CRCR Practice 141 Questions with Answers 2023,100% CORRECT

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 activities? A. Complete a community needs assessment and develop a discoun ...

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 activities? 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 Hospitals can only convert to an inpatient case to observation if: A. The patient's health plan approves B. The hospital utilization review committee determines before the patient is discharged and prior to billing, that an observation setting would be more appropriate C. The level of intensity of treatment does not warrant an admission D. The patient in consultation with the attending and before billing requests the change - CORRECT ANSWERSB. The hospital utilization review determines before the patient is discharged and prior to billing, that an observation setting would be more appropriate Hospitals need which of the following information sets to assess a patient's financial status? A. Income, Expenses, Debt B. Demographic, Income, Assets, Expenses C. Income, Expenses, and Capacity to take on more debt D. Asset liquidity, Income, Expenses, Credit worthiness - CORRECT ANSWERSB. Demographic, Income, Assets, Expenses ICD-10-CM and ICD-10-PCD code sets are modifications of: A. The international ICD-10 codes as developed by the WHO (World Health Organization) B. ICD 9 codes C. CPT codes D. DRGs - CORRECT ANSWERSB. ICD 9 codes Identifying the patient in the MPI, creating the registration record, completing medical necessity screening, determining insurance eligibility, obtaining insurance benefits, resolving managed care requirements, and completing financial education/resolution are all: A. The data collection steps for scheduling and pre-registering a patient B. Registration steps that must be completed before an medical services are provided C. The steps mandated for billing Medicare Part A D. The process of closing an account - CORRECT ANSWERSA. The data collection steps for scheduling and pre-registering a patient 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 within 24 hours, the patient: A. Will be admitted as an inpatient B. Will remain in observation for up to 72 hours after which the patient is 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 and the primary care physician and a future course of care will then be determined - CORRECT ANSWERSA. Will be admitted as an inpatient The impact of denials on the revenue cycle includes all of the following EXCEPT: A. Loss of revenue B. Increased collection fees C. Staff productivity D. Quality reputation - CORRECT ANSWERSD. Quality reputation The importance of medical records being maintained by HIM is that the patient records: A. Are evidence used in assessing the quality of care B. Are the primary source for clinical data required for reimbursement by health plans and liability payers C. Are the strongest evidence and defense in the event of a Medicare audit D. Are the evidence cited in quality review - CORRECT ANSWERSB. Are the primary source for clinical data required for reimbursement by health plans and liability payers The Important Message from Medicare provides beneficiaries information concerning their: A. Obligation to reimburse the hospital for any services not covered by the Medicare program B. Right to refuse to use lifetime reserve days for the current stay C. Right to appeal a discharge decision if the patient disagrees with the plan D. Understanding of billing issues and the deductible and/or co-insurance due for the current visit - CORRECT ANSWERSC. Right to appeal a discharge decision if the patient disagrees with the plan Improving the overall patient experience requires revenue cycle leadership and staff to simultaneously be: A. Clear on policies and firm and consistent in applying the policies B. Careful in screening patient demands C. Monitoring cost and charges the patient incurs D. Inquisitive, responsive, innovative and flexible - CORRECT ANSWERSD. Inquisitive, responsive, innovative and flexible In a self-insured (or self-funded) plan, the costs of medical care are: A. Borne by the employer on a pay-as-you-go basis B. Backed-up by stop-loss insurance against a catastrophic claim C. Mandated by the Affordable Care Act for small business unable to obtain commercial coverage D. Created by a combination of employer and employee contributions - CORRECT ANSWERSA. Borne by the employer on a pay-as-you-go basis In choosing a setting for patient financial discussions, organizations should first and foremost: A. Have processes in place to document the discussions B. Assess locations for convenience, professionalism, and comfort C. Respect the patient's privacy D. Ensure all staff involved are properly trained and the patient financial education is included in all discussions - CORRECT ANSWERSC. Respect the patient's privacy Incorrect data gathering can cause all of the