CRCR Certification Exam 372 Questions with Answers 2023,100% CORRECT

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CRCR Certification Exam 372 Questions with Answers 2023 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 direct control of accounts receivable services c) Increased costs due to vendor ineffectiveness d) Reduced internal staffing costs and a reliance on outsourced staff - CORRECT ANSWERSd) Reduced internal staffing costs and a reliance on outsourced staff 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) - CORRECT ANSWERSb) Judicial review by a federal district court 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 - CORRECT ANSWERSa) The principles and standards by which organizations operate 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 - CORRECT ANSWERSa) Charitable pledges 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 - CORRECT ANSWERSc) Which diagnoses, signs, or symptoms are reimbursable 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 - CORRECT ANSWERSc) The time it takes to collect anticipated revenue 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 - CORRECT ANSWERSb) The fact that charge master lists the total charge, not net charges that reflect charges after a payer's contractual adjustment 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 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 - CORRECT ANSWERSc) Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow 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 - CORRECT ANSWERSc) Systematic procedures to ensure that the provisions of regulations imposed by a government 10. 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 - CORRECT ANSWERSb) To a select patient group 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 - CORRECT ANSWERSa) Identify, compare, and choose providers that offer the desired level of value 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 - CORRECT ANSWERSb) HMO 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 - CORRECT ANSWERSa) The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt 14. 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 - CORRECT ANSWERSa) Scheduling, pre-registration, insurance verification and managed care processing 15. 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 - CORRECT ANSWERSd) A mutual hold-harmless clause 16. 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 - CORRECT ANSWERSd) Case Management 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 - CORRECT ANSWERSa) Revenue codes 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 - CORRECT ANSWERSa) Monitor compliance 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 - CORRECT ANSWERSb) Should take place between the patient or guarantor and properly trained provider representatives The purpose of a financial report is to: a) Provide a public record, if requested b) Present financial information to decision makers c) Prepare tax documents d) Monitor expenses - CORRECT ANSWERSb) Present financial information to decision makers 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 - CORRECT ANSWERSa) Registration staff may routinely contact managed are plans for prior authorizations before the patient is seen by the on-duty physician 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 - CORRECT ANSWERSc) The submitted claim does not have the physicians signature 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 - CORRECT ANSWERSd) The Provider Reimbursement Review Board 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 - CORRECT ANSWERSa) Generation of timely and accurate billing 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 - CORRECT ANSWERSc) The portion of the bill outside of the patient's self-pay 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 - CORRECT ANSWERSa) A beneficiary appeal 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 - CORRECT ANSWERSd) Obtain higher compensation for physicians 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 - CORRECT ANSWERSa) When providers re-bill claims based on nonpayment from the initial bill submission 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 - CORRECT ANSWERSa) Purchase qualified health benefit plans regardless of insured's health status The most common resolution methods for credit balances include all 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 - CORRECT ANSWERSa) Designate the overpayment for charity care 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 - CORRECT ANSWERSd) An electronic transfer of funds from payer to payee Revenue cycle activities occurring at the point-of-service include all 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 - CORRECT ANSWERSc) Providing charges to the third-party payer as they are incurred 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 - CORRECT ANSWERSb) Until the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days 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 - CORRECT ANSWERSb) Provide a method of measuring the collection and control of A/R 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 - CORRECT ANSWERSb) Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions 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 - CORRECT ANSWERSd) Ensure that she/he accesses the correct information in the historical database 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 - CORRECT ANSWERSa) Explain to the patient their financial responsibility and to determine the plan for payment 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 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 - CORRECT ANSWERSd) Services and procedures that are custodial in nature All of the following are forms of hospital payment contracting EXCEPT a) Contracted Rebating b) Per Diem Payment c) Fixed Contracting d) Bundled Payment - CORRECT ANSWERSa) Contracted Rebating 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 - CORRECT ANSWERSd) The Medicare Administrative Contractor (MAC) at the end of the hospice cap period With the advent of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is out 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 - CORRECT ANSWERSd) Assist patients in understanding their insurance coverage and their financial obligation 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 - CORRECT ANSWERSd) Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system 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 - CORRECT ANSWERSa) Meet income and assets requirements 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 - CORRECT ANSWERSb) By copying the provider's attorney on a written statement of conversation 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 - CORRECT ANSWERSa) With admission as an inpatient 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 - CORRECT ANSWERSb) Will be admitted as an inpatient 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 - CORRECT ANSWERSd) Inaccurate or incomplete patient data will delay payment or cause denials 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" - CORRECT ANSWERSd) Medicare determines are "reasonable and necessary" 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 - CORRECT ANSWERSd) From the midnight census 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 - CORRECT ANSWERSc) Accurate billing Once the EMTALA requirements are satisfied a) Third-party payer information should be collected from the patient and the payer should be notified of the ED visit b) The patient then assumes full liability for services unless a third-party is notified or the patient applies for financial assistance with the first 48 hours c) The remaining registration processing is initiated at the bedside or in a registration area d) An initial registration record is completed so that the proper coding can be initiated - CORRECT ANSWERSc) The remaining registration processing is initiated at the bedside or in a registration area This directive was developed to promote and ensure healthcare quality and value and also, to protect consumers and workers in the healthcare system. This directive is called a) Payer quality monitoring b) Medicare patient and staff safety standards c) Joint Commission for Accreditation of Healthcare Organizations (JCAHO) safety d) Patient bill of rights - CORRECT ANSWERSd) Patient bill of rights A scheduled inpatient represents an opportunity for the provider to do which of the following? a) Refer the patient to another location with the health system b) Comply with EMTALA (Emergency Medical Treatment and Labor Act) requirements before service c) Complete registration and insurance approval before service d) Register the patient after he or she is placed in a bed on that service unit. - CORRECT ANSWERSc) Complete registration and insurance approval before service The first and most critical step in registering a patient, whether scheduled or unscheduled, is a) Having the