HFMA CRCR
Through what document does a hospital establish compliance standards? - ANScode of
conduct
What is the purpose OIG work plant? - ANSIdentify 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? - ANSNon-diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do? - ANSReport 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 - ANSThey must be billed separately to the part B Carrier
what is a recurring or series registration? - ANSOne registration record is created for multiple
days of service
What are nonemergency patients who come for service without prior notification to the provider
called? - ANSUnscheduled patients
Which of the following statement apply to the observation patient type? - ANSIt is used to
evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient -
ANSPhysician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? - ANSComplete 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? - ANSProcedure time
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: - ANSDocumentation of the medical necessity for the test
What is the advantage of a pre-registration program - ANSIt reduces processing times at the
time of service
, What date are required to establish a new MPI(Master patient Index) entry - ANSThe
responsible party's full legal name, date of birth, and social security number
Which of the following statements is true about third-party payments? - ANSThe 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 -
ANSstop loss
what documentation must a primary care physician send to HMO patient to authorize a visit to a
specialist for additional testing or care? - ANSReferral
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? - ANSMedical screening
and stabilizing treatment
Which of the following is a step in the discharge process? - ANSHave 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? - ANSTo 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? - ANSThe patient's outstanding medical
bills exceed a defined dollar amount or percentage of assets.
What patient assets are considered in the financial assistance application? - ANSSources of
readily available funds , vehicles, campers, boats and saving accounts
If the patient cannot agree to payment arrangements, What is the next option? - ANSWarn the
patient that unpaid accounts are placed with collection agencies for further processing
What core financial activities are resolved within patient access? - ANSscheduling ,
pre-registration, insurance verification and managed care processing
What is an unscheduled direct admission? - ANSA patient who arrives at the hospital via
ambulance for treatment in the emergency department
Through what document does a hospital establish compliance standards? - ANScode of
conduct
What is the purpose OIG work plant? - ANSIdentify 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? - ANSNon-diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do? - ANSReport 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 - ANSThey must be billed separately to the part B Carrier
what is a recurring or series registration? - ANSOne registration record is created for multiple
days of service
What are nonemergency patients who come for service without prior notification to the provider
called? - ANSUnscheduled patients
Which of the following statement apply to the observation patient type? - ANSIt is used to
evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient -
ANSPhysician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? - ANSComplete 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? - ANSProcedure time
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: - ANSDocumentation of the medical necessity for the test
What is the advantage of a pre-registration program - ANSIt reduces processing times at the
time of service
, What date are required to establish a new MPI(Master patient Index) entry - ANSThe
responsible party's full legal name, date of birth, and social security number
Which of the following statements is true about third-party payments? - ANSThe 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 -
ANSstop loss
what documentation must a primary care physician send to HMO patient to authorize a visit to a
specialist for additional testing or care? - ANSReferral
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? - ANSMedical screening
and stabilizing treatment
Which of the following is a step in the discharge process? - ANSHave 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? - ANSTo 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? - ANSThe patient's outstanding medical
bills exceed a defined dollar amount or percentage of assets.
What patient assets are considered in the financial assistance application? - ANSSources of
readily available funds , vehicles, campers, boats and saving accounts
If the patient cannot agree to payment arrangements, What is the next option? - ANSWarn the
patient that unpaid accounts are placed with collection agencies for further processing
What core financial activities are resolved within patient access? - ANSscheduling ,
pre-registration, insurance verification and managed care processing
What is an unscheduled direct admission? - ANSA patient who arrives at the hospital via
ambulance for treatment in the emergency department