following EXCEPT: A. Risks in patient safety and compliance B. Denied claims C. The inability to engage physicians in quality outcomes D. Low quality outcomes - CORRECT ANSWERSC. The inability to engage physicians in quality outcomes Indemnity plans usually reimburse: A. Only for contracted services B. A claim up to 80% of the charges C. A certain percentage of the charges after the patient meets the policy's annual deductible D. A patient for out-of-pocket charges - CORRECT ANSWERSC. A certain percentage of the charges after the patient meets the policy's annual deductible 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 Medicare determination appeal B. A payment review C. A Medicare supplemental review D. A beneficiary appeal - CORRECT ANSWERSD. A beneficiary appeal In order to provide a patient with information that is meaningful to them, all of the following must be included EXCEPT: A. The type of hospital service based on CPT/HCPCS or MS-DRG code B. The patient's health plan C. The patient's benefit plan D. The attending/admitting physician - CORRECT ANSWERSD. The attending/admitting physician Insurance verification results in which of the following? A. The accurate identification of the patient's eligibility and benefits B. Consistent formatting of the patient's name and identification number C. The resolution of managed care and billing requirements D. The identification of physician fee schedule amounts and NPI (National Provider Identifier) numbers - CORRECT ANSWERSA. The accurate identification of the patient's eligibility and benefits Insurance verification results in which of the following? A. The accurate identification of the patient's eligibility and benefits B. The consistent formatting of the patient's name and identification number C. The resolution of managed care and billing requirements D. The identification of physician fee schedule amounts and the NPI (National Provider Identifier) numbers - CORRECT ANSWERSA. The accurate identification of the patient's eligibility and benefits In the balance resolution process, providers should: A. Stress to the patient that serious consequences may result from refusal to pay B. Remind the patient of their legal responsibility to pay the balance due C. Ask if the patient if he or she would like to receive information about payment options and supportive financial assistance programs D. Tag the patient's record for possible financial assistance for bad debt - CORRECT ANSWERSC. Ask if the patient if he or she would like to receive information about payment options and supportive financial assistance programs In the pre-service stage, the requested service is screened for medical necessity, health plan coverage and benefits are verified and: A. Billing authorization is signed by the patient B. The patient signs the consents for treatment C. The patient signs a statement attesting an understanding and acceptance of payment policies D. Pre-authorizations are obtained - CORRECT ANSWERSD. Pre-authorizations are obtained It is important to have high registration quality standards because quality failures: A. May have legal implications B. Impact the patient's ability to obtain additional services C. May cause service departments to change scheduling requirements D. Impact the provider's Joint Commission results on review day - CORRECT ANSWERSA. May have legal implications The legal authority to request and analyze provider claim documentation to ensure that services provided were reasonable and necessary is given to: A. Recovery Audit Contractors (RAC) B. All health plans C. The Office of the U.S. Inspector General (OIC) D. State Insurance Commissioners - CORRECT ANSWERSA. Recovery Audit Contractors (RAC) Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare established guideline(s) used to determine: A. What Medicare reimburses and what should be referred to Medicaid B. Medicare outpatient reimbursement rates C. Which diagnoses, signs, or symptoms are reimbursable D. Medicare and Medicaid provider eligibility - CORRECT ANSWERSC. Which diagnoses, signs, or symptoms are reimbursable Maintaining routine contact with the health plan or liability 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. Case Management C. HIM staff D. Managed Care Contract Staff - CORRECT ANSWERSB. Case Management Medicare beneficiaries remain in the same "benefit period": A. Up to 60 days B. Up to hospitalization discharge C. Until the beneficiary is "hospitalization-free" for 60 consecutive days D. Each calendar year - CORRECT ANSWERSC. Until the beneficiary is "Hospitalization-free" for 60 consecutive days The Medicare Bundled Payments for Care Initiative (BCPI) is designated to: A. Prevent duplicate billing B. Drive down cost as one payment is shared by all care givers in a s single episode of care C. "Stretch" the impact of patient self-pay by squeezing costs down through a lump-sum payment to providers D. Align