the following statements is not an advantage of utilizing an outsourcing vendor? (Ans- The need for legal review if the outside vendor's staff represents themselves as employees of the healthcare facility. Each hospital covered by the 501(r) regulations is required to develop a financial assistance policy. Which of the following elements is not a required element of the policy? (Ans- The notice that individuals eligible for financial assistance under this policy may be charged more than the amount generally billed (AGB) to insured patients. (KC4.1) There are 9 daily reconciliation process steps. Select the proper order of the first four steps. (Ans- 1. Obtain totals of all payments - cash, check credit card, debit card. 2. Divide remittances into batches and obtain a second total of the electronic remittance advices by payment and contractual allowances. 3. Endorse checks immediately. 4. Prepare the bank deposit for all payments. There are 9 daily reconciliation process steps. Select the proper order of steps 4 - 7. (Ans- 4. Prepare the bank deposit for all payments. 5. Separate cash payments and contractual adjustments into separate batches and use separate payment and adjustment codes. 6. Post unidentified payments to an unidentified case account (deposit everything, do not hold unidentified payments). 7. Balance and post batches. There are 9 daily reconciliation process steps. Select the proper order of steps 7 - 9. (Ans 7. Balance and post batches. 8. Balance payments to the bank deposit. 9. Balance the bank deposit to the general ledger. Sue Smith came into the hospital. her insurance provider sent and EFT directly into the hospital's account at the bank. John, the hospital representative receives an electronic Level 2 ERA. What should he do next? (Ans- Manually match the ERA to the patient account. What is EFT? (Ans- The electronic transfer of funds from payer to payee through the banking system. Which option would be the most appropriate to resolve a credit balance due to duplicate payments? (Ans- Notify payer, send refund or complete take back from as directed by payer. (KC4.2) Which option would be the most appropriate to resolve a credit balance due to late charge credits processing? (Ans- Submit corrected claim to payer or remove the credit charges from patient's account. Which option would be the most appropriate to resolve a credit balance due to primary and secondary payers both paying as primary? (Ans- Determine correct primary, notify incorrect payer of overpayment. Which option would be the most appropriate to resolve a credit balance due to inaccurate upfront collections? (Ans- Determine overpayment amount; issue refund check to patient. [Show More]

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