CERTIFIED REVENUE CYCLE REPRESENTATIVE
COMPLETE PREPARATION GUIDE WITH
INSURANCE CLAIMS AND DENIAL
MANAGEMENT REVIEW
◉ Self-funded benefit plans may choose to coordinate benefits using
the gender rule or what other rule?
Answer: Birthday
◉ In what type of payment methodology is a lump sum or bundled
payment negotiated between the payer and some or all providers?
Answer: Case rates
◉ What customer service improvements might improve the patient
accounts department?
Answer: Holding staff accountable for customer service during
performance reviews
◉ What is an ABN (Advance Beneficiary Notice of Non-coverage)
required to do?
Answer: Inform a Medicare beneficiary that Medicare may not pay
for the order or service
,◉ What type of account adjustment results from the patient's
unwillingness to pay for a self-pay balance?
Answer: Bad debt adjustment
◉ What is the initial hospice benefit?
Answer: Two 90-day periods and an unlimited number of
subsequent periods
◉ When does a hospital add ambulance charges to the Medicare
inpatient claim?
Answer: If the patient requires ambulance transportation to a skilled
nursing facility
◉ How should a provider resolve a late-charge credit posted after an
account is billed?
Answer: Post a late-charge adjustment to the account
◉ an increase in the dollars aged greater than 90 days from date of
service indicate what about accounts
Answer: They are not being processed in a timely manner
◉ What is an advantage of a preregistration program?
Answer: It reduces processing times at the time of service
,◉ What are the two statutory exclusions from hospice coverage?
Answer: Medically unnecessary services and custodial care
◉ What core financial activities are resolved within patient access?
Answer: Scheduling, insurance verification, discharge processing,
and payment of point-of-service receipts
◉ What statement applies to the scheduled outpatient?
Answer: The services do not involve an overnight stay
◉ How is a mis-posted contractual allowance resolved?
Answer: Comparing the contract reimbursement rates with the
contract on the admittance advice to identify the correct amount
◉ What type of patient status is used to evaluate the patient's need
for inpatient care?
Answer: Observation
◉ Coverage rules for Medicare beneficiaries receiving skilled
nursing care require that the beneficiary has received what?
Answer: Medically necessary inpatient hospital services for at least
3 consecutive days before the skilled nursing care admission
, ◉ When is the word "SAME" entered on the CMS 1500 billing form
in Field 0$?
Answer: When the patient is the insured
◉ What are non-emergency patients who come for service without
prior notification to the provider called?
Answer: Unscheduled patients
◉ If the insurance verification response reports that a subscriber
has a single policy, what is the status of the subscriber's spouse?
Answer: Neither enrolled not entitled to benefits
◉ Regulation Z of the Consumer Credit Protection Act, also known as
the Truth in Lending Act, establishes what?
Answer: Disclosure rules for consumer credit sales and consumer
loans
◉ What is a principal diagnosis?
Answer: Primary reason for the patient's admission
◉ Collecting patient liability dollars after service leads to what?
Answer: Lower accounts receivable levels
COMPLETE PREPARATION GUIDE WITH
INSURANCE CLAIMS AND DENIAL
MANAGEMENT REVIEW
◉ Self-funded benefit plans may choose to coordinate benefits using
the gender rule or what other rule?
Answer: Birthday
◉ In what type of payment methodology is a lump sum or bundled
payment negotiated between the payer and some or all providers?
Answer: Case rates
◉ What customer service improvements might improve the patient
accounts department?
Answer: Holding staff accountable for customer service during
performance reviews
◉ What is an ABN (Advance Beneficiary Notice of Non-coverage)
required to do?
Answer: Inform a Medicare beneficiary that Medicare may not pay
for the order or service
,◉ What type of account adjustment results from the patient's
unwillingness to pay for a self-pay balance?
Answer: Bad debt adjustment
◉ What is the initial hospice benefit?
Answer: Two 90-day periods and an unlimited number of
subsequent periods
◉ When does a hospital add ambulance charges to the Medicare
inpatient claim?
Answer: If the patient requires ambulance transportation to a skilled
nursing facility
◉ How should a provider resolve a late-charge credit posted after an
account is billed?
Answer: Post a late-charge adjustment to the account
◉ an increase in the dollars aged greater than 90 days from date of
service indicate what about accounts
Answer: They are not being processed in a timely manner
◉ What is an advantage of a preregistration program?
Answer: It reduces processing times at the time of service
,◉ What are the two statutory exclusions from hospice coverage?
Answer: Medically unnecessary services and custodial care
◉ What core financial activities are resolved within patient access?
Answer: Scheduling, insurance verification, discharge processing,
and payment of point-of-service receipts
◉ What statement applies to the scheduled outpatient?
Answer: The services do not involve an overnight stay
◉ How is a mis-posted contractual allowance resolved?
Answer: Comparing the contract reimbursement rates with the
contract on the admittance advice to identify the correct amount
◉ What type of patient status is used to evaluate the patient's need
for inpatient care?
Answer: Observation
◉ Coverage rules for Medicare beneficiaries receiving skilled
nursing care require that the beneficiary has received what?
Answer: Medically necessary inpatient hospital services for at least
3 consecutive days before the skilled nursing care admission
, ◉ When is the word "SAME" entered on the CMS 1500 billing form
in Field 0$?
Answer: When the patient is the insured
◉ What are non-emergency patients who come for service without
prior notification to the provider called?
Answer: Unscheduled patients
◉ If the insurance verification response reports that a subscriber
has a single policy, what is the status of the subscriber's spouse?
Answer: Neither enrolled not entitled to benefits
◉ Regulation Z of the Consumer Credit Protection Act, also known as
the Truth in Lending Act, establishes what?
Answer: Disclosure rules for consumer credit sales and consumer
loans
◉ What is a principal diagnosis?
Answer: Primary reason for the patient's admission
◉ Collecting patient liability dollars after service leads to what?
Answer: Lower accounts receivable levels
