HFMA CRCR questions and answers 100% guaranteed success.

HFMA CRCR questions and answers 100% guaranteed success. Through what document does a hospital establish compliance standards? - correct answer. code of conduct What is the purpose OIG work plant? - correct 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? - correct answer. Non-diagnostic service provided on Tuesday through Friday What does a modifier allow a provider to do? - correct 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 - correct answer. They must be billed separately to the part B Carrier what is a recurring or series registration? - correct 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? - correct answer. Unscheduled patients Which of the following statement apply to the observation patient type? - correct answer. It is used to evaluate the need for an inpatient admission which services are hospice programs required to provide around the clock patient - correct answer. Physician, Nursing, Pharmacy Scheduler instructions are used to prompt the scheduler to do what? - correct 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? - correct 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: - correct answer. Documentation of the medical necessity for the test What is the advantage of a pre-registration program - correct answer. It reduces processing times at the time of service What date are required to establish a new MPI(Master patient Index) entry - correct 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? - correct 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 - correct 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? - correct 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? - correct answer. Medical screening and stabilizing treatment Which of the following is a step in the discharge process? - correct 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? - correct 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? - correct answer. $100.00 When is a patient considered to be medically indigent? - correct 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? - correct 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? - correct answer. Warn the patient that unpaid accounts are placed with collection agencies for further processing What core financial activities are resolved within patient access? - correct answer. scheduling , pre-registration, insurance verification and managed care processing What is an unscheduled direct admission? - correct 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? - correct answer. As a substitute for an inpatient admission Patients who require periodic skilled nursing or therapeutic care receive services from what type of program? - correct answer. Home health agency Every patient who is new to the healthcare provider must be offered what? - correct answer. A printed copy of the provider privacy notice Which of the following statements apples to self insured insurance plans? - correct answer. The employer provides a traditional HMO health plan In addition to the member's identification number, what information is recorded in a 270 transaction - correct answer. Name What process does a patient's health plan use to retroactively collect payments from liability automobile or worker's compensation plan? - correct answer. Subrogation In what type of payment methodology is a lump sum of bundled payment negotiated between the payer and some or all providers? - correct answer. DRG/Case rate What Restriction does a managed care plan place on locations that must be used if the plan is to pay for the service provided? - correct answer. Site of service limitation Which of the following statements applies to private rooms? - correct answer. If the medical necessity for a private room is documented in the chart. The patients insurance will be billed for the differential Which of the following is true about screening a beneficiary of possible MSP(Medicare secondary payer) situations? - correct answer. It is necessary to ask the patient each of the MSP questions Which of the following is not true of Medicare Advantage Plans? - correct answer. A patient must have both Medicare Part A and B benefits to be eligible for a Medicare Advantage plan Which of the following is a valid reason for a payer to deny a claim? - correct answer. Failure to complete authorization Which of the following statements is NOT a possible consequence of selecting the wrong patient in the MPI(master patient index) - correct answer. Claim is paid in full Which of the following statements is true of a Medicare Advantage Plan? - correct answer. This plan supplements Part A and Part B benefits Which is the following is not a characteristic of Medicaid HMO plan? - correct answer. Medicaid-eligible patients are never required to join a Medicaid HMO plan Which of the following is violation of the EMTALA ? - correct answer. Registration staff members routinely contact managed care plans for prior authorizations before the patients is seen by the on duty physician Which of the following statements is true of the important message from Medicare notification requirements? - correct answer. Notification can be issued no earlier than 7 days before admission and no more than 2 days before discharge. What is the self pay balance after insurance - correct answer. The portion of the adjudicated claim that is due from the patient Which of the following options is an alternative to valid long term payment plans - correct answer. Bank loans The patient has the following benefit plan $400 per family member deductible, to a maximum of $1200 per year and $2000 per family member co insurance, to a family maximum of $6000 per year excluding the deductible . Five family members are enrolled in this benefit plan. What is the maximum out of pocket expense that that family could incur during the calendar year? - correct answer. $6000 What type of plan restricts benefits for non-emergency care to approve providers only? - correct answer. A POS (point of service )plan What does scheduling allow provider staff to do? - correct answer. Review the appropriateness of the service requested When an adult patient is covered by both his own and his spouse health insurance plan, which of the statements is true? - correct answer. The patients insurance plan is primary Mrs. Jones , a Medicare beneficiary was admitted to the hospital on June 20,2010. As of the admission date, she had only used 8 inpatient days in the current benefit period. If she is not discharge on what date will Mr jones exhaust her full coverage days. - correct answer. August 9, 2010 In order to meet eligibility guidelines for healthcare benefits, Medicaid beneficiaries must fall into a specified need category and meet what other types of requirements - correct answer. Income and assets Fee for service plans pay claims based on a percentage of charges. How are patients out of pocket cost calculated? - correct answer. They are calculated quarterly Indemnity plans usually reimburse what? - correct answer. A certain percentage of charges after patient meets policy's annual deductible. Departments that need to be included in Charge master maintenance include all EXCEPT - correct answer. Quality Assurance Using HIPPA standardized transaction sets allow providers to: - correct answer. Submit a standardized transaction to any of the health plans with which it conducts business. Which of the following is NOT included in the standardized quality measures? - correct answer. Cost of services The ACO investment model will test the use of pre-paid shared savings to: - correct answer. Encourage new ACOs to form in rural and underserved areas.