patient initial the HIPAA privacy statement b) Verifying insurance to activate the patient medical record c) Verifying the patient's identification d) Check the schedule for treatment availability - CORRECT ANSWERSc) Verifying the patient's identification The legal authority to request and analyze provider clam documentation to ensure that IPPS services were reasonable and necessary is given to a) Recovery Audit Contractors (RAC) b) The Office of the U.S. Inspector General (OIG) c) All health plans d) State insurance commissioners - CORRECT ANSWERSb) The Office of the U.S. Inspector General (OIG) An advantage of a pre-registration program is a) The opportunity to reduce processing times at the time of service b) The ability to eliminate no-show appointments c) The opportunity to reduce the corporate compliance failures within the registration process d) The marketing value of such a program - CORRECT ANSWERSc) The opportunity to reduce the corporate compliance failures within the registration process Claims with dates of service received later than one calendar year beyond the date of service, will be a) Denied by Medicare b) The provider's responsibility but can be deemed charity care c) Fully paid with interest d) The full responsibility of the patient. - CORRECT ANSWERSa) Denied by Medicare This concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits a) Third-party invoicing b) Account resolution c) Claims processing d) Billing - CORRECT ANSWERSc) Claims processing The ACO investment model will test the use of pre-paid shared savings to a) Raise quality ratings in designated hospitals. b) Encourage new ACOs to form in rural and underserved areas c) Attract physicians to participate in the ACO payment system d) Invest in treatment protocols that reduce costs to Medicare - CORRECT ANSWERSb) Encourage new ACOs to form in rural and underserved areas Chapter 13 Bankruptcy, debtor rehabilitation, is a court proceeding a) That establishes a payment priority order to creditors' claims b) That classifies the debtor as eligible for government financial assistance for housing, medical treatment and food as debts are paid c) That creates a clear court-supervised payment accountability plan going forward d) That reorganizes a debtor's holdings and instructs creditors to look to the debtor's future earnings for payment - CORRECT ANSWERSd) That reorganizes a debtor's holdings and instructs creditors to look to the debtor's future earnings for payment HFMA's patient financial communication best practices specify that patients should be told about the types of services provided and a) A satisfaction survey regarding clinical service providers b) The price of service to their covering health plan c) The service providers that typically participate in the service, e.g., radiologists, pathologists, etc. d) An expiration of why a specific service is not provided - CORRECT ANSWERSc) The service providers that typically participate in the service, e.g., radiologists, pathologists, etc. The important Message from Medicare provides beneficiaries information concerning their: a) Understanding of billing issues and the deductibles and/or co-insurance due for the current visit 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) Obligation to reimburse the hospital for any services not covered by the Medicare program - CORRECT ANSWERSc) Right to appeal a discharge decision if the patient disagrees with the plan All of the following are potential causes of credit balances EXCEPT: a) Duplicate payments b) Primary and secondary payers both paying as primary c) Inaccurate upfront collections based on incorrect liability estimates d) A patient's choice to build up a credit against future medical bills - CORRECT ANSWERSd) A patient's choice to build up a credit against future medical bills 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) Prescriptions - CORRECT ANSWERSa) A co-insurance payment for all Part B covered services The importance of medical records being maintained by HIM is that the patient records a) Are the primary source for clinical data required for reimbursement by health plans and liability payers b) Are the strongest evidence and defense in the event of a Medicare audit c) Are evidence used in assessing the quality of care d) Are the evidence cited in quality review - CORRECT ANSWERSa) Are the primary source for clinical data required for reimbursement by health plans and liability payers A decision on 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 home care coverage b) Current medical needs c) The likelihood of an adverse event occurring to the patient d) The patient's medical history - CORRECT ANSWERSa) The patient's home care coverage Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish a) Provider and physician reimbursement for specific diagnoses and tests b) Prospective Medicare patient financial responsibilities for a given diagnosis c) Reasonable and customary prices for services in a given area d) What services or healthcare items are covered under Medicare - CORRECT ANSWERSd) What services or healthcare items are covered under Medicare What are some core elements if a board-approved financial assistance policy? a) Payment requirements, staffing hours, and admission policies b) Case management, payment methods, and discharge policies c) Deposit requirements, pre-registration calling hours, and charity care policy d) Eligibility, application process, and nonpayment collection activities - CORRECT ANSWERSd) Eligibility, application process, and nonpayment collection activities The ICD-10 codes set and CPT/HCPCS code sets combines provide a) Pricing floors for services b) The financial data required for activity-based costing c) Patients an overview of services covered by their health insurance plan d) The specificity and coding needed to support reimbursement claims - CORRECT ANSWERSd) The specificity and coding needed to support reimbursement claims A recurring/series registration is characterized by a) A creation of multiple registrations for multiple services b) The creation of one registration record for multiple days of service c) The creation of multiple patient types for one date of service d) The creation of one registration record per diagnosis per visit - CORRECT ANSWERSb) The creation of one registration record for multiple days of service Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the provider may not ask about a patient's insurance information if it would delay what? a) Complete course of treatment b) Medical screening and stabilizing treatment c) Admission to observation status d) Transfer to another facility - CORRECT ANSWERSb) Medical screening and stabilizing treatment In resolving medical accounts, a law firm may be used as: a) An independent auditor of a financial assistance policy b) Legal counsel to patients regarding financing options c) An independent broker of patient financial assistance from banks d) A substitute for a collection agency - CORRECT ANSWERSd) A substitute for a collection agency 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 a physician's office on an urgent basis 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 the patient if he or she would like to receive information about payment options and supportive financial assistance programs d) Tag the patients record for possible financial assistance for bad debt - CORRECT ANSWERSc) Ask the patient if he or she would like to receive information about payment options and supportive financial assistance programs Which of the following in NOT included in the Standardized Quality Measures a) Clinical outcomes b) Patient perceptions c) Health care processes d) Cost of services - CORRECT ANSWERSd) Cost of services 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-authorization are obtained - CORRECT ANSWERSd) Pre-authorization are obtained Improving the overall patient experience requires revenue cycle leadership and staff to simultaneously be: a) Clear on policies and consistent in applying the policies b) Careful in screening patient demands c) Monitoring the costs and charges the patient incurs d) Inquisitive, responsive and flexible - CORRECT ANSWERSa) Clear on policies and consistent in applying the policies Hospitals need which of the following information sets to assess a patient's financial status: a) Income, expenses, debt b) Patient and guarantor's income, expenses and assets c) Income, expenses and capacity to take on more debt d) Assets liquidity, Income, expenses, credit worthiness - CORRECT ANSWERSb) Patient and guarantor's income, expenses and assets For scheduled patients, important revenue cycle activities I the Time of Service stage DO NOT INCLUDE: a) Pre-registration record is activated, consents are signed, and co-payment is collected b) Positive patient identification is completed, and patient is given an armband c) Final bill is presented for payment d) Preprocessed