Certified Revenue Cycle Representative - CRCR

Certified Revenue Cycle Representative - CRCR Which of the following statements are true of HFMA's Financial Communications Best Practices - The best practices were developed specifically to help patients understand the cost of services, their individual insurance benefits, and their responsibility for balances after insurance, if any. The patient experience includes all of the following except: - The average number of positive mentions received by the health system or practice and the public comments refuting unfriendly posts on social media sites. Corporate compliance programs play an important role in protecting the integrity of operations and ensuring compliance with federal and state requirements. The code of conduct is: - All of the above Specific to Medicare fee-for-service patients, which of the following payers have always been liable for payment? - Public health service programs, Federal grant programs, veteran affairs programs, black lung program services and work-related injuries and accidents (worker' compensation claims) Provider policies and procedures should be in place to reduce the risk of ethics violations. Examples of ethics violations include: - All of the above Providers are now being reimbursed with a focus on the value of the services provided, rather than volume, which requires collaboration among providers. What is the intended outcome of collaborations made through an ACO delivery system for a population of patients? - To eliminate duplicate services, prevent medical errors and ensure appropriateness of care. Historically, revenue cycle has delt with contractual adjustments, bad debt and charity deductions from gross revenue. Although deductions continue to exist, the definition of net revenue has been modified through the implementation of ASC 606. Developed by the Financial Accounting Standards Board (FASB), this change became effective in 2018. What is the new terminology now employed in the calculation of net patient services revenues? - Explicit prices concessions and implicit price concessions Key performance indicators set standards for A/R and provide a method for measuring the control and collection of A/R. What are the two KPIs used to monitor performance related to the production and submission of claims to third party payers and patients (self-pay)? - Elapsed days from discharge to final bill and elapsed days from final bill to claim/bill submission. Consents are signed as part of the post-services process. - True **False Patient service costs are calculated in the pre-service process for schedule patients - **True False The patient is scheduled and registered for service is a time-of-service activity - True **False The patient account is monitored for payment is a time-of-service activity - True **False Case management and discharge planning services are a post-service activty - True **False Sending the bill electronically to the health plan is a time-of-service activity - True **False What happens during the post-service stage? - **A. Final coding of all services, preparation and submission of claims, payment processing and balance billing and resolution. B. Orders are entered, results are reported, charges are generated, and diagnostic and procedural coding is initiated. C. The encounter record is generated, and the patient and guarantor information is obtained and/or updated as required. D. The focus is on the patient and his/her financial care, in addition to the clinical care provided for the patient. The following statements describe best practices established by the Medical Debt Task Force. Check the box next to the True statements - **Educate Patients **Coordinate to avoid duplicate patient contacts Exercise moderate judgement when communicating with providers about scheduled services **Be consistent in key aspects of account resolution Report to healthcare plans when the patient's account is transferred to collection agency **Follow best practices for communication Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle initiative? - A. Patient Financial Communications B. Price Transparency C. Medical Account Resolution **D. Process Compliance What is the objective of the HCAHPS initiative? - **A. To provide a standardized method for evaluating patients' perspective on hospital care. B. To provide clear communication and good customer service, which will give the provider a competitive edge. C. To conduct evaluations concerning patients' perspective on hospital care. D. To make certain that during registration key information is verified by means of a picture ID and an insurance card. Which option is NOT a department that supports and collaborates with the revenue cycle? - A. Information Technology B. Clinical Services C. Finance **D. Assisted Living Services Which option is NOT a continuum of care provider? - A. Physician **B. Health Plan Contracting C. Hospice D. Skilled Nursing Facility Which of the following are essential elements of an effective compliance program? - **Reasonable methods to achieve compliance with standards, including monitoring systems and hotlines **Established compliance standards and procedures Automatic dismissal of any employee excluded from participation in a federal healthcare program **Designation of a compliance officer employed within the Billing Department **Oversight of personnel by high-level personnel. Annually, the OIG publishes a work plan of compliance issues and objectives that will be focused on throughout the following year. Identify which option is NOT a work plan task mentioned in this course. - A. Payments to Physicians for Co-Surgery Procedures B. Denials and Appeals in Medicare Part D