HFMA CRCR Exam With 100% Correct Answers Latest Update 2023/2024 Graded A+

HFMA CRCR Exam With 100% Correct Answers Latest Update 2023/2024 Graded A+. Through what document does a hospital establish compliance standards? Ans code of conduct What is the purpose OIG work plant? Ans Identify 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? Ans Non-diagnostic service provided on Tuesday through Friday What does a modifier allow a provider to do? Ans Report a specific circumstance that affected a procedure or service without changing the code or its definition IF outpatient diagnostic services are provided within three days of the admission of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these charges Ans They must be billed separately to the part B Carrier what is a recurring or series registration? Ans One registration record is created for multiple days of service What are nonemergency patients who come for service without prior notification to the provider called? Ans Unscheduled patients Which of the following statement apply to the observation patient type? Ans It is used to evaluate the need for an inpatient admission which services are hospice programs required to provide around the clock patient Ans Physician, Nursing, Pharmacy Scheduler instructions are used to prompt the scheduler to do what? Ans Complete the scheduling process correctly based on service requeste The Time needed to prepare the patient before service is the difference between the patients arrival time and which of the following? Ans Procedure time Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include: Ans Documentation of the medical necessity for the test What is the advantage of a pre-registration program Ans It reduces processing times at the time of service What date are required to establish a new MPI(Master patient Index) entry Ans The responsible party's full legal name, date of birth, and social security number Which of the following statements is true about third-party payments? Ans The 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 the pre-set level Ans stop loss what documentation must a primary care physician send to HMO patient to authorize a visit to a specialist for additional testing or care? Ans Referral 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? Ans Medical screening and stabilizing treatment Which of the following is a step in the discharge process? Ans Have a case management service complete the discharge plan The hospital has a APC 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? Ans To 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? Ans $100.00 When is a patient considered to be medically indigent? Ans The patient's outstanding medical bills exceed a defined dollar amount or percentage of assets. What patient assets are considered in the financial assistance application? Ans Sources of readily available funds , vehicles, campers, boats and saving accounts If the patient cannot agree to payment arrangements, What is the next option? Ans Warn the patient that unpaid accounts are placed with collection agencies for further processing What core financial activities are resolved within patient access? Ans scheduling , pre-registration, insurance verification and managed care processing What is an unscheduled direct admission? Ans A patient who arrives at the hospital via ambulance for treatment in the emergency department When is it not appropriate to use observation status? Ans As a substitute for an inpatient admission Patients who require periodic skilled nursing or therapeutic care receive services from what type of program? Ans Home health agency Every patient who is new to the healthcare provider must be offered what? Ans A printed copy of the provider privacy notice Which of the following statements apples to self insured insurance plans? Ans The employer provides a traditional HMO health plan In addition to the member's identification number, what information is recorded in a 270 transaction Ans Name What process does a patient's health plan use to retroactively collect payments from liability automobile or worker's compensation plan? Ans Subrogation In what type of payment methodology is a lump sum of bundled payment negotiated between the payer and some or all providers? Ans DRG/Case rate What Restriction does a managed care plan place on locations that must be used if the plan is to pay for the service provided? Ans Site of service limitation Which of the following statements applies to private rooms? Ans If the medical necessity for a private room is documented in the chart. The patients insurance will be billed for the differential Which of the following is true about screening a beneficiary of possible MSP(Medicare secondary payer) situations? Ans It is necessary to ask the patient each of the MSP questions Which of the following is not true of Medicare Advantage Plans? Ans A 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? Ans Failure to complete authorization Which of the following statements is NOT a possible consequence of selecting the wrong patient in the MPI(master patient index) Ans Claim is paid in full Which of the following statements is true of a Medicare Advantage Plan? Ans This plan supplements Part A and Part B benefits Which is the following is not a characteristic of Medicaid HMO plan? Ans Medicaid-eligible patients are never required to join a Medicaid HMO plan Which of the following is violation of the EMTALA ? Ans Registration 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? Ans Notification 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 Ans The 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 Ans Bank loans The patient has the following benefit plan $400 per family member deductible, to a maximum of $1200 per year and $2000 per family member co insurance, to a family maximum of $6000 per year excluding the deductible . Five family members are enrolled in this benefit plan. What is the maximum out of pocket expense that that family could incur during the calendar year? Ans $6000 What type of plan restricts benefits for non-emergency care to approve providers only? Ans A POS (point of service )plan What does scheduling allow provider staff to do? Ans Review the appropriateness of the service requested When an adult patient is covered by both his own and his spouse health insurance plan, which of the statements is true? Ans The patients 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 discharge on what date will Mr jones exhaust her full coverage days. Ans August 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 Ans Income and assets Fee for service plans pay claims based on a percentage of charges. How are patients out of pocket cost calculated? Ans They are calculated quarterly Indemnity plans usually reimburse what? Ans A certain percentage of charges after patient meets policy's annual deductible. Departments that need to be included in Charge master maintenance include all EXCEPT Ans Quality Assurance Using HIPPA standardized transaction sets allow providers to: Ans Submit 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? Ans Cost of services The ACO investment model will test the use of pre-paid shared savings to: Ans Encourage 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: Ans HMO Ambulance services are billed directly to the health plan for: Ans 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. 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: Ans The Provider Reimbursement Review Board. For scheduled payments, important revenue cycle activities in the time-of-service stage DO Not include: Ans Obtaining or updating patient and guarantor information Hospital can only convert an inpatient case to observation if: Ans The 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? Ans Demographic, Income, Assets and Expenses. HIPAA privacy rules require covered entities to take all, of the following actions EXCEPT: Ans Use only designated software platforms to secure patient date.