patients may report to a designated "express" desk - CORRECT ANSWERSc) Final bill is presented for payment The Electronic Remittance Advice (ERA) data set is : a) Used for Electronic Funds Transfers between hospitals and a bank b) A standardized form that provides 3rd party payment details to providers c) Required for annual Medicare quality reporting forms d) Safeguards the Electronic claims process - CORRECT ANSWERSb) A standardized form that provides 3rd party payment details to providers Appropriate training for patient financial counseling 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 records d) Available patient financing options - CORRECT ANSWERSc) Documenting the conversation in the medical records All of the following information should be reviewed as part of schedule finalization EXCEPT: a) The results of any and all test b) The service to be provided c) The arrival time and procedure time d) The patient's preparation instructions - CORRECT ANSWERSa) The results of any and all test 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 Because 501(r) regulations focus on identifying potential eligible financial assistants 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 schedule d) Expedite payment processing of normal accounts receivable to protect cash flow - CORRECT ANSWERSb) Hold financial conversations with patients as soon as possible Which option is a benefit of pre-registering a patient for services a) The patient arrival process is expedited, reducing wait times and delays b) The verification of insurance after completion of the services c) Service departments have the ability to override schedules and block time to reduce testing volume d) The patient receiving multiple calls from the provider - CORRECT ANSWERSa) The patient arrival process is expedited, reducing wait times and delays HIPPA had adopted Employer Identification Numbers (EIN) to be used in standard transactions to identify the employer of an individual described in a transaction EIN's are assigned by a) The Social Security Administration b) The US department of the Treasury c) The United States department of labor d) The Internal Revenue Service - CORRECT ANSWERSd) The Internal Revenue Service The nightly room charge will be incorrect if the patient's a) Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system. b) Pharmacy orders to the ICU 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 ICU to the Medical/Surgical floor is not reflected in the registration system. With any remaining open balances, after insurance payments have been posted, the account financial liability is a) Written off as bad debt b) Potentially transferred to the patient c) Sold to a collection agency d) Treated as the cost of doing business - CORRECT ANSWERSb) Potentially transferred to the patient 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 any patient balance due - CORRECT ANSWERSb) Ensure that she/he accesses the correct information in the historical database Identifying the patient, in the MPI, creating the registration record, completing medical necessity screening, determining insurance eligibility and 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 any 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 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 A four-digit number code established by the National Uniform Billing Committee (NUBC) that categorizes/classifies a line item in the charge master is known as a) HCPCs codes b) ICD-10 Procedural codes c) CPT codes d) Revenue codes - CORRECT ANSWERSd) Revenue codes 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 Medicare patients are NOT required to produce a physician order to receive which of these 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 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 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 to another facility In Chapter 7 straight bankruptcy filling a) The court establishes a creditor payment schedule with the longest outstanding claims paid first b) The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt 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 liquidates the debtor's nonexempt property, pays creditors, and begins to pay off the largest claims first. All claims are paid some portions of the amount owed. - CORRECT ANSWERSb) The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt 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 ANSWERSb) Case management Which of the following is required for participation in Medicaid a) Obtain a supplemental health insurance policy b) Meet income and assets requirements c) Meet a minimum yearly premium d) Be free of chronic conditions - CORRECT ANSWERSb) Meet income and assets requirements When primary payment is received, the actual reimbursement a) Is compared to the expected reimbursement b) Is recorded by Patient Accounting and the patient's account is the closed c) Is compared to the expected reimbursement, the remaining contractual adjustments are posted, and secondary claims are submitted d) Trigger that the secondary claims can then be prepared. - CORRECT ANSWERSc) Is compared to the expected reimbursement, the remaining contractual adjustments are posted, and secondary claims are submitted Days in A/R is calculated based on the value of a) Total cash received to date b) The time it takes to collect anticipated revenue c) The total accounts receivable on a specific date d) Total anticipated revenue minus expenses - CORRECT ANSWERSc) The total accounts receivable on a specific date All of the following are forms of hospital payment contracting EXCEPT a) Per diem payment b) Bundled Payment c) Fixed Contracting d) Contracted Rebating - CORRECT ANSWERSd) Contracted Rebating The standard claim form used for billing by hospitals, nursing facilities, and other in-Patient services is called the a) UB-04 b) 1500 c) COST REPORT d) REMITTANCE NOTICE - CORRECT ANSWERSa) UB-04 To maximize the value derived from customer complaints, all consumer complaints should be a) Responded to within two business days b) Tracked and shared to improve the customer experience c) Handled by a specially trained "service" team d) Brought immediately to management's attention - CORRECT ANSWERSa) Responded to within two business days The HCAHPS (hospital consumer assessment of healthcare providers and systems) Initiative was launched to a) Gather national date on overall trust in the nation's health care system b) Create a national database on physician quality c) Provide a standardized method for evaluating patient's perspective on hospital care. d) Provide data for building shared savings reimbursement for quality procedures. - CORRECT ANSWERSc) Provide a standardized method for evaluating patient's perspective on hospital care. Health Plan Contracting Departments do all of the following EXCEPT a) Establish a global reimbursement rate to use with all third-party payer b) Review all managed care contracts for accuracy for loading 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) Establish a global reimbursement rate to use with all third-party payer The benefit of 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 Medicare-coverage healthcare through the plan and do not need to worry about "part" or "part b" benefits d) Patients receive significant discounting on services contracted by the federal government - CORRECT ANSWERSc) Patients generally have their Medicare-coverage healthcare through the plan and do not need to worry about "part" or "part b" benefits Once the EMTALA requirements are satisfied a) Third-party payer info should be collected from the patient and the payer should be notified of the ED visit b) An initial registration record is completed so that the proper coding can be initiated c) The patient then assumes 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 ANSWERSa) Third-party payer info should be collected from the patient and the payer should be notified of the ED visit 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 info about their negative experience to potential patients or through social media channels c) Potentially negative treatment outcomes leading to expanding length-of-stay d) Lowered quality outcomes for the dissatisfied patient - CORRECT ANSWERSb) The customer passing on info about their negative experience to potential patients or through social media channels 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 ANSWERSa) Occurs during service 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 businesses 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 patients privacy d) Ensure all staff involved are properly trained and the patient financial education is included in all discussions - CORRECT ANSWERSc) Respect the patients privacy 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 patients account c) Completing balance activities d) Issuing receipts - CORRECT ANSWERSd) Issuing receipts