CSBI HFMA COMPLETE COURSE REVIEW
GUIDE
◉ 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
◉ 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?
Answer: 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?
Answer: $100.00
GUIDE
◉ 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
◉ 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?
Answer: 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?
Answer: $100.00
