HFMA CRCR Exam Questions with Solutions

HFMA CRCR Exam Questions with Solutions Through what document does a hospital establish compliance standards? - ANS code of conduct What is the purpose of the 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 non-emergency patients who come for service without prior notification to the provider called? - ANS Unscheduled patients Which of the following statements 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 request The Time needed to prepare the patient before service is the difference between the patient's 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 medicall