Which option is a government-sponsored health care program that is financed through Taxes and general revenue funds a) Medicaid b) Medicare c) Insurance exchange d) Social security - CORRECT ANSWERSb) Medicare It is important to calculate reserves to ensure a) Stable financial operations and accurate financial reporting b) Collateral for credit c) Expense coverage in the event of a revenue short fall d) Coverage of B/D write offs and charity care costs - CORRECT ANSWERSa) Stable financial operations and accurate financial reporting Successful account resolution begins 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 ANSWERSb) Collecting all deductibles and copayments during the pre-service stage 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 A portion of the accounts receivable inventory which has NOT qualified for billing includes a) Charitable pledges b) Accounts assigned to a pre-collection agency c) Accounts coded but held within the suspense period d) Accounts created during pre-registration but not activated - CORRECT ANSWERSa) Charitable pledges Checks received through mail, cash received through mail, and lock box are all examples of a) Highly fraud prone processes b) Payment methods in which the majority of fraud occurs c) Payment methods being phased out for more secure payment method options d) Control points for cash posting - CORRECT ANSWERSd) Control points for cash posting 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 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 the 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 Charges as the most appropriate measurement of utilization enables a) Accuracy of expense and cost capture b) Managing of expense budgets c) Effective HIM planning d) Generation of timely and accurate billing - CORRECT ANSWERSa) Accuracy of expense and cost capture 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) HMO b) PPO c) MSO d) GPO - CORRECT ANSWERSa) HMO Charges are the basis for a) Third party and regulatory review of resources used b) Evaluating quality c) Separation of fiscal responsibilities between the patient and the health plan d) Demonstrating medical necessity - CORRECT ANSWERSc) Separation of fiscal responsibilities between the patient and the health plan Chapter 13 Bankruptcy, debtor rehabilitation is a court proceeding a) That reorganizes a debtor's holdings and instructs creditors to look to the debtor's future earnings for payment b) That establishes a payment priority order to creditors c) That creates a clear court-supervised payment accountability plan going forward d) That classifies the debtor as eligible for government financial assistance for housing medical treatment and food as debts are paid - CORRECT ANSWERSa) That reorganizes a debtor's holdings and instructs creditors to look to the debtor's future earnings for payment Patient financial 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 patients claim d) Timely, comprehensive and specifying next steps - CORRECT ANSWERSb) Consistent, clear and transparent Key performance indicators (KPIs) set standards for accounts receivables (A/R) and a) Establish productivity targets b) Provide a method of measuring the collection and control of A/R c) Provide evidence of financial status d) Make allowance for accurate revenue forecasting - CORRECT ANSWERSb) Provide a method of measuring the collection and control of A/R 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 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 visits 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 It is important to have high registration quality standards because a) Inaccurate or incomplete patient data will delay payment or cause denials b) Incomplete registrations will trigger exclusion from Medicare participation c) Inaccurate registration may cause discharge before full treatment is obtained d) Incomplete registrations will raise satisfaction scores for the hospital - CORRECT ANSWERSa) Inaccurate or incomplete patient data will delay payment or cause denials When recovery audit contractors (RAC) identify improper payments as overpayments 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 12 months - CORRECT ANSWERSc) Send a demand letter to the provider to recover the over payment amount Internal controls addressing coding and reimbursement changes are put I place to guard against a) Underpayments b) Denials c) Compliance fraud by upcoding d) Charge master error - CORRECT ANSWERSc) Compliance fraud by upcoding The patient discharge process begins when a) The physician writes the discharge orders b) Clinical services are completed, and patient accounts have all the info 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 have generated and accurate bill and there is agreement on the handling of patient financial responsibilities - CORRECT ANSWERSa) The physician writes the discharge orders 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 The physician who wrote the order for an inpatient service and is in charge of the patients treatment during admission 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 An originating site is a) The location where the patients 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 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's patient financial communications best practices specify that patients should be told about the types of services provided and a) An explanation of why a specific service is not provided b) The service providers that typically participate in the service, e.g. Radiologists, pathologists, etc. c) A satisfaction survey regarding clinical service providers d) The price of service to their covering health plan - CORRECT ANSWERSb) The service providers that typically participate in the service, e.g. Radiologists, pathologists, etc. Telemed seeks to improve a patient's health by a) Permitting 2-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 2-way real time interactive communication between the patient and the clinical professional A large number of credit balances are not the result of overpayments but of a) Posting errors in the patient accounting system b) Incorrect claim submissions c) Inadequate staff training d) Banking transaction errors - CORRECT ANSWERSa) Posting errors in the patient accounting system 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 The office of inspector general (OIG) publishes a compliance work plan a) Monthly b) Quarterly c) Semi-annually d) Annually - CORRECT ANSWERSd) Annually Through what document does a hospital establish compliance standards? - CORRECT ANSWERSCode of Conduct What is the purpose OIG work plan? - CORRECT ANSWERSIdentify Acceptable compliance programs in various provider setting If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? - CORRECT ANSWERSNon-diagnostic services provided on Tuesday through Friday What does a modifier allow a provider to do? - CORRECT ANSWERSReport a specific circumstance that affected a procedure or service without changing the code or its definition. If outpatient diagnostic services are provided within three day of the admission of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to - CORRECT ANSWERSThey must be billed separately to the Part B carrier What is a recurring or series registration? - CORRECT ANSWERSOne registration record is created for multiple days of service What are nonemergency patients who come for service without prior notification to the provider called? - CORRECT ANSWERSUnscheduled patients Which of the following statements apply to the observation patient type? - CORRECT ANSWERSIt is used to evaluate the need for an inpatient admission Which services are hospice programs required to provide on a around-the-clock patient - CORRECT ANSWERSPhysician, nursing, and pharmacy Scheduler instructions are used to prompt the scheduler to do what? - CORRECT ANSWERSComplete the scheduling process correctly based on service requested The time needed to prepare the patient before service is the difference between the patient's arrival time and which of the following? - CORRECT ANSWERSProcedure time Medicare guidelines require that when a test is ordered for which an LCD (Local coverage determination) or NCD (National coverage determination) exists, the information provided on the order must include which of the following? - CORRECT ANSWERSDocumentation of the medical necessity for the test. What is an advantage of a preregistration program? - CORRECT ANSWERSIt reduces processing times at the time of service What date are required to establish a new MPI (Master Patient Index) entry - CORRECT ANSWERSThe responsible party's full legal name, date of birth, and Social Security number Which of the following statements is true about third-party payments? - CORRECT ANSWERSThe payments are received by the provider from the payer responsible for reimbursing the provider for the patient's covered services Which provision