HFMA: Healthcare Financial Management Association Exam (2023/ 2024) Questions and Verified Answers

HFMA: Healthcare Financial Management Association Exam (2023/ 2024) Questions and Verified Answers 1. Which of the following options is an alternative to valid long-term payment plans? ~ Answer: Bank loans 2. What type of plan restricts benefits for nonemergency care to approved providers only? ~ Answer: A PPO (preferred provider organization) plan 3. What does scheduling allow provider staff to do? ~ Answer: Review the appropriateness of the service requested 4. When an adult patient is covered by both his own and his spouse's health insurance plan, which of the statements is true? ~ Answer: The patient's insurance plan is primary 5. If a claim is related to an accident, what must the hospital report? ~ Answer: County in which the accident occurred 6. 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? ~ Answer: Income and expense 7. Most managed care plans do not permit patient balance billing except for what circumstance? ~ Answer: Deductible and co-payment 8. Fee-for-service plans pay claims based on a percentage of charges. How are patients out-of-pocket costs calculated? ~ Answer: They are limited by federal ERISA (Employment Retirement Income Securities Act) statutes 9. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims after what happens? ~ Answer: 120 days passes, but the claim must then be withdrawn from liability carrier 10. What form is used to bill Medicare? ~ Answer: UB-04 11. What are the two statutory exclusions from hospice coverage? ~ Answer: Medically unnecessary services and custodial care