HFMA Guide 2.0 Exam Questions
With Verified Answers
Pre-Service, Time-of-Service, Post-Service - ANSWER 3 critical segments of the
revenue cycle
Pre-service segment (for scheduled patients) - ANSWER Scheduling and pre-access
processing is completed. The patient is scheduled, pre-registered for service and the
required data is collected.
Time-of-service segment (scheduled and unscheduled patients) - ANSWER A final
account review is completed for a scheduled patient prior to his/her arrival. Upon arrival,
the patient is positively identified, the pre-registration record is activated, consents are
signed, and co-payments or other agreed upon amounts are collected. For unscheduled
patients, comprehensive registration and financial processing is completed, this mirrors
the work that was completed for the scheduled patients prior to service.
Post-service segment (after the patient is discharged) - ANSWER Account activities
occur after the patient is discharged until the account reaches a zero balance
Patient Financial Communications, Price Transparency, Medical Account Resolution -
ANSWER Three HFMA revenue cycle initiatives
Medical Debt Task Force - ANSWER Developed medical account resolution best
practices
Out-of-pocket cost, the price of service prior to care, the provider's payment
expectation, and the payment terms. - ANSWER Patients are consumers of healthcare
and want to be informed of these 4 things
Physicians
Skilled Nursing Facilities
Home Health Agencies
Durable Medical Equipment
Hospice
, Assisted Living - ANSWER Care providers within the healthcare system
Continuum of Care - ANSWER way of coordinating and linking healthcare resources to
avoid duplication thus facilitating a seamless movement among care settings.
involves healthcare professionals in multiple settings at multiple levels working together
with the overall goal of coordinating patients' healthcare
Purpose of a compliance program - ANSWER to mitigate potential fraud and abuse in
the industry-specific key risk areas.
2020 OIG Work Plan tasks - ANSWER Medicare Payments Made Outside of the
Hospice Benefit
Denials and Appeals in Medicare Part C and Part D
Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
Review of Home Health Claims for Services With 5 to 10 Skilled Visits
Three-Day DRG Window Rule - ANSWER requires certain outpatient services that are
provided within three days of the admission date, by hospitals or by entities wholly
owned or controlled by hospitals, to be billed as part of an inpatient stay.
Purpose of the ABN - ANSWER to inform a Medicare beneficiary "before he or she
receives specified items or services that might otherwise be paid for" that Medicare
certainly or probably will not pay for those items or services on that particular occasion.
Situations where Medicare acts as secondary payer - ANSWER Working Aged
Accident or Other Liability
Disability
End-Stage Renal Disease (ESRD)
Correct Coding Initiative (CCI) - ANSWER Ensures that the most comprehensive
groups of codes, rather than the component parts, are billed
Business ethics or organizational ethics - ANSWER represent the principles and
standards by which organizations operate.
Ethics violations that impact the revenue cycle - ANSWER Financial misconduct
Overcharging
Theft of property
Falsifying records to boost reimbursement
Miscoding claims
Ethical behavior - ANSWER considered to be actions that are the right thing to do, not
just what is required by a law, regulation or rule
With Verified Answers
Pre-Service, Time-of-Service, Post-Service - ANSWER 3 critical segments of the
revenue cycle
Pre-service segment (for scheduled patients) - ANSWER Scheduling and pre-access
processing is completed. The patient is scheduled, pre-registered for service and the
required data is collected.
Time-of-service segment (scheduled and unscheduled patients) - ANSWER A final
account review is completed for a scheduled patient prior to his/her arrival. Upon arrival,
the patient is positively identified, the pre-registration record is activated, consents are
signed, and co-payments or other agreed upon amounts are collected. For unscheduled
patients, comprehensive registration and financial processing is completed, this mirrors
the work that was completed for the scheduled patients prior to service.
Post-service segment (after the patient is discharged) - ANSWER Account activities
occur after the patient is discharged until the account reaches a zero balance
Patient Financial Communications, Price Transparency, Medical Account Resolution -
ANSWER Three HFMA revenue cycle initiatives
Medical Debt Task Force - ANSWER Developed medical account resolution best
practices
Out-of-pocket cost, the price of service prior to care, the provider's payment
expectation, and the payment terms. - ANSWER Patients are consumers of healthcare
and want to be informed of these 4 things
Physicians
Skilled Nursing Facilities
Home Health Agencies
Durable Medical Equipment
Hospice
, Assisted Living - ANSWER Care providers within the healthcare system
Continuum of Care - ANSWER way of coordinating and linking healthcare resources to
avoid duplication thus facilitating a seamless movement among care settings.
involves healthcare professionals in multiple settings at multiple levels working together
with the overall goal of coordinating patients' healthcare
Purpose of a compliance program - ANSWER to mitigate potential fraud and abuse in
the industry-specific key risk areas.
2020 OIG Work Plan tasks - ANSWER Medicare Payments Made Outside of the
Hospice Benefit
Denials and Appeals in Medicare Part C and Part D
Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
Review of Home Health Claims for Services With 5 to 10 Skilled Visits
Three-Day DRG Window Rule - ANSWER requires certain outpatient services that are
provided within three days of the admission date, by hospitals or by entities wholly
owned or controlled by hospitals, to be billed as part of an inpatient stay.
Purpose of the ABN - ANSWER to inform a Medicare beneficiary "before he or she
receives specified items or services that might otherwise be paid for" that Medicare
certainly or probably will not pay for those items or services on that particular occasion.
Situations where Medicare acts as secondary payer - ANSWER Working Aged
Accident or Other Liability
Disability
End-Stage Renal Disease (ESRD)
Correct Coding Initiative (CCI) - ANSWER Ensures that the most comprehensive
groups of codes, rather than the component parts, are billed
Business ethics or organizational ethics - ANSWER represent the principles and
standards by which organizations operate.
Ethics violations that impact the revenue cycle - ANSWER Financial misconduct
Overcharging
Theft of property
Falsifying records to boost reimbursement
Miscoding claims
Ethical behavior - ANSWER considered to be actions that are the right thing to do, not
just what is required by a law, regulation or rule
