hfma-crcr-exam-flash-cards
A claim is denied for the following reasons, EXCEPT:
a) The health plan cannot identify the subscriber
b) The frequency of service was outside the coverage timeline
c) The submitted claim does not have the physicians signature
d) The subscriber was not enrolled at the time of service - answer>>>>C
A comprehensive "Compliance Program" is defined as
a) Annual legal audit and review for adherence to regulations
b) Educating staff on regulations
c) Systematic procedures to ensure that the provisions of
regulations imposed by a government agency are being met
d) The development of operational policies that correspond to
regulations - answer>>>>C
A decision on whether a patient should be admitted as an inpatient or become an
outpatient observation patient requires medical judgments based on all of the following
EXCEPT
a) The patient's home care coverage
b) Current medical needs
c) The likelihood of an adverse event occurring to the patient
d) The patient's medical history - answer>>>>A
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) HCPCs codes
b) ICD-10 Procedural codes
c) CPT codes
d) Revenue codes - answer>>>>D
A large number of credit balances are not the result of overpayments but of
a) Posting errors in the pt accounting system
b) Incorrect claim submissions
c) Inadequate staff training
d) Banking transaction errors - answer>>>>A
A Medicare Part A benefit period begins:
,a) With admission as an inpatient
b) The first day in which an individual has not been a hospital
inpatient not in a skilled nursing facility for the previous 60 days
c) Upon the day the coverage premium is paid
d) Immediately once authorization for treatment is provided by the
health plan - answer>>>>A
A nightly room charge will be incorrect if the patient's
a) Discharge for the next day has not been charted
b) Condition has not been discussed during the shift change report
meeting
c) Pharmacy orders to the ICU have not been entered in the
pharmacy system
d) Transfer from ICU (intensive care unit) to the Medical/Surgical
floor is not reflected in the registration system - answer>>>>D
A portion of the accounts receivable inventory which has NOT qualified for billing
includes
a) Charitable pledges
b) Accounts assigned to a pre-collection agency
c) Accounts coded but held within the suspense period
d) Accounts created during pre-registration but not activated - answer>>>>A
A portion of the accounts receivable inventory which has NOT qualified for billing
includes:
a) Charitable pledges
b) Accounts created during pre-registration but not activated
c) Accounts coded but held within the suspense period
d) Accounts assigned to a pre-collection agency - answer>>>>A
A recurring/series registration is characterized by
a) A creation of multiple registrations for multiple services
b) The creation of one registration record for multiple days of service
c) The creation of multiple patient types for one date of service
d) The creation of one registration record per diagnosis per visit - answer>>>>B
A recurring/series registration is characterized by
a) The creation of one registration record for multiple days of service
b) The creation of multiple registrations for multiple services
c) The creation of one registration record per diagnosis per visits
d) The creation of multiple pt types for one date of service - answer>>>>A
A scheduled inpatient represents an opportunity for the provider to do which of the
,following?
a) Refer the patient to another location with the health system
b) Comply with EMTALA (Emergency Medical Treatment and Labor Act)
requirements before service
c) Complete registration and insurance approval before service
d) Register the patient after he or she is placed in a bed on that service
unit. - answer>>>>C
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - answer>>>>120 days passes, but the claim then be
withdrawn from the liability carrier
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - answer>>>>120 days passes, but the claim then be
withdrawn from the liability carrier
A 68 year old patient, a Medicare beneficiary, was in a car accident. A medical
insurance claim was filed with the auto insurance carrier. Six months later this claim
remains unpaid. How can the provider pursue payment from Medicare? -
answer>>>>The provider must first bill the auto insurer; however, after a period of 120
days, if the claim remains unpaid, the provider may cancel the liability claim and bill
Medicare.
ABC Hospital has experienced a 16% increase in new patients over the past 6 months.
The hospital is understaffed in its insurance claim and payment processing department
and cannot handle this increase in work load. It is considering hiring an outsourcing
vendor to assist. What are the steps that the hospital needs to take to establish and
ensure a successful vendor relationship? - answer>>>>**A. Distribute a RFP to solicit
vendor capabilities, evaluate vendor's expertise to provide outsourcing services, visit
vendor locations, perform vendor reference checks, talk with vendor clients, interview
vendor employees to assess experience level.
