HFMA CRCR
Study online at https://quizlet.com/_bkvcem
1. Through what document does a hospital establish code of conduct
compliance standards?
2. What is the purpose OIG work plant? Identify Acceptable com-
pliance programs in vari-
ous provider setting
3. If a Medicare patient is admitted on Friday, what ser- Non-diagnostic service
vices fall within the three-day DRG window rule? provided on Tuesday
through Friday
4. What does a modifier allow a provider to do? Report a specific circum-
stance that affected a pro-
cedure or service without
changing the code or its
definition
5. IF outpatient diagnostic services are provided within They must be billed sepa-
three days of the admission of a Medicare beneficiary rately to the part B Carrier
to an IPPS (Inpatient Prospective Payment System)
hospital, what must happen to these charges
6. what is a recurring or series registration? One registration record is
created for multiple days
of service
7. What are nonemergency patients who come for ser- Unscheduled patients
vice without prior notification to the provider called?
8. Which of the following statement apply to the obser- It is used to evaluate the
vation patient type? need for an inpatient ad-
mission
, HFMA CRCR
Study online at https://quizlet.com/_bkvcem
9. which services are hospice programs required to pro- Physician, Nursing, Phar-
vide around the clock patient macy
10. Scheduler instructions are used to prompt the sched- Complete the scheduling
uler to do what? process correctly based on
service requeste
11. The Time needed to prepare the patient before service Procedure time
is the difference between the patients arrival time and
which of the following?
12. Medicare guidelines require that when a test is or- Documentation of the
dered for a LCD or NCD exists, the information provid- medical necessity for the
ed on the order must include: test
13. What is the advantage of a pre-registration program It reduces processing
times at the time of service
14. What date are required to establish a new MPI(Master The responsible party's
patient Index) entry full legal name, date of
birth, and social security
number
15. Which of the following statements is true about The payments are re-
third-party payments? ceived by the provider
from the payer respon-
sible for reimbursing the
provider for the patient's
covered services.
16. Which provision protects the patient from medical ex- stop loss
penses that exceed the pre-set level
17. Referral
, HFMA CRCR
Study online at https://quizlet.com/_bkvcem
what documentation must a primary care physician
send to HMO patient to authorize a visit to a specialist
for additional testing or care?
18. Under EMTALA (Emergency Medical Treatment and Medical screening and
Labor Act) regulations, the provider may not ask about stabilizing treatment
a patient's insurance information if it would delay
what?
19. Which of the following is a step in the discharge Have a case management
process? service complete the dis-
charge plan
20. The hospital has a APC based contract for the payment To the approved APC pay-
of outpatient services. Total anticipated charges for ment rate
the visit are $2,380. The approved APC payment rate
is $780. Where will the patients benefit package be
applied?
21. A patient has met the $200 individual deductible and $100.00
$900 of the $1000 co-insurance responsibility. The
co-insurance rate is 20%. The estimated insurance
plan responsibility is $1975.00. What amount of coin-
surance is due from the patient?
22. When is a patient considered to be medically indigent? The patient's outstanding
medical bills exceed a de-
fined dollar amount or
percentage of assets.
23. What patient assets are considered in the financial Sources of readily avail-
assistance application? able funds , vehicles,
Study online at https://quizlet.com/_bkvcem
1. Through what document does a hospital establish code of conduct
compliance standards?
2. What is the purpose OIG work plant? Identify Acceptable com-
pliance programs in vari-
ous provider setting
3. If a Medicare patient is admitted on Friday, what ser- Non-diagnostic service
vices fall within the three-day DRG window rule? provided on Tuesday
through Friday
4. What does a modifier allow a provider to do? Report a specific circum-
stance that affected a pro-
cedure or service without
changing the code or its
definition
5. IF outpatient diagnostic services are provided within They must be billed sepa-
three days of the admission of a Medicare beneficiary rately to the part B Carrier
to an IPPS (Inpatient Prospective Payment System)
hospital, what must happen to these charges
6. what is a recurring or series registration? One registration record is
created for multiple days
of service
7. What are nonemergency patients who come for ser- Unscheduled patients
vice without prior notification to the provider called?
8. Which of the following statement apply to the obser- It is used to evaluate the
vation patient type? need for an inpatient ad-
mission
, HFMA CRCR
Study online at https://quizlet.com/_bkvcem
9. which services are hospice programs required to pro- Physician, Nursing, Phar-
vide around the clock patient macy
10. Scheduler instructions are used to prompt the sched- Complete the scheduling
uler to do what? process correctly based on
service requeste
11. The Time needed to prepare the patient before service Procedure time
is the difference between the patients arrival time and
which of the following?
12. Medicare guidelines require that when a test is or- Documentation of the
dered for a LCD or NCD exists, the information provid- medical necessity for the
ed on the order must include: test
13. What is the advantage of a pre-registration program It reduces processing
times at the time of service
14. What date are required to establish a new MPI(Master The responsible party's
patient Index) entry full legal name, date of
birth, and social security
number
15. Which of the following statements is true about The payments are re-
third-party payments? ceived by the provider
from the payer respon-
sible for reimbursing the
provider for the patient's
covered services.
16. Which provision protects the patient from medical ex- stop loss
penses that exceed the pre-set level
17. Referral
, HFMA CRCR
Study online at https://quizlet.com/_bkvcem
what documentation must a primary care physician
send to HMO patient to authorize a visit to a specialist
for additional testing or care?
18. Under EMTALA (Emergency Medical Treatment and Medical screening and
Labor Act) regulations, the provider may not ask about stabilizing treatment
a patient's insurance information if it would delay
what?
19. Which of the following is a step in the discharge Have a case management
process? service complete the dis-
charge plan
20. The hospital has a APC based contract for the payment To the approved APC pay-
of outpatient services. Total anticipated charges for ment rate
the visit are $2,380. The approved APC payment rate
is $780. Where will the patients benefit package be
applied?
21. A patient has met the $200 individual deductible and $100.00
$900 of the $1000 co-insurance responsibility. The
co-insurance rate is 20%. The estimated insurance
plan responsibility is $1975.00. What amount of coin-
surance is due from the patient?
22. When is a patient considered to be medically indigent? The patient's outstanding
medical bills exceed a de-
fined dollar amount or
percentage of assets.
23. What patient assets are considered in the financial Sources of readily avail-
assistance application? able funds , vehicles,
