CSBI HFMA ESSENTIAL STUDY QUESTIONS
AND ANSWERS
◉ 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
◉ When is a patient considered to be medically indigent?
Answer: The patient's outstanding medical bills exceed a defined
dollar amount or percentage of assets.
◉ What patient assets are considered in the financial assistance
application?
Answer: Sources of readily available funds , vehicles, campers, boats
and saving accounts
, ◉ If the patient cannot agree to payment arrangements, What is the
next option?
Answer: Warn the patient that unpaid accounts are placed with
collection agencies for further processing
◉ What core financial activities are resolved within patient access?
Answer: scheduling , pre-registration, insurance verification and
managed care processing
◉ What is an unscheduled direct admission?
Answer: A patient who arrives at the hospital via ambulance for
treatment in the emergency department
◉ When is it not appropriate to use observation status?
Answer: As a substitute for an inpatient admission
◉ Patients who require periodic skilled nursing or therapeutic care
receive services from what type of program?
Answer: Home health agency
◉ Every patient who is new to the healthcare provider must be
offered what?
AND ANSWERS
◉ 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
◉ When is a patient considered to be medically indigent?
Answer: The patient's outstanding medical bills exceed a defined
dollar amount or percentage of assets.
◉ What patient assets are considered in the financial assistance
application?
Answer: Sources of readily available funds , vehicles, campers, boats
and saving accounts
, ◉ If the patient cannot agree to payment arrangements, What is the
next option?
Answer: Warn the patient that unpaid accounts are placed with
collection agencies for further processing
◉ What core financial activities are resolved within patient access?
Answer: scheduling , pre-registration, insurance verification and
managed care processing
◉ What is an unscheduled direct admission?
Answer: A patient who arrives at the hospital via ambulance for
treatment in the emergency department
◉ When is it not appropriate to use observation status?
Answer: As a substitute for an inpatient admission
◉ Patients who require periodic skilled nursing or therapeutic care
receive services from what type of program?
Answer: Home health agency
◉ Every patient who is new to the healthcare provider must be
offered what?