B. Evaluate vendor's expertise in providing outsourcing services, visit vendor locations,
interview vendor employees to assess expertise level.
Access - answer>>>>An individual's ability to obtain medical services on a timely and
financially acceptable level
Access - answer>>>>An individual's ability to obtain medical services on a timely and
financially acceptable level
According to the Department of Health and Human Services guidelines, what is NOT
considered income? - answer>>>>Sale of property, house, or car
, According to the Department of Health and Human Services guidelines, what is NOT
considered income? - answer>>>>Sale of property, house, or car
Accurate identification of the patient is the first step in the scheduling process.
Identifiers used in various combination to achieve accurate patient identification
include? - answer>>>>Full legal name, date of birth, sex and social security number
Across all care settings, if a patient consents to a financial discussion during a medical
encounter to expedite discharge, the HFMA best practice is to:
a) Make sure that the attending staff can answer questions and
assist in obtaining required patient financial data
b) Have a patient financial responsibilities kit ready for the patient,
containing all of the required registration forms and instructions
c) Support that choice, providing that the discussion does not
interfere with patient care or disrupt patient flow
d) Decline such request as finance discussions can disrupt patient
care and patient flow - answer>>>>C
Across all care settings, if a pt consents to a financial discussion during a medical
encounter
to expedite discharge, the HFMA best practice is to
a) Have a pt financial responsibilities kit ready for the pt containing all of the required
registration forms and instructions
b) Make sure that the attending staff can answer questions and assist in obtaining
required pt financial data
c) Support that choice, providing that the discussion does not interfere with pt care or
disrupt pt flow
d) Decline such request as finance discussions can disrupt pt care and pt flow -
answer>>>>C
Administrative Services Only (ASO) - answer>>>>Usually contracted administrative
services to a self-insured health plan
Administrative Services Only (ASO) - answer>>>>Usually contracted administrative
services to a self-insured health plan
Agency fees are: - answer>>>>A. Paid by patients.
**B. The cost to the provider for collection agency monies offset by the return on
baddebt accounts.
C. Only reported annually to the provider.
D. Waived for accounts aged greater than one year from date of service.
All of the following are conditions that disqualify a procedure or service from being paid
for by Medicare EXCEPT
A claim is denied for the following reasons, EXCEPT:
a) The health plan cannot identify the subscriber
b) The frequency of service was outside the coverage timeline
c) The submitted claim does not have the physicians signature
d) The subscriber was not enrolled at the time of service - answer>>>>C
A comprehensive "Compliance Program" is defined as
a) Annual legal audit and review for adherence to regulations
b) Educating staff on regulations
c) Systematic procedures to ensure that the provisions of
regulations imposed by a government agency are being met
d) The development of operational policies that correspond to
regulations - answer>>>>C
A decision on whether a patient should be admitted as an inpatient or become an
outpatient observation patient requires medical judgments based on all of the following
EXCEPT
a) The patient's home care coverage
b) Current medical needs
c) The likelihood of an adverse event occurring to the patient
d) The patient's medical history - answer>>>>A
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) HCPCs codes
b) ICD-10 Procedural codes
c) CPT codes
d) Revenue codes - answer>>>>D
A large number of credit balances are not the result of overpayments but of
a) Posting errors in the pt accounting system
b) Incorrect claim submissions
c) Inadequate staff training
d) Banking transaction errors - answer>>>>A
A Medicare Part A benefit period begins:
,a) With admission as an inpatient
b) The first day in which an individual has not been a hospital
inpatient not in a skilled nursing facility for the previous 60 days
c) Upon the day the coverage premium is paid
d) Immediately once authorization for treatment is provided by the
health plan - answer>>>>A
A nightly room charge will be incorrect if the patient's
a) Discharge for the next day has not been charted
b) Condition has not been discussed during the shift change report
meeting
c) Pharmacy orders to the ICU have not been entered in the
pharmacy system
d) Transfer from ICU (intensive care unit) to the Medical/Surgical
floor is not reflected in the registration system - answer>>>>D
A portion of the accounts receivable inventory which has NOT qualified for billing
includes
a) Charitable pledges
b) Accounts assigned to a pre-collection agency
c) Accounts coded but held within the suspense period
d) Accounts created during pre-registration but not activated - answer>>>>A
A portion of the accounts receivable inventory which has NOT qualified for billing
includes:
a) Charitable pledges
b) Accounts created during pre-registration but not activated
c) Accounts coded but held within the suspense period
d) Accounts assigned to a pre-collection agency - answer>>>>A
A recurring/series registration is characterized by
a) A creation of multiple registrations for multiple services
b) The creation of one registration record for multiple days of service
c) The creation of multiple patient types for one date of service
d) The creation of one registration record per diagnosis per visit - answer>>>>B
A recurring/series registration is characterized by
a) The creation of one registration record for multiple days of service
b) The creation of multiple registrations for multiple services
c) The creation of one registration record per diagnosis per visits
d) The creation of multiple pt types for one date of service - answer>>>>A
A scheduled inpatient represents an opportunity for the provider to do which of the
,following?