incentives between hospitals, physicians, and non-physician providers in order to better coordinate patient care - CORRECT ANSWERSD. Align incentives between hospitals, physicians, and non-physician providers in order to better coordinate patient care The Medicare fee-for-service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: A. Redetermination by the company that handles claims for Medicare B. review by the Medicare Appeals Council (Appeals Council) C. Judicial review by a federal district court D. Medical Necessity review by an independent physicians panel - CORRECT ANSWERSD. Medical Necessity review by an independent physicians panel Medicare has established guidelines called Local Coverage Determinations (LCD) and National Coverage Determinations (NCD that establish: A. Reasonable and customary prices for services in a given area B. Prospective Medicare patient financial responsibilities for a given diagnosis C. Provider and physician reimbursement for specific diagnoses and tests D. What services or healthcare items are covered under Medicare - CORRECT ANSWERSD. What services or healthcare items are covered uder Medicare Medicare Part B has an annual deductible, and the beneficiary is responsible for: A. A co-insurance payment for all Part B covered services B. Physician's office fees C. Tests outside of an inpatient setting D. Prescrirptions - CORRECT ANSWERSA. A co-insurance payment for all Part B covered services Medicare patients are NOT required to produce a physician's order to receive which of the services? A. Diagnostic mammography, flu vaccine or B-12 shots B. Diagnostic mammography, flu vaccine or pneumonia vaccine C. Screening mammography, flu vaccine or pneumonia vaccine D. Screening mammography, flu vaccine or B-12 shots - CORRECT ANSWERSC. Screening mammography, flu vaccine or pneumonia vaccine The most effective payment plan programs: A. Screen patients to determine if they are capable of paying B. Are rigorous in patient follow-up C. Do not allow missed payments D. Are turned over to a collection agency - CORRECT ANSWERSA. Screen patients to determine if they are capable of paying Most major health insurance payers, including Medicare and Medicaid, offer: A. Hard-copy documentation of insurance coverage B. Insurance verification through agents who are available during normal business hours C. Electronic verification of insurance coverage D. Provider "self-service" web portal accessible through the policy holder's plan ID number - CORRECT ANSWERSC. Electronic verification of insurance coverage Most major health plans including Medicare and Medicaid, offer: A. Toll free verification hot lines, staffed around the clock B. Electronic and/or web portal verification C. Patient "verification of benefits" cards D. A grace period for obtaining verification within 72 hours of treatment - CORRECT ANSWERSB. Electronic and/or web portal verification A nightly room charge will be incorrect if the patient's: A. Transfer from the ICU (Intensive care unit) to the Medical/Surgical floor is not reflected in the registration system B. Pharmacy orders have not been entered into the pharmacy system C. Condition has not been discussed during the shift change report meeting D. Discharge for the next day has not been charted - CORRECT ANSWERSA. Transfer from the ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system Once the EMTALA requirements are satisfied: A. Third-party payer information should be collected from the patient and payer be notified of the ED visit B. An initial registration record is completed so that the proper coding can be initiated C. The patients then assume full liability for services unless a third-party payer is notified or the patient applies for financial assistance within the first 48 hours D. The remaining registration processing is initiated either at the bedside or in a registration area - CORRECT ANSWERSD. The remaining registration processing in initiated either at the bedside or in a registration area Once the price is estimated in the pre-service stage, a provider's financial best practice is to: A. Allow the patient time to compare prices with other providers B. Have another employee double check the price estimate C. Lock-in prices D. Explain to the patient their financial responsibility and to determine the plan for payment - CORRECT ANSWERSD. Explain to the patient their financial responsibility and to determine the plan for payment An originating site is: A. The location where the patient's bill is generated B. The location of the patient at the time the service is provided C. The site that generates reimbursement of a claim D. The location of the medical treatment provider - CORRECT ANSWERSB. The location of the patient at the time the service is provided Outside the emergency department setting, patient financial discussions may take place during the registration or discharge process in a location that: A. Doesn't