protects the patient from medical expenses that exceed pre-set level? - CORRECT ANSWERSStop loss What documentation must a primary care physician send to an HMO (health maintenance organization) patient to authorize a visit to a specialist for additional testing or care? - CORRECT ANSWERSReferral Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the provider may not ask about a patient's insurance information if it would delay what? - CORRECT ANSWERSMedical screening and stabilizing treatment Which of the following is a step in the discharge process? - CORRECT ANSWERSHave case management services complete the discharge plan The hospital has a APC (ambulatory payment classification)-based contract for the payment of outpatient services. Total anticipated charges for the visit are $2,380. The approved APC payment rate is $780. Where will the patients' benefit package be applied? - CORRECT ANSWERSTo the approved APC payment rate A patient has met the $200 individual deductible and $900 of the $1000 co-insurance responsibility. The co-insurance rate is 20%. The estimated insurance plan responsibility is $1975.00. What amount of coinsurance is due from the patient? - CORRECT ANSWERS$100 When is a patient considered to be medically indigent? - CORRECT ANSWERSThe patient's outstanding medical bills exceed a defined dollar amount or percentage of assets. What patient assets are considered in the financial assistance applications? - CORRECT ANSWERSSources of readily available funds, such as vehicles, campers, boats and savings accounts If the patient cannot agree to payment arrangements, what is the next option? - CORRECT ANSWERSWarn the patient that unpaid accounts are placed with collection agencies for further processing What core financial activities are resolved within patient access? - CORRECT ANSWERSScheduling, pre-registration, insurance verification, and managed care processing What is an unscheduled direct admission? - CORRECT ANSWERSA patient who arrives at the hospital via ambulance for treatment in the emergency department When is it not appropriate to use observation status? - CORRECT ANSWERSAs a substitute for an inpatient admission Parents who require periodic skilled nursing or therapeutic care receive services from what type of program? - CORRECT ANSWERSHome health agency Every patient who is new to the healthcare provider must be offered what? - CORRECT ANSWERSA printed copy of the provider's privacy notice Which of the following statements applies to self-insured insurance plans? - CORRECT ANSWERSThe employer provides a traditional HMO (health maintenance organization) health plan In addition to the member's identification number, what information is records in a 270 transaction? - CORRECT ANSWERSName What process does a patients' health plan use to retroactively collect payments from liability, automobile, or worker's compensation plans? - CORRECT ANSWERSSubrogation In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - CORRECT ANSWERSDRG (diagnosis-related groups) rates What restriction does a managed care plan place on locations that must be used if the plan is to pay for the service provided? - CORRECT ANSWERSSite-of-service limitation Which of the following statements applies to private rooms? - CORRECT ANSWERSIf the medical necessity for a private room is documented in the chart, the patient's insurance will be billed for the differential. Which of the following is true about screening a beneficiary of possible MSP (Medicare Secondary Payer) situations? - CORRECT ANSWERSIt is necessary to ask the patient each of the MSP questions Which of the following is not true of Medicare Advantage Plans? - CORRECT ANSWERSA patient must have both Medicare Part A and B benefits to be eligible for a Medicare Advantage plan Which of the following is a valid reason for a payer to deny a claim? - CORRECT ANSWERSFailure to complete authorization Which of the following statements is NOT a possible consequence of selecting the wrong patient in the MPI (master patient index)? - CORRECT ANSWERSClaim is paid in full Which of the following statements is true of a Medicare Advantage Plan? - CORRECT ANSWERSThis plan supplements Part A and Part B benefits Which is the following is not a characteristic of a Medicaid HMO (health maintenance organization) plan? - CORRECT ANSWERSMedicaid-eligible patients are never required to join a Medicaid HMO plan Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act)? - CORRECT ANSWERSRegistration staff members routinely contact managed care plans for prior authorizations before the patients is seen by the on-duty physician Which of the following statements is true of the important Message from Medicare notification requirements? - CORRECT ANSWERSNotification can be issued no earlier than 7 days before admission and no more than 2 days before discharge What is the self-pay balance after insurance? - CORRECT ANSWERSThe portion of the adjudicated claim that is due from the patient Which of the following options is an alternative to valid long-term payment plans? - CORRECT ANSWERSBank loans The patient has the following benefit plan: $400per family member deductible, to a maximum of $1,200 per year and $2,000 per family member co-insurance, to a family maximum of $6,000 per year, excluding the deductible. Five family members are enrolled in this benefit plan. What is the maximum out-of-pocket expense that the family could incur during the calendar year? - CORRECT ANSWERS$6,000 What type of plan restricts benefits for nonemergency care to approve providers only? - CORRECT ANSWERSA POS (point-of-service) plan What does scheduling allow provider staff to do? - CORRECT ANSWERSReview the appropriateness of the service requested When an adult patient is covered by both his own and his spouse's health insurance plan, which of the statements is true? - CORRECT ANSWERSThe patient's insurance plan is primary Mrs. Jones, a Medicare beneficiary, was admitted to the hospital on June 20, 2010. As of the admission date, she had only used 8 inpatient days in the current benefit period. If she is not discharged, on what date will Mrs. Jones exhaust her full coverage days. - CORRECT ANSWERSAugust 9, 2010 In order to meet eligibility guidelines for healthcare benefits, Medicaid beneficiaries must fall into a specified need category and meet what other types of requirements. - CORRECT ANSWERSIncome and asset Fee-for-service plans pay claims based on a percentage of charges. How are patients out-of-pocket costs calculated? - CORRECT ANSWERSThey are calculated quarterly Indemnity plans usually reimburse what? - CORRECT ANSWERSA certain percentage of charges after patient meets policy's annual deductible. Departments that need to be included in Charge master maintenance include all EXCEPT: - CORRECT ANSWERSQuality Assurance Using HIPPA standardized transaction sets allow providers to: - CORRECT ANSWERSSubmit a standardized transaction to any of the health plans with which it conducts business. Which of the following is NOT included in the standardized quality measures? - CORRECT ANSWERSCost of services The ACO investment model will test the use of pre-paid shared savings to: - CORRECT ANSWERSEncourage new ACOs to form in rural and underserved areas. 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: - CORRECT ANSWERSHMO Ambulance services are billed directly to the health plan for: - CORRECT ANSWERSServices 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. Any provider that has filed a timely cost report may appeal in an adverse final decision received from the Medicare Administrative Contractor (MAC), the appeal may be filed with: - CORRECT ANSWERSThe Provider Reimbursement Review Board. ICD-10-CM and ICD-10-PCD code sets are modifications of: - CORRECT ANSWERSICD-9 Codes. For scheduled payments, important revenue cycle activities in the time-of-service stage DO Not include: - CORRECT ANSWERSObtaining or updating patient and guarantor information Hospital can only convert an inpatient case to observation if: - CORRECT ANSWERSThe hospital utilization review committee determines before the patient is discharged and prior to billing that an observation setting would be more appropriate. Hospital need which of the following information sets to assess a patient's financial status? - CORRECT ANSWERSDemographic, Income, Assets and Expenses. HIPAA privacy rules require covered entities to take all, of the following actions EXCEPT: - CORRECT ANSWERSUse only designated software platforms to secure patient date. When Recovery Audit Contractors (RAC) identify improper payments as overpayment. the claims processing contractor must: - CORRECT ANSWERSSend a demand letter to the provider to recover the over payment amount. Which HIPPA transaction set provides electronic processing of 8insurance verification requests and responses? - CORRECT ANSWERSThe 270-271 set 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: - CORRECT ANSWERSSupport that choice, providing that the discussion does not interfere with patient care or disrupt patient flow. A scheduled inpatient represents an opportunity for the provider to do which of the following? - CORRECT ANSWERSComplete registration and insurance approval before service The Medicare Bundled Payments for Care Initiative (BCP) is designed to: - CORRECT ANSWERSAlign incentives between hospitals, physicians, and non-physician providers in-order to better coordinate patient care. To maximize the value derived from customer complaints, all consumer complaints should be: - CORRECT ANSWERSTracked and shared to improve customer experience The soft cost of a dissatisfied customer is: - CORRECT ANSWERSThe customer passing on information about their negative experience to potential patients or through social media channels. Applying the contracted payment methodology to the total charges yields: - CORRECT ANSWERSAn estimate price The importance of medical records maintained by HIM is that the patient records: - CORRECT ANSWERSAre the primary source for clinical data required for reimbursement by health plans and liability payers? Important Revenue Cycle Activities in the pre-service stage include: - CORRECT ANSWERSObtaining or updating patient and guarantor information In the pre-service stage, the cost of the schedule services is identified and the patient's health plan and benefits are used to calculate: - CORRECT ANSWERSThe amount the patient may be expected to pay after insurance. The disadvantage of outsourcing includes all, of the following Except - CORRECT ANSWERSReduces internal staffing costs and a reliance on outsourced staff. Marinating routine contact with health plan or liability payer, making sure all required information is provided and all needed approvals are obtained is the responsibility of who: - CORRECT ANSWERSCase Management A claim is denied for the following reasons EXCEPT: - CORRECT ANSWERSThe submitted claim does not have the physician signature All Hospitals are required to establish a written financial assistance policy that applies to: - CORRECT ANSWERSAll emergency and medically necessary care Examples of ethics violation that impact the revenue cycle include all of the following EXCEPT: - CORRECT ANSWERSSeeking payment options for self-pay Verbal orders from a physician for a service(s) are: - CORRECT ANSWERSAcceptable if given to "qualified" staff as defined in a hospitals policies and procedures Medicare has established guidelines called Local Coverage Determination (LCD) and National Coverage Determination (NCD) that establish: - CORRECT ANSWERSWhat serviced or healthcare items are covered under Medicare A decision on whether a patient should be admitted as an inpatient or become an outpatient observation patient requires medical judgement based on all of the following EXCEPT: - CORRECT ANSWERSThe patient's home care coverage What is the first step of the daily cash reconciliation process? - CORRECT ANSWERSObtaining cash, check, credit card and debit card payment from that day The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to: - CORRECT ANSWERSMedicare and Medicaid payments The correct coding initiative program consist of: - CORRECT ANSWERSEdits that are implemented within provider's claim processing system The Affordable Health Care Act legislated the development of Health Insurance Exchange, where individuals and small businesses can: - CORRECT ANSWERSPurchase health benefits plans regardless of insured's health status Before classifying and subsequently writing off an account to financial assistance or bad debit, the hospital must establish policy define appropriate criteria, implement procedures for identifying accounts and: - CORRECT ANSWERSMonitor compliance The Electronic Remittance Advice (ERA) data sets are: - CORRECT ANSWERSA standardized for that provides 3rd party payment details to providers The first and most critical step in registering a patient, whether scheduled or unscheduled is: - CORRECT ANSWERSVerifying the patient's identification The standard claim form used for the billing by hospitals, nursing facilities, and other inpatient services is called the: - CORRECT ANSWERSUB-04 A four-digit number code established by the National Uniform Billing Committee (NUBC) that categorizes/classifies a line in the charge master is known as: - CORRECT ANSWERSRevenue codes Internal controls addressing coding and reimbursement charges are put in place to guard against: - CORRECT ANSWERSCompliance fraud by "upcoding" The 501(R) regulations require non-for-profit providers (501) ©(3) organizations to do which of the following activities: - CORRECT ANSWERSComplete a community needs assessment and develop a discount program for patient's balances after insurance payment During pre-registration, a search for the patient's MRI number is initiated using which of the following data sets: - CORRECT ANSWERSPatient's full legal name and date of birth or the patient's Social Security number The Business ethics, or organizational ethics represent: - CORRECT ANSWERSThe principles and standards by which organizations operate Providers are advised that it is best to establish patient financial responsibility and assistance policies and make sure they are followed internally and by: - CORRECT ANSWERSThird-party payers The advantage to using a third-part, collection agency includes all of the following EXCEPT: - CORRECT ANSWERSProviders pay pennies on each dollar collected. Local Coverage Determination (LCD) and National Coverage Determinations (NCD) are Medicare established guidelines used to determine: - CORRECT ANSWERSWhich diagnosis, signs, or symptoms are reimbursable Claims with the dates of service received later than one calendar year beyond the date of service will be: - CORRECT ANSWERSDenied by Medicare In the pre-service stage, the requested service is screened for medical necessity, health plan coverage and benefits are verified and: - CORRECT ANSWERSPre-authorization are obtained For scheduled patients, important revenue cycle activities in the time-of -service stage DO NOT include: - CORRECT ANSWERSFinal bill is presented for payment Claim edits are: - CORRECT ANSWERSRules developed to verify the accuracy of claims based on each health plan's policies If a medical service authorization, who is typically responsible for obtaining the authorization: - CORRECT ANSWERSThe provider scheduling Concurrent review and discharge planning - CORRECT ANSWERSOccurs during service The fundamental approach in managing denials is: - CORRECT ANSWERSTo analyze the type and sources of denials and consider process changes to eliminate further denials The first thing a health plan does when processing a claim is: - CORRECT ANSWERSCheck if the patient is a health plan beneficiary and what is the coverage Outsourcing options should be evaluated as - CORRECT ANSWERSAny other business service purchase Insurance verification results in which of the following: - CORRECT ANSWERSThe accurate identification of the patient's eligibility and benefits EMTLA and HFMA best practices specify that in an Emergency Department setting: - CORRECT ANSWERSNo patient financial discussions should occur before a patient is screened and stabilized The HCCAHPS (Hospital Consumer Assessment of Healthcare Provider's and Systems) initiative was launched to: - CORRECT ANSWERSProvide a standardized method for evaluation patients' perspective on hospital care All of the following are potential causes of credit balances EXCEPT: - CORRECT ANSWERSA patient's choice to build up a credit against future medical bills Medicare will only pay for tests and services that: - CORRECT ANSWERSCan be demonstrated as necessary This was developed to promote and ensure healthcare quality and value and also to protect consumers and workers in the healthcare system. This directive is called: - CORRECT ANSWERSJoint Commission for Acceleration of Healthcare Organizations (JCAHO) safety standards It is important to calculate reserves to ensure: - CORRECT ANSWERSA stable financial operations and accurate financial reporting An advantage of a pre-registration program in - CORRECT ANSWERSThe opportunity to reduce processing times at the time of service To be eligible for Medicaid, an individual must: - CORRECT ANSWERSMeet income and asset requirements The patient discharge process begins when: - CORRECT ANSWERSThe physician writes the order Appropriate training for patient financial counseling staff must cover all of the following EXCEPT: - CORRECT ANSWERSDocumenting the conversation in the medical records Patients should be informed that costs presented in a price estimation may: - CORRECT ANSWERSOnly determine the percentage of the total that the patients is responsible for and not the actual cost. Any healthcare insurance plan that providers or insures comprehensive health maintenance and services for an enrolled