HFMA CRCR 2023//2024

HFMA CRCR 2023//2024 Through what document does a hospital establish compliance standards? - ANSWER code of conduct What is the purpose OIG work plant? - ANSWER 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? - ANSWER Non-diagnostic service provided on Tuesday through Friday What does a modifier allow a provider to do? - ANSWER 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 - ANSWER They must be billed separately to the part B Carrier what is a recurring or series registration? - ANSWER 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? - ANSWER Unscheduled patients Which of the following statement apply to the observation patient type? - ANSWER It is used to evaluate the need for an inpatient admission which services are hospice programs required to provide around the clock patient - ANSWER Physician, Nursing, Pharmacy Scheduler instructions are used to prompt the scheduler to do what? - ANSWER 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? - ANSWER 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: - ANSWER Documentation of the medical necessity for the test What is the advantage of a pre-registration program - ANSWER It reduces processing times at the time of service What date are required to establish a new MPI(Master patient Index) entry - ANSWER 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? - ANSWER 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 - ANSWER 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? - ANSWER 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? - ANSWER Medical screening and stabilizing treatment Which of the following is a step in the discharge process? - ANSWER Have a case management service complete the discharge plan