disrupt patient flow B. Meets patient's needs C. Is clearly identifiable as a patient financial services location D. Contains technology dedicated to patient accounts - CORRECT ANSWERSA. Doesn't disrupt patient flow 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. Medicare C. The Medicare Administrative Contractor (MAC) at the end of the hospice cap period D. Each state's Medicaid plan - CORRECT ANSWERSC. The Medicare Administrative Contractor (MAC) at the end of the hospice cap period The patient discharge process begins when: A. The physician writes the discharge orders B. Clinical services are completed and patient accounts have all the information necessary to bill C. The physician writes the discharge orders and the third-party payer sign-off on the necessity of the services provided D. Clinical services are completed, patient accounts can generate an accurate bill and there is an agreement on the handling of patient financial responsibilities - CORRECT ANSWERSA. The physician writes the discharge orders Patient financial communications best practices produce communications best practices produce communications that are: A. Timely and remind patients of their financial responsibilities B. Consistent, clear and transparent C. Current and report the status of a patient's claim D. Timely, comprehensive and specifying next steps - CORRECT ANSWERSB. Consistent, clear and transparent Patients expect value for their healthcare dollar, including greater transparency of: A. Physician rates B. Quality and price information C. Hospital accreditation D. Malpractice legal rights - CORRECT ANSWERSB. Quality and price information The patient should receive written information about the provider's supportive financial assistance programs at: A. Registration or discharge B. The first billing immediately after discharge C. Any point during the course of treatment D. Admission - CORRECT ANSWERSA. Registration or discharge Patients should be informed that costs presented in a price estimate may: A. Vary from estimates, depending on the actual services performed B. Be guaranteed if the patient satisfies all patient financial responsibilities at the time of registration C. Be lower as price estimates use the highest market price D. Only determine the percentage of the total that the patient is responsible for and not the actual cost - CORRECT ANSWERSA. Vary from estimates, depending on the actual services performed The physician who wrote the order for service and is in charge of the patient's care is: A. The patient's personal physician B. The primary care physician C. The attending physician D. The Physician Patient Care Director - CORRECT ANSWERSC. The attending physician 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 consumers to: A. Negotiate the cost of health plan premiums B. Customize health care with a personally chosen mix of providers C. Identify, compare, and choose providers that offer the desired level of value D. Verify the cost of individual clinicians - CORRECT ANSWERSC. Identify, compare, and choose providers that offer the desired level of value The process of pre-registration ensures: A. Accurate billing B. Early and productive communication with any third party payer C. That access staff will have the complete and valid information needed to finalize any remaining pre0access activities D. The patient arrives understanding their financial responsibilities - CORRECT ANSWERSC. That access staff will have the complete and valid information needed to finalize any remaining pre-access activities The purpose of the ACA mandated Community Health Needs Assessment is: A. To obtain the data needed to determine the local allocation of federal healthcare funding B. To identify significant health needs, prioritize those needs and identify resources to address them C. To provide community benefit outreach to those without insurance and who have not had a physical within the past two years D. To create health information databases, calibrated to local needs, and to improve claims processing accuracy - CORRECT ANSWERSB. To identify significant health needs, prioritize those needs and identify resources to address them Recognizing that health coverage is complicated and not all patients are able to navigate this terrain, HFMA best practices specify that: A. A representative of the health plan be included in the patient financial responsibilities discussion B. The patient accounts staff have someone assigned to research coverage on behalf of patients C. Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions D. patient coverage education may need to be provided by the health plan - CORRECT ANSWERSC. Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions A recurring/series registration is characterized by: A. The creation of one registration record for multiple days of service B. The creation of multiple registrations for multiple services C. The creation of one registration record per diagnosis per visit D. The creation of multiple patient types for one date of service - CORRECT ANSWERSA. The creation of one registration record for multiple days of service Reimbursement and budget personnel actively model coding and reimbursement changes that result from the coding are put in place to guard against: A. Underpayments B. Denials C. Compliance fraud by "upcoding" D. Chargemaster error - CORRECT ANSWERSC. Compliance fraud by "upcoding" The result of accurate census balancing on a daily basis is: A. The overall accuracy of resource planning B. The correct recording of room charges C. The increased efficiency in treatment D. Improved ability to plan nursing staff support services - CORRECT ANSWERSB. The correct recording of room charges Revenue cycle activities occurring at the point-of-service include all of the following EXCEPT: A. The provision of case management and discharge planning services B. Providing charges to the third-party payer as they are incurred C. The generation of charges D. The monitoring of charges - CORRECT ANSWERSA. The provision of case management and discharge planning services Scheduled procedures routinely include: A. Physician notification that scheduling is complete B. Patient preparation instructions C. Information on financial obligations D. The scheduler's name and contact information - CORRECT ANSWERSB. Patient preparation instructions The soft cost of a dissatisfied customer is: A. The "cost" of staff providing extra attention in trying to perform service recovery B. The customer passing on information about their negative experience to potential patients or through social media channels C. A potentially negative treatment environment due to patient hostility D. Lowered quality outcomes for the dissatisfied patient - CORRECT ANSWERSB. The customer passing on information about their negative experience to potential patients or through social media channels Successful account resolution beings with: A. Educating patients on their estimated financial responsibility B. Collecting all deductibles and copayments during the pre-service stage C. Accurate documentation of services D. Patient compliance with the course of treatment - CORRECT ANSWERSA. Educating patients on their estimated financial responsibility A successful pre-registration program: A. Helps the patient feel welcome B. Identifies clearly what information must be gathered including demographic data, insurance data, and financial information C. Thoroughly discusses the patient's financial obligation D. Collects patient deductibles and co-pays - CORRECT ANSWERSB. Identifies clearly what information must be gathered including demographic data, insurance data, and financial information Telemed seeks to improve a patient's health by: A. Permitting two-way, real time interactive communication between the patient, and the clinical professional B. Using high-compression fiber optics to transmit medical data C. Providing relevant, on-demand consumer medical education D. Providing physician access to the most current medical research - CORRECT ANSWERSA. Permitting two-way, real time interactive communication between the patient, and the clinical professional Tests and services can only be provided: A. As inpatient services B. Once the patient agrees to meet their financial responsibilities C. With valid physician orders D. After any authorizations are obtained - CORRECT ANSWERSC. With valid physician orders This directive was developed to promote and ensure healthcare quality and value and also to protect consumers and workers in the healthcare system. Theis directive is called: A. Payer quality monitoring B. Patient bill of rights C. Medicare patient and staff safety standards D. Joint Commission for Accreditation of Healthcare Organization(JCAHO) safety standards - CORRECT ANSWERSB. Patient bill of rights The three types of utilization reviews used to ensure that resources and services are provided in the most efficient and effective ways are: A. Prospective review, Retrospective review and payment review B. Retrospective review, Systemic review and testing review C. Concurrent review, Discharge review and Placement review D. Prospective review, Concurrent review and Retrospective review - CORRECT ANSWERSD. Prospective review, Concurrent review and Retrospective review To be eligible for Medicaid, and individual must: A. Have no unpaid income taxes B. Meet income and asset requirements C. Be employed at least 15 hours a week D. Be actively seeking employment if unemployed - CORRECT ANSWERSB. Meet income and asset requirement To provide a patient with information that is meaningful to them, all the following factors must be included EXCEPT: A. The actual physician reimbursement B. The patient's benefit plan C. The type of hospital service based on CPT or MD-DRG code D. The patient's insurance carrier - CORRECT ANSWERSA. The