CRCR questions with complete solutions latest 2023

CRCR questions with complete solutions latest 2023HFMA patient financial communications best practices call for annual training for all staff EXCEPT A. Patient access B. Customer service representatives **C. Nursing D. Staff who engage in patient financial communications discussions What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? Medical necessity documentation B. The CMS 1500 Part B attachment C. Correct Part A and B procedural codes **D. Revenue codes The most common resolution methods for credit balances include all of the following EXCEPT A. Designate the overpayment for charity care B. Determine the correct primary payer and notify incorrect payer of overpayment C. Submit the corrected claim to the payer incorporating credits D. Either send a refund or complete a takeback form as directed by the payer. Net Accounts Receivable is A. The total bad debt B. Total debt owed by an entity **C. The amount an entity is reasonably confident of collecting from overall accounts receivable D. The total claims amount billed to health plans For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions A. May take place between the patient and discharge planning **B. Should take place between the patient or guarantor and properly trained provider representatives C. Are optional D. Are focused on verifying required third-party payer information Scheduled procedures routinely include A. Physician's office contact information B. Physician notification that scheduling is complete C. The scheduler's name and contact information **D. Patient preparation instructions ICD-10-CM and ICD-10-PCS code sets are modifications of A. DRGs B. CPT codes C. ICD 9 codes **D. The international ICD-10 codes as developed by the WHO (World Health Organization) The Medicare Bundled Payments for Care Initiative (BCPI) is designed to A. Prevent duplicate billing B. "Stretch" the impact of patient self-pay by squeezing costs down through a lump-sum payment to providers **C. Align incentives between hospitals, physicians, and non-physician providers in order to better coordinate patient care D. Drive down physician fees by forcing physicians to share equitably in one payment Which of the following is required for participation in Medicaid A. Be free of chronic conditions B. Meet a minimum yearly premium C. Obtain a supplemental health insurance policy **D. Meet income and assets requirements A four digit number code established by the National Uniform Billing Committee (NUBC) that categorizes/classifies a line item in the charge master is known as A. CPT codes B. ICD-10 Procedural codes C. HCPCs codes **D. Revenue codes Checks received through mail, cash received through mail, and lock box are all examples of A. Payment methods being phased out for more secure payment method option **B. Control points for cash posting C. Payment methods in which the majority of fraud occurs D. Highly fraud prone processes If further treatment can only be provided in a hospital setting, the patient's condition cannot be evaluated and/or treated within 24 hours, or if there is not an anticipation of improvement in the patient's condition within 24 hours, the patient A. Will remain in observation for up to 72 hours after which the patient is admitted as an inpatient B. Will have his/her case reviewed by the attending physician, a consulting physician and the primary care physician and a future course of care will then be determined C. Will be discharged and if needed, designated to a priority one outpatient status **D. Will be admitted as an inpatient Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare established guideline(s) used to determine A. Medicare and Medicaid provider eligibility **B. What Medicare reimburses and what should be referred to Medicaid C. Which diagnoses, signs, or symptoms are reimbursable D. Medicare outpatient reimbursement rates The ACO Investment model will test the use of pre-paid shared savings to **A. Encourage new ACOs to form in rural and underserved areas B. Attract physicians to participate in the ACO payment system C. Raise quality ratings in designated hospital D. Invest in treatment protocols that reduce costs to Medicar The consumers' right to revoke consent to receive auto-dialed calls and text messages is regulated by A. The Patient Protection and Affordable Care Act (PPACA) **B. The Telephone Consumer Protection Act (TCPA) C. The Interstate-Commerce Commission D. Health Insurance Protection and Portability Act (HIPAA) Medicare has established guidelines called Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish A. Provider and physician reimbursement for specific diagnoses and tests B. Prospective Medicare patient financial responsibilities for a given diagnosis C. Reasonable and customary prices for services in a given area **D. What services or healthcare items are covered under Medicare The best practice in billing is to generate bills that are A. Direct in summarizing charges and in requesting prompt payment B. Comprehensive and all-inclusive **C. Clear, concise, correct, and patient-friendly D. Timely and specifies the patient's next steps Appropriate training for patient financial counseling staff must cover all of the following EXCEPT A. Available patient financing options **B. Documenting the conversation in the medical record C. Financial assistance policies D. Patient financial communications best practices specific to staff role For scheduled patients, which of the following are NOT important revenue cycle activities in the time-of-service stage? A. Pre-registration record is activated, consents are signed, and co-payment are collected B. Pre-processed patients are directed to a designated "express arrival" desk C. Positive patient identification is completed, and the patient is given an armband **D. Final bill is presented for payment All of the following are steps in verifying insurance EXCEPT A. Identifying and documenting the patient's health plan benefits B. Confirming the patient's eligibility for benefits C. The patient signing the statement of financial responsibility **D. Sequencing plans involved in a coordination of benefits (COB) situation Medicare beneficiaries may appeal A. For a waiver from pre-authorization of treatment for specified chronic conditions B. Only payment issues seriously affecting the patient's access to care C. Virtually any issue related to the provision and payment of services **D. For reclassification of ongoing services not covered by Medicare as a Medicare Chronic Care Exemption What is the Continuum of Care? A. The clinical treatment course selected by the attending physician