CRCR Certification Exam Latest Updated

Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - ANSWER-The Medicare Administrative Contractor (MAC) at the end of the hospice cap period Which of the following is required for participation in Medicaid - ANSWER-Meet Income and Assets Requirements In choosing a setting for patient financial discussions, organizations should first and foremost - ANSWER-Respect the patients privacy A nightly room charge will be incorrect if the patient's - ANSWER-Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can - ANSWER-Purchase qualified health benefit plans regardless of insured's health status A portion of the accounts receivable inventory which has NOT qualified for billing includes: - ANSWER-Charitable pledges What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? - ANSWER-Revenue codes This directive was developed to promote and ensure healthcare quality and value and also to protect consumers and workers in the healthcare system. This directive is called - ANSWER-Patient bill of rights The activity which results in the accurate recording of patient bed and level of care assessment, patient transfer and patient discharge status on a real-time basis is known as - ANSWER-Case management Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? - ANSWER-Registration staff may routinely contact managed are plans for prior authorizations before the patient is seen by the on-duty physician HIPAA had adopted Employer Identification Numbers (EIN) to be used in standard transactions to identify the employer of an individual described in a transaction EIN's are assigned by - ANSWER-The Internal Revenue Service Checks received through mail, cash received through mail, and lock box are all examples of - ANSWER-Control points for cash posting What are some core elements if a board-approved financial assistance policy? - ANSWER-Eligibility, application process, and nonpayment collection activities A recurring/series registration is characterized by - ANSWER-The creation of one registration record for multiple days of service With the advent of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to - ANSWER-Assist patients in understanding their insurance coverage and their financial obligation The purpose of a financial report is to: - ANSWER-Present financial information to decision makers Patient financial communications best practices produce communications that are - ANSWER-Consistent, clear and transparent Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish - ANSWER-What services or healthcare items are covered under Medicare Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with - ANSWER-The Provider Reimbursement Review Board Concurrent review and discharge planning - ANSWER-Occurs during service Duplicate payments occur: - ANSWER-When providers re-bill claims based on nonpayment from the initial bill submission An individual enrolled in Medicare who is dissatisfied with the government's claim determination is entitled to reconsideration of the decision. This type of appeal is known as - ANSWER-A beneficiary appeal Insurance verification results in which of the following - ANSWER-The accurate identification of the patient's eligibility and benefits The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: - ANSWER-Judicial review by a federal district court Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the providermay not ask about a patient's insurance information if it would delay what? - ANSWER-Medical screening and stabilizing treatment Ambulance services are billed directly to the health plan for - ANSWER-Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility Key performance indicators (KPIs) set standards for accounts receivables (A/R) and - ANSWER-Provide a method of measuring the collection and control of A/R he patient discharge process begins when - ANSWER-The physician writes the discharge orders The nightly room charge will be incorrect if the patient's - ANSWER-Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system. The soft cost of a dissatisfied customer is - ANSWER-The customer passing on info about their negative experience to potential pts or through social media channels An advantage of a pre-registration program is - ANSWER-The opportunity to reduce the corporate compliance failures within the registration process It is important to have high registration quality standards because - ANSWER-Inaccurate or incomplete patient data will delay payment or cause denials Telemed seeks to improve a patient's health by - ANSWER-Permitting 2-way real time interactive communication between the patient and the clinical professional Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a monthly fee is known as a - ANSWER-HMO Identifying the patient, in the MPI, creating the registration record, completing medical necessity screening, determining insurance eligibility and benefits resolving managed care, requirements and completing financial education/resolution are all - ANSWER-The data collection steps for scheduling and pre-registering a patient Medicare Part B has an annual deductible, and the beneficiary is responsible for - ANSWER-A co-insurance payment for all Part B covered services The standard claim form used for billing by hospitals, nursing facilities, and other inpatient - ANSWER-UB-04 Charges are the basis for - ANSWER-Separation of fiscal responsibilities between the patient and the health plan All of the following are forms of hospital payment contracting EXCEPT - ANSWER-Contracted Rebating The most common resolution methods for credit balances include all of the following EXCEPT: - ANSWER-Designate the overpayment for charity care Ambulance services are billed directly to the health plan for - ANSWER-The portion of the bill outside of the patient's self-pay A claim for reimbursement submitted to a third-party payer that has all the information and documentation required for the payer to make a decision on it is known as - ANSWER-A clean claim The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to - ANSWER-Medicare and Medicaid payments The Correct Coding Initiative Program consists of - ANSWER-Edits that are implemented within providers' claim processing systems To provide a patient with information that is meaningful to them, all of the following factors must be included EXCEPT - ANSWER-The actual physician reimbursement Which department supports/collaborates with the revenue cycle? - ANSWER-Information Technology Medicare Part B has an annual deductible and the beneficiary is responsible for - ANSWER-a co-insurance payment for all Part B covered services The two types of claims denial appeals are - ANSWER-Beneficiary and Provider Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) - ANSWER-Registration staff members routinely contact managed care plans for prior authorizations before the patient is seen by the on duty physician Rural Health Clinics (RHC) personnel can provide services in all of the following locations, EXCEPT - ANSWER-Providing inpatient services in the RHC The patient discharge process begins when - ANSWER-The physician writes the discharge order Departments that need to be included in charge master maintenance include all of the following EXCEPT - ANSWER-Quality Assurance The first thing a health plan does when processing a claim is - ANSWER-Check if the patient is a health plan beneficiary and what is the coverage Vital to accurate calculations of a patient's self-pay amount is - ANSWER- The most accurate way to validate patient information is to - ANSWER-require clinical staff to verify information at each treatment encounter In order for Regulation Z to apply, a hospital must - ANSWER- All of the following are minimum requirements for new patients with no MPI number EXCEPT - ANSWER-Address A typical routine patient financial discussion would include - ANSWER-Explaining the benefits identified through verifying the patients insurance Components of financial education include informing the patient of the hospital's financial policies, assessing the patient's ability to pay and - ANSWER-Reviewing payment alternatives with the patient so appropriate resolution of the health care financial obligation is achieved HFMA best practices indicate that the technology evaluation is conducted to - ANSWER-Continually align technology with processes rather than technology dictating processes Scheduler instructions are used to prompt the scheduler to - ANSWER-Complete the scheduling process correctly based on service requested When billing Rural Health Clinic services on a UB-04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521). Although codes are collapsed into a single revenue code, it is still important to list the appropriate CPT codes as part - ANSWER-These codes will be used to determine medical necessity and useful in determining what happened during the encounter What is likely to occur if credit balances are not identified separately from debit balances in accounts receivable? - ANSWER-The accounts receivable level would be understated The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as - ANSWER-insurance verification and reimbursable charges Unless the patient encounter is an emergency, it is more efficient and effective to - ANSWER-Collect all information after the patient has been discharged Applying the contracted payment amount to the amount of total charges yields - ANSWER-A pricing agreement "Hard-coded" is the term used to refer to - ANSWER-Codes for services, procedures, and drugs automatically assigned by the charge master The advantages to using a third-party collection agency include all of the following EXCEPT - ANSWER-Providers pay pennies on each dollar collected Which of the following is usually covered on a Conditions of Admission form - ANSWER-Release of information The 501(r) regulations require not-for-profit providers (501(c)(3) organizations) to do which of the following activities. - ANSWER-Complete a community needs assessment and develop a discount program for patient balances after insurance payment To be eligible for Medicaid, an individual must - ANSWER-meet income and asset requirements Eliminating mail time and reducing data entry time, electronically monitoring the receipt of claims and online claim adjudication, more prompt payment are all benefits achieved by - ANSWER-The electronic submission of claims using electronic transfers There are unique billing requirements based on - ANSWER-The provider type The unscheduled "direct" admission represents a patient who: - ANSWER-Is admitted from a physician's office on an urgent basis In resolving medical accounts, a law firm may be used as: - ANSWER-A substitute for a collection agency The legal authority to request and analyze provider claim documentation to ensure that - ANSWER-The Office of the U.S. Inspector General (OIG) The office of inspector general (OIG) publishes a compliance work plan - ANSWER-Annually Room and bed charges are typically posted - ANSWER-From the midnight census All of the following information should be reviewed as part of schedule finalization EXCEPT: - ANSWER-The results of any and all test Revenue cycle activities occurring at the point-of-service include all of the following EXCEPT: - ANSWER-Providing charges to the third-party payer as they are incurred HFMA's patient financial communications best practices specify that pts should be told about the - ANSWER-The service providers that typically participate in the service, e.g. radiologists ,pathologists, etc. The core financial activities resolved within patient access include: - ANSWER-Scheduling, pre-registration, insurance verification and managed care processing A decision on whether a patient should be admitted as an inpatient or become about patient observation patient requires medical judgments based on all of the following EXCEPT - ANSWER-The patient's home care coverage Which option is a benefit of pre-registering a patient for services - ANSWER-The patient arrival process is expedited, reducing wait times and delays Days in A/R is calculated based on the value of - ANSWER-The total accounts receivable on a specific date Case Management requires that a case manager be assigned - ANSWER-To a select patient group Which of the following is required for participation in Medicaid? - ANSWER-Meet income and assets requirements All of the following are steps in safeguarding collections EXCEPT - ANSWER-Issuing receipts The Electronic Remittance Advice (ERA) data set is : - ANSWER-A standardized form that provides third party payment details to providers All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT - ANSWER-Services and procedures that are custodial in nature Medicare beneficiaries remain in the same "benefit period" - ANSWER-Until the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days It is important to calculate reserves to ensure - ANSWER-Stable financial operations and accurate financial reporting A claim is denied for the following reasons, EXCEPT: - ANSWER-The submitted claim does not have the physicians signature HFMA best practices call for patient financial discussions to be reinforced - ANSWER-By changing policies to programs Patients should be informed that costs presented in a price estimate may - ANSWER-Vary from estimates, depending on the actual services performed The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physicians to do all of the following EXCEPT: - ANSWER-Obtain higher compensation for physicians