actual physician reimbursement The Two Midnight Rule allows hospitals to account for total hospital time including: A. Off site ancillary services B. Costs outside of what is regular and customary occurring within the first 48 hours of inpatient care C. Outpatient time directly preceding the inpatient admission D. Attending physician "on-call" time - CORRECT ANSWERSC. Outpatient time directly preceding the inpatient admission Under EMTALA (Emergency Medial Treatment Labor Act) regulations, the provider may not ask about a patient's insurance information if it would delay what? A. Transfer to another facility B. Complete course of treatment C. Admission to observation status D. Medical screening and stabilizing treatment - CORRECT ANSWERSD. Medical screening and stabilizing treatment Unless the patient encounter is an emergency, it is more efficient and effective to: A. Collect all information after the patient has been discharged B. Use historical information and contact the patient only if the claim is rejected C. Obtain the required demographic and insurance information before services are rendered D. Contact the patient's physician to obtain the necessary registration information after services are rendered - CORRECT ANSWERSC. Obtain the required demographic and insurance information before services are rendered Unless the patient encounter is an emergency, it is more efficient and effective to: A. Collect all information after the patient has been discharged B. Use historical information and contact the patient only if the claim rejects C. Obtain the required demographic and insurance information before services are rendered D. Contact the patient's physician to obtain the necessary registration information after services are rendered - CORRECT ANSWERSC. Obtain the required demographic and insurance information before services are rendered The unscheduled "direct" admission represents a patient who: a) Is admitted from a physician's office on an urgent basis b) Arrives at the hospital via ambulance for treatment in the emergency room c) Is an ambulatory patient who collapses in the hospital lobby d) Arrives on the medical helicopter for trauma services - CORRECT ANSWERSA. Is admitted from the physician's office on an urgent basis Vital to accurate calculations of a patient's self-pay amount is: A. Understanding exactly how each contracted payer adjudicates the benefit package provided to the patient B. Knowing exactly what each contracted payer will accept as an "approved" charge C. The total out-of-pocket that a patient must meet before a third-party payer is liable D. Understanding the payer's claims adjudication requirements - CORRECT ANSWERSC. The total out-of-pocket that a patient must meet before a third-party payer is liable What activities are completed when a scheduled, pre-registered patient arrives for service?: A. Verifying insurance, activating the record, and directing the patient to the service area B. Scanning the driver's license or other photo 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 serve area - CORRECT ANSWERSC. Activating the record, obtaining signatures, and finalizing financial issues What are some core elements of a board-approved financial policy: A. Charity care, payment methods, and installment payment guidelines B. Case management, payment methods, and discharge policies C. Payment requirements, staffing hours, and admission policies D. Deposit requirements, pre-registration calling hours, and charity care policy - CORRECT ANSWERSA. Charity care, payment methods, and installment payment guidelines What is likely to occur if credit balances are not identified separately from debit balances in accounts receivable? A. The organization would be required to refund overpayments with interest B. The accounts receivable level would be understated C. Cash flow projections would be jeopardized D. The accuracy and integrity of fiscal year end audits would be suspect - CORRECT ANSWERSB. The accounts receivable level would be understated What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? A. Revenue codes B. The CMS 1500 Part B C. Medical necessity documentation D. Correct Part A and B procedural codes - CORRECT ANSWERSA. Revenue codes What is the first step of the daily reconciliation process? A. Obtaining the prior business days total cash, plus actual current cash received B. Obtaining cash, check, credit card, and debit card payments received that day C. Obtaining the daily total of cash received minus any know adjustments such as refunds or write-offs made the same day D. Obtaining the number of transactions and their total cash value minus budgeted average daily expense - CORRECT ANSWERSB. Obtaining cash, check, credit card, and debit card payments received that day 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 - CORRECT ANSWERSB. Bad debt adjustment When accounts are reported as uncollectable and