group of persons based on a monthly fee is known as a - CORRECT ANSWERSHMO Chapter 11 Bankruptcy permits a debtor to: - CORRECT ANSWERSWork out a court-supervised plan with creditors A portion of the accounts receivable inventory which has NOT qualified for billing includes: - CORRECT ANSWERSAccounts created during pre-registration but not activated Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by: - CORRECT ANSWERSThe Medicare Administrative Contractor (MAC) at the end of the hospice cap period The ICD-10 code set and CPT/HCPCS code sets combined provide: - CORRECT ANSWERSThe specificity and coding accuracy needed to support reimbursement claims Charges, as the most appropriate measurement of utilization, enables: - CORRECT ANSWERSGeneration of timely and accurate billing Days in A/R calculated based on the value of: - CORRECT ANSWERSThe total account receivable on a specific date Medicare benefits provide coverage for: - CORRECT ANSWERSInpatient hospital services, skilled nursing care. And home health care HFMA best practices call for patient financial discussions to be reinforced: - CORRECT ANSWERSBy issuing a new invoice to the patient All of following are steps in safeguarding collections EXCEPT: - CORRECT ANSWERSPlacing collections in a lock-box for posting review the next business day The code indication of the disposition of the patient at the conclusion of service is called the: - CORRECT ANSWERSPatient discharge status code HIPPA has adopted Employer Identification Numbers (EINs) to be used in standard transactions to identify the employer of an individual described in a transaction. EINs are created and assigned by: - CORRECT ANSWERSThe Internal Revenue Service The purpose of the ACA mandated Community Health Needs Assessment is: - CORRECT ANSWERSTo provide community benefit outreach to those without insurance and who have not had a physical within the past 2 years What is Continuum of Care: - CORRECT ANSWERSThe coordination and linkage of resource needed to avoid the duplication of services and the facilitation of seamless movement among care settings. Account Receivable (A/R) aging reports - CORRECT ANSWERSIdentify past due accounts likely to become bad debit Applying the contracted payment amount to the amount of total charges yields: - CORRECT ANSWERSAn estimated price for the patient's responsibility Most major health plans including Medicare and Medicaid offer: - CORRECT ANSWERSElectronic and/or web portal verification What are some elements of a board-approved financial assistance policy: - CORRECT ANSWERSEligibility application process and nonpayment collection activities Which of the following is usually covered on a Conditions of Admissions form: - CORRECT ANSWERSPatient's bill of rights. Net Accounts Receivable is - CORRECT ANSWERSThe amount an entity is reasonably confident of collection form overall accounts A common billing issue with hospital-based physician's is - CORRECT ANSWERSThey are not contracted with the patient's health plan to provide services HFMA's patient financial communications best practices specify that patients should be told about the types of services provided and - CORRECT ANSWERSThe services providers that typically participate in the service, radiologist, pathologist, ect. What data required to establish a new MPI (master patient index) entry - CORRECT ANSWERSThe patient's full legal name, date of birth and sex Through what document does a hospital establish compliance standards? - CORRECT ANSWERSCode of Conduct Code of Conduct - CORRECT ANSWERSIdentify Acceptable compliance programs in various provider settings If outpatient diagnostic services are provided within three days of the admission of a Medicare Beneficiary to an IPPS hospital, what must happen to these charges - CORRECT ANSWERSThey must be combined with the inpatient bill and paid under the MS-DRG system Why is the OIG pursuing the Medicare Secondary Payer initiative? - CORRECT ANSWERSIt reviews Medicare payments for beneficiaries who have other insurance and assesses the effectiveness of procedures in preventing inappropriate Medicare payments for beneficiaries with other insurance coverage. Departments that need to be included in Charge Master maintenance include all EXCEPT: - CORRECT ANSWERSQuality Assurance Using HIPPAA standardized transaction sets allows providers to: - CORRECT ANSWERSSubmit a standardized transaction to any of the health plans with which it conducts business. Any healthcare insurance that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons on a monthly fee is known as a: - CORRECT ANSWERSHMO Any provider that has filed a timely cost report may appeal in an adverse final decision received from the Medicare Administrative Contractor (MAC), this appeal may be filed with: - CORRECT ANSWERSThe Provider Reimbursement Review Board. For scheduled payments, important revenue cycle activities in the time-of-service stage DO NOT include: - CORRECT ANSWERSObtaining or updating patient and guarantor information Hospitals can only convert an inpatient case to observation if: - CORRECT ANSWERSThe hospital utilization review committee determines before the patient is discharged and prior to billing that an observation setting would be more appropriate. HIPPA privacy rules require covered entities to take all of the following actions EXCEPT: - CORRECT ANSWERSUse only designated software platforms to secure patient data. When Recovery Audit Contractors (RAC) identify improper payments as overpayments, the claims processing contractor must: - CORRECT ANSWERSSend a demand letter to the provider to recover the overpayment amount Which HIPPAA transaction set provides electronic processing of insurance verification requests and responses? - CORRECT ANSWERSThe 270-271 set. The Medicare Bundled Payments for Care Initiative (BCPI) is designed to:` - CORRECT ANSWERSAlign incentives between hospitals, physicians, and non-physician providers in-order to better coordinate patient care. Applying the contracted payment methodology to the total charged yields: - CORRECT ANSWERSAn estimated price The importance of medical records being maintained by HIM is that the patient records: - CORRECT ANSWERSAre the primary source for clinical date required for reimbursement by health plans and liability payers In the pre-service stage, cost of the schedule services is identified and the patient's health plan and benefits are used to calculate: - CORRECT ANSWERSThe amount the patient may be expected to pay after insurance. The disadvantage of outsourcing includes all, of the following EXCEPT: - CORRECT ANSWERSReduces internal staffing costs and a reliance on outsourced staff. All hospitals are required to establish a written financial assistance policy that applies to: - CORRECT ANSWERSAll emergency and medically necessary care Examples of ethics violations that impact the revenue cycle include all of the following EXCEPT: - CORRECT ANSWERSSeeking payment options for self-pay A decision on whether a patient should be admitted as an inpatient or become an outpatient observation patient requires medical judgement basement on all of the following EXCEPT: - CORRECT ANSWERSThe patient's home care coverage The Affordable Health Care Act legislative the development of Health Insurance Exchange where individuals and small businesses can: - CORRECT ANSWERSPurchase health benefits plans regardless of insured's health status Before classifying and subsequently writing off an account to financial assistance or bad debit, the hospital must establish policy, define appropriate criteria, implement procedures for identifying accounts and: - CORRECT ANSWERSMonitor compliance The four-digit number code established by the National Uniform Committee (NUBC that categorizes/classifies a line in the charge master is known as: - CORRECT ANSWERSRevenue codes During pre-registration, a search for the patient's MPI number is initiated using which of the following data sets: - CORRECT ANSWERSPatient's full legal name and date of birth or the patient's Social Security number Claims with dates of service received later than one calendar year beyond the date of service will be - CORRECT ANSWERSDenied by Medicare For scheduled patients, important revenue cycle activities in the time-of-service stage DO NOT include: - CORRECT ANSWERSFinal bill is presented for payment If a medical service requires authorization, who is typically responsible for obtaining the authorization: - CORRECT ANSWERSThe provider scheduling The fundamental approach in managing denials is - CORRECT ANSWERSTo analyze the type and sources of denials and consider process changes to eliminate further denials Outsourcing options should be evaluated as: - CORRECT ANSWERSAny other business service purchase EMTALA and HFMA best practices specify that, in an Emergency Department Setting: - CORRECT ANSWERSNo patient financial discussions should occur before a patient is screened and stabilized The HCAHPS (Hospital Consumer Assessment of Healthcare Provider's and Systems) initiative was launched to: - CORRECT ANSWERSProvide a standardized method for evaluation patients' perspective on hospital care All of the following are steps in safeguarding collections EXCEPT: - CORRECT ANSWERSPlacing collections in a lock-box for posting review the next business day What data are required to establish a new MPI (Master Patient Index) entry - CORRECT ANSWERSThe patient's full legal name, date of birth and sex Hospital can only convert an inpatient case to observation if the hospital utilization review committee determines this status before the patient is discharged and: - CORRECT ANSWERSPrior to billing, that an observation setting will be more appropriate Which of the following techniques is an acceptable way to complete the MSP (Medicare Secondary Payer) screening for a liability situation? - CORRECT ANSWERSAsk if the current service is related to an accident What do the MSP (Medicare Secondary Payer) disability rules require? - CORRECT ANSWERSThat the patient is younger than 65 years Why do managed care plans have agreements with hospitals, physicians, and other healthcare providers to offer a range of services to plan members? - CORRECT ANSWERSTo reduce healthcare costs What are numbered receipts used for? - CORRECT ANSWERSTo ensure that all payments are properly accounted for and deposited. Which of the following items are considered valid proof of income documents? - CORRECT ANSWERSCopies of paycheck stubs from the most recent three months The important message from Medicare IM provides beneficiaries with information concerning what? - CORRECT ANSWERSRight to appeal a discharge decision if patient disagrees with the plan What type of information is typically collected during the scheduling contract? - CORRECT ANSWERSPatient name, date of birth, sex, diagnosis, requested test or procedure, preferred date of service, ordering physician, and patients telephone number MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims after what happens? - CORRECT ANSWERSLiability is established and the provider receives a payment from the liability carrier What form is used to bill Medicare? - CORRECT ANSWERSUB-04 What are the two statutory exclusions from hospice coverage? - CORRECT ANSWERSGeneral inpatient care and medical social services Which of the following are examples of hospital-based physicians? - CORRECT ANSWERSPhysician assistants, hospitalists, and emergency department physicians What is an advantage of provider-based clinic? - CORRECT ANSWERSThe opportunity to discount professional component services and inflate technical component services without violating Medicare billing rules What is an example of a technical denial? - CORRECT ANSWERSBilling within the timely filing's rules How does the financial counseling process begin? - CORRECT ANSWERSScreen the patient for financial assistance by completing the charity application How does a health plan recover dollars paid for a liability claim from the liability carrier? - CORRECT ANSWERSSubrogation What type of account adjustment results from the patient's inability to pay a self-pay balance? - CORRECT ANSWERSty adjustment The revenue cycle begins with scheduling a patient for service and ends with what? - CORRECT ANSWERSThe archiving of the fully resolved account How does increasing the provision for bad debts affect the financial statement? - CORRECT ANSWERSReduces gross receivables and increase operation expense for the period A successful Medicare pay-for-performance initiative will likely result in what? - CORRECT ANSWERSHigher payments while covering sicker beneficiaries What are some component of the charge master? - CORRECT ANSWERSRoom charges and detailed ancillary charges According to the Department of Health and Human Services guidelines, which of the following is not considered income? - CORRECT ANSWERSSale of property, house or car Most managed care plans do not permit patient balance billing except for what circumstances? - CORRECT ANSWERSdeductible and copayment requirements The situation where neither the patient nor spouse is employed is described to the payer using: - CORRECT ANSWERSA condition code The regulations and requirements for creating accountable care organizations, which allowed providers to begin creating these organization were finalized. - CORRECT ANSWERS2010 Which services are hospice programs required to provide on an around-the clock basis? - CORRECT ANSWERSPhysician, nursing, and pharmacy What is the purpose of the initial step in the outpatient testing scheduling process? - CORRECT ANSWERSIdentify the correct patient in the provider's database or add the patient to the database The time needed to prepare the patient before services is the difference between the patient's arrival time and which of the following? - CORRECT ANSWERSScheduled time. Medicare guidelines require that when a test is ordered for which an LCD or NCD exists, the information provided on the order must include which of the following? - CORRECT ANSWERSDocumentation of the medical necessity for the test. What Is an advantage of a preregistration program? - CORRECT ANSWERSIt reduces processing times at the time of service What data a required to establish a new MPI? - CORRECT ANSWERSThe patients full legal name, date of birth and sex A mother and father both cover their 16-year-old child as a dependent on their health insurance plans, which both follow the birthday rule. The mothers date of birth is 1/19/1968; and the fathers date of birth is 7/19/1967. Whose plan is the primary payer? - CORRECT ANSWERSThe mothers plan What is a co-payment? - CORRECT ANSWERSThe fixed amount that is due for a specific service? A patient's annual out-of-pocket limitation is $3,000 excluding deductible. To date this calendar year the patient has satisfied the $500 deductible and has paid $2300 in coinsurance to coinsurance to various providers. For the balance of the calendar year, what is the maximum amount of coinsurance the patient will owe? - CORRECT ANSWERS$700.00 What type of plan allows the subscriber to pay lower premium costs in return for a higher deductible? - CORRECT ANSWERSConsumer directed health plan What is a characteristic of a managed care contracting methodology? - CORRECT ANSWERSProspectively set rates for inpatient and outpatient services Which provision protects the patient from medical expenses that exceed a pre-set level? - CORRECT ANSWERSStop loss What document must a primary care physician sent to HMO patient to authorize a visit to a specialist for additional testing or care - CORRECT ANSWERSReferral What activities are completed when a scheduled pre-registered patient arrives for services? - CORRECT ANSWERSActivating the record, obtaining signatures, and finalizing financial issues Under EMTALA regulations, the provider may not ask about a patient's insurance information if it would delay what? - CORRECT ANSWERSMedical screening and stabilizing treatment Collecting patient liability dollars after service leads to what? - CORRECT ANSWERSIncreased efforts by patient accounting staff to resolve these balances The important Message from Medicare provided beneficiaries with information concerning what? - CORRECT ANSWERSRight to appeal a discharge decision if the patient disagrees with the plan What is an effective tool to help staff collect payments at time of service? - CORRECT ANSWERSDevelop scripts for the process of requesting payments At the end of each shift, what must happen to cash, checks, and credit card transaction documents? - CORRECT ANSWERSThey must be balanced Why is it important to have high quality standards for registration? - CORRECT ANSWERSBecause quality failures may have legal implications How does utilization review staff use correct insurance information? - CORRECT ANSWERSTo obtain approval for inpatient days and coordinate service What circumstance would result in an incorrect nightly room charge? - CORRECT ANSWERSIf the patient's transfer from ICU to the medical/surgical floor is not reflected in the registration system. Which of the following statements describe the goal of financial counseling services? - CORRECT ANSWERSTo help the patient understand insurance coverage, including what the patient will owe for the current services. Patients who require periodic skilled nursing or therapeutic care receive services from what type of program? - CORRECT ANSWERSHome Health Agency Comprehensive pre-registration date includes which of the following? - CORRECT ANSWERSComplete insurance and emergency contact information 61. Which of the following statements is true of internal inpatient transfers? - CORRECT ANSWERSTransfers are coordinated by the bed-placement coordinator and are not recorded in the system until patient is moved to the receiving unit an bed [Show More]

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