HFMA CRCR EXAM LATEST EXAM 160+ QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) RATED A+

HFMA CRCR EXAM LATEST EXAM 160+ QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) RATED A+ 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 ANS They must be billed separately to the part B Carrier what is a recurring or series registration? - CORRECT ANS 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 ANS Unscheduled patients Which of the following statement apply to the observation patient type? - CORRECT ANS It is used to evaluate the need for an inpatient admission which services are hospice programs required to provide around the clock patient - CORRECT ANS Physician, Nursing, Pharmacy Scheduler instructions are used to prompt the scheduler to do what? - CORRECT ANS Complete the scheduling process correctly based on service requested The Time needed to prepare the patient before service is the difference between the patient’s arrival time and which of the following? - CORRECT ANS 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 ANS Documentation of the medical necessity for the test What is the advantage of a pre-registration program - CORRECT ANS It reduces processing times at the time of service What date are required to establish a new MPI (Master patient Index) entry - CORRECT ANS 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 ANS 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 ANS 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 ANS 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 ANS Medical screening and stabilizing treatment Which of the following is a step in the discharge process? – 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? -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 ANS $100.00 When is a patient considered to be medically indigent? - CORRECT ANS 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 ANS 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 ANS Warn the patient that unpaid accounts are placed with collection agencies for further processing What core financial activities are resolved within patient access? - CORRECT ANS scheduling, preregistration, insurance verification and managed care processing What is an unscheduled direct admission? - CORRECT ANS 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 ANS As a substitute for an inpatient admission Patients who require periodic skilled nursing or therapeutic care receive services from what type of program? - CORRECT ANS Home health agency Every patient who is new to the healthcare provider must be offered what? - CORRECT ANS A printed copy of the provider privacy notice Which of the following statements apples to self-insured insurance plans? - CORRECT ANS 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 ANS Name What process does a patient's health plan use to retroactively collect payments from liability automobile or worker's compensation plan? - CORRECT ANS Subrogation In what type of payment methodology is a lump sum of bundled payment negotiated between the payer and some or all providers? - CORRECT ANS 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 ANS Site of service limitation Which of the following statements applies to private rooms? - CORRECT ANS If the medical necessity for a private room is documented in the chart. The patient’s 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 ANS It is necessary to ask the patient each of the MSP questions Which of the following is not true of Medicare Advantage Plans? - CORRECT ANS 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 ANS 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 ANS Claim is paid in full Which of the following statements is true of a Medicare Advantage Plan? - CORRECT ANS This plan supplements Part A and Part B benefits Which is the following is not a characteristic of Medicaid HMO plan? - CORRECT ANS Medicaideligible patients are never required to join a Medicaid HMO plan