returned to the provider by the collection agency: A. The provider may enter into litigation to collect the amount due B. The provider's policies are followed to ensure that the bad debt expense and allowance for uncollectable accounts correctly reflect the status of these returned accounts C. The default is reported to consumer credit agencies creating a downgrade in the debtor's credit worthiness rating D. The account is simply written off as bad debt - CORRECT ANSWERSB. The provider's policies are followed to ensure that the bad debt expense and allowance for uncollectable accounts correctly reflect the status of these returned accounts When Recovery Audit Contractors (RAC) identify improper payments as over payments, the claims processing contractor must: A. Assume legal responsibility for repaying the overage amount B. Make recovery of the overpayment the top processing priority C. Send a demand letter to the provider to recover the over payment amount D. Conduct an audit of all the effected providers claims within the past twelve months - CORRECT ANSWERSC. Send a demand letter to the provider to recover the over payment amount When there is a request for service, the scheduling staff member must confirm the patient's unique identification information to: A. Verify the patient's insurance coverage if the patient is a returning customer B. Ensure that she/he accesses the correct information in the historical database C. Confirm that physician orders have been received D. Check if there is any patient balance due - CORRECT ANSWERSB. Ensure that she/he accesses the correct information in the historical database Which department supports/collaborates with the revenue cycle? A. Information Technology B. Hospice C. Software Applications D. Continuum of Care - CORRECT ANSWERSA. Information Technology Which level of HCPCS codes begin with a single letter followed by four numeric digits? A. Level I B. Level II C. Level III D. None of the above - CORRECT ANSWERSB. Level II or C. Level III Which level of HCPCS modifiers consist of 5 digits and is approved by the American Medical Association? A. Level I B. Level II C. Level III D. None of the above - CORRECT ANSWERSA. Level I Which of the following statements applies to the scheduled outpatient? A. The services meet inpatient acuity criteria B. The services never require preauthorization C. The services are provided on an ongoing basis D. The services do not involve an overnight stay - CORRECT ANSWERSD. The services do not involve an overnight stay Which option is a benefit of pre-registering patients for service? A. The patient arrival processing is expedited, reducing wait times and delays B. The verification of insurance after completion of service C. Service departments having the ability to override schedules and block times to reduce testing volumes D. The patient receiving multiple calls from the provider - CORRECT ANSWERSA. That patient arrival processing is expedited, reducing wait times and delays Which option is a federally-aided, state-operated program established to provide health and long-term care coverage for low-income individuals or families? A. Medicaid B. Medicare C. Insurance Exchange D. Social Security - CORRECT ANSWERSA. Medicaid Which option is a government-sponsored program that is financed through taxes and general revenue funds? A. Medicaid B. Medicare C. Insurance Exchange D. Social Security - CORRECT ANSWERSB. Medicare Which statement applies to the scheduled outpatient? A. Their services meet inpatient acuity criteria B. Their services never require pre-authorization C. Their services are provided on an ongoing basis D. Their services do not involve an overnight stay - CORRECT ANSWERSD. Their services do not involve an overnight stay Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? A. Registration staff my routinely contact manage care plans for prior authorizations before the patient is seen by the on-duty physician B. Co-Payments may be collected at the time of service once the medical screening and stabilization activities are completed C. Signage must be posted where it can be easily seen and read by patients D. Initial registration activities may occur so long as these activities do not delay treatment or suggest that treatment will not be provided to uninsured individuals. - CORRECT ANSWERSA. Registration staff my routinely contact manage care plans for prior authorizations before the patient is seen by the on-duty physician Which statement is a requirement of the important Message from Medicare notification process? A. Notification is required at admission and no later than 4 days before discharge B. Notification is required no earlier than 7 days prior to admission and no more than 2 days prior to discharge C. Notification is only required if the patient's discharge D. Notification is not required for beneficiaries enrolled in a Medicare Advantage plan - CORRECT ANSWERS