a) Refer the patient to another location with the health system
b) Comply with EMTALA (Emergency Medical Treatment and Labor Act)
requirements before service
c) Complete registration and insurance approval before service
d) Register the patient after he or she is placed in a bed on that service
unit. - answer>>>>C
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - answer>>>>120 days passes, but the claim then be
withdrawn from the liability carrier
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - answer>>>>120 days passes, but the claim then be
withdrawn from the liability carrier
A 68 year old patient, a Medicare beneficiary, was in a car accident. A medical
insurance claim was filed with the auto insurance carrier. Six months later this claim
remains unpaid. How can the provider pursue payment from Medicare? -
answer>>>>The provider must first bill the auto insurer; however, after a period of 120
days, if the claim remains unpaid, the provider may cancel the liability claim and bill
Medicare.
ABC Hospital has experienced a 16% increase in new patients over the past 6 months.
The hospital is understaffed in its insurance claim and payment processing department
and cannot handle this increase in work load. It is considering hiring an outsourcing
vendor to assist. What are the steps that the hospital needs to take to establish and
ensure a successful vendor relationship? - answer>>>>**A. Distribute a RFP to solicit
vendor capabilities, evaluate vendor's expertise to provide outsourcing services, visit
vendor locations, perform vendor reference checks, talk with vendor clients, interview
vendor employees to assess experience level.
B. Evaluate vendor's expertise in providing outsourcing services, visit vendor locations,
interview vendor employees to assess expertise level.
Access - answer>>>>An individual's ability to obtain medical services on a timely and
financially acceptable level
Access - answer>>>>An individual's ability to obtain medical services on a timely and
financially acceptable level
According to the Department of Health and Human Services guidelines, what is NOT
considered income? - answer>>>>Sale of property, house, or car
, According to the Department of Health and Human Services guidelines, what is NOT
considered income? - answer>>>>Sale of property, house, or car
Accurate identification of the patient is the first step in the scheduling process.
Identifiers used in various combination to achieve accurate patient identification
include? - answer>>>>Full legal name, date of birth, sex and social security number
Across all care settings, if a patient consents to a financial discussion during a medical
encounter to expedite discharge, the HFMA best practice is to:
a) Make sure that the attending staff can answer questions and
assist in obtaining required patient financial data
b) Have a patient financial responsibilities kit ready for the patient,
containing all of the required registration forms and instructions
c) Support that choice, providing that the discussion does not
interfere with patient care or disrupt patient flow
d) Decline such request as finance discussions can disrupt patient
care and patient flow - answer>>>>C
Across all care settings, if a pt consents to a financial discussion during a medical
encounter
to expedite discharge, the HFMA best practice is to
a) Have a pt financial responsibilities kit ready for the pt containing all of the required
registration forms and instructions
b) Make sure that the attending staff can answer questions and assist in obtaining
required pt financial data
c) Support that choice, providing that the discussion does not interfere with pt care or
disrupt pt flow
d) Decline such request as finance discussions can disrupt pt care and pt flow -
answer>>>>C
Administrative Services Only (ASO) - answer>>>>Usually contracted administrative
services to a self-insured health plan
Administrative Services Only (ASO) - answer>>>>Usually contracted administrative
services to a self-insured health plan
Agency fees are: - answer>>>>A. Paid by patients.
**B. The cost to the provider for collection agency monies offset by the return on
baddebt accounts.
C. Only reported annually to the provider.
D. Waived for accounts aged greater than one year from date of service.
All of the following are conditions that disqualify a procedure or service from being paid
for by Medicare EXCEPT
