CRