STUDY GUIDE 2023/2024 CRCR EXAM (QUESTIONS AND ANSWERS)

STUDY GUIDE 2023/2024 CRCR EXAM (QUESTIONS AND ANSWERS) Which of the following statements are true of HFMA's Patient Financial Communications Best Practices? - CORRECT ANSWER-The best practices were developed specifically to help patients understand the cost of services, their individual insurance benefits, and their responsibility for balances after insurance, if any. The patient experience includes all of the following except: - CORRECT ANSWERRecognition that revenue cycle processes must be patient-centric and efficient. This is especially true in the areas of scheduling, registration, admitting, financial counseling and account resolution conversation with patients. Corporate compliance programs play an important role in protecting the integrity of operations and ensuring compliance with federal and state requirements. The code of conduct is: - CORRECT ANSWER-A critical tool to ensure compliance, essential and integral component, fosters an environment, (all of the above) Specific to Medicare free-for-service patients, which of the following payers have always been liable for payment? - CORRECT ANSWER-Black lung service programs, veteran affairs program, working aged programs, ESRD, and disability Provider policies and procedures should be in place to reduce the risk of ethics violations. Examples include: - CORRECT ANSWER-financial misconduct, theft of property, applying policies in inconsistent manner (all of the above) What is the intended outcome of collaborations made through an ACO delivery system for a population of patients? - CORRECT ANSWER-To eliminate duplicate services, prevent medical errors and ensure appropriateness of care What is the new terminology now employed in the calculation of net patient service revenues? - CORRECT ANSWER-explicit price concessions and implicit price concessions What are the two KPIs used to monitor performance related to the production and submission of claims to third party payers and patients (self-pay)? - CORRECT ANSWER-Elapsed days from discharge to final bill and elapsed days from final bill to claim/bill submission What happens during the post-service stage? - CORRECT ANSWER-Final coding of all services, preparation and submission of claims, payment processing and balance billing and resolution. The following statements describe best practices established by the Medicaid Debt Task Force. Select true statements. - CORRECT ANSWER-educate patients, coordinate to avoid duplicate patient contacts, be consistent in key aspects of account resolution, follow best practices for communication Which option is NOT a main HFMA Healthcare Dollars & Sense revenue cycle initiative? - CORRECT ANSWER-Process Compliance What is the objective of the HCAHPS initiative? - CORRECT ANSWER-To provide a standardized method for evaluating patient's perspective on hospital care Which option is NOT a department that supports and collaborates with the revenue cycle? - CORRECT ANSWER-Assisted Living Services Which option is NOT a continuum of care provider? - CORRECT ANSWER-Health Plan Contracting Which of the following are essential elements of an effective compliance program? - CORRECT ANSWER-established compliance standards and procedures, oversight of personnel by high-level personnel, reasonable methods to achieve compliance with standards, including monitoring systems and hotlines Annually, the OIG publishes a work plan of compliance issues and objects that will be focused on the throughout the following year. Identify which option is NOT a work plan task mentioned in this course. - CORRECT ANSWER-Standard Unique Employer Identifier In order to promote the use of correct coding methods on a national basis and prevent payment errors due to improper coding, CMS developed what? - CORRECT ANSWERThe Correct Coding Initiative(CCI) What do business/organizational ethics represent? - CORRECT ANSWER-Principles and standards by which organizations operate What is the intended outcome of collaborations made through an ACO delivery system? - CORRECT ANSWER-To ensure appropriateness of care, elimination of duplicate services, and prevention of medical errors for a population of patients Which of these statements describes the new methodology for the determinations of net patient service revenue? - CORRECT ANSWER-Net patient service revenue is defined a the total incurred charges, less the explicit price concession, less any applicable implicit price concession(s) as applied to the specific portfolio of accounts. What are KPIs? - CORRECT ANSWER-Key Performance Indicators, which set standards for accounts receivable (A/R) and provide a method of measuring the collection and control of A/R Which patient types are typically considered acute care patient types? - CORRECT ANSWER-Observation, newborn, Emergency(ED) Accurate identification of the patient is the first step in the scheduling process. Identifiers used in various combination to achieve accurate patient identification include: - CORRECT ANSWER-Full legal name, date of birth, sex and social security number Pre-registration is defined as: - CORRECT ANSWER-The collection of demographic information, insurance data, financial information, providing reminders, prep information, and identifying the potential need for financial assistance for scheduled patients. Which of the following statements accurately describe the various Medicare benefit programs: - CORRECT ANSWER-Medicare part A provides benefits for inpatient hospital services, skilled nursing care and home health care; Medicare Part B covers outpatient and professional services; Medicare Part C or Medicare Advantage plans are managed care plans combining Part A and Part B coverages; and Medicare Part D is the prescription drug coverage benefit. Which of the following statements about Medicaid eligibility is not true? - CORRECT ANSWER-Medicaid categories are restricted to children, pregnant women, and elderly in nursing homes Examples of managed care plans include: - CORRECT ANSWER-HMO, PPO, EPO, POS, Concierge plans, Medicare Advantage plans, Direct contracting for specific services from specific providers (all of the above) Patient Financial Communications best practices include all of the following activities except: - CORRECT ANSWER-Collecting payment or initiating the process to immediately remove the patient from the service schedule. Which statement includes the required components of an accurate pricing determination: - CORRECT ANSWER-Insurance coverages and benefits, service or test involved, diagnosis and procedure codes, total estimated charges, adjudication calculations based on the patient's benefit package. The value of a robust scheduling and pre-registration process includes all of the following except: - CORRECT ANSWER-Identification of patients who are likely to be "no shows". Which patients are considered scheduled? - CORRECT ANSWER-Recurring/Series Patients Name the guideline that Medicare established to determine which diagnoses, signs, or symptoms are payable. - CORRECT ANSWER-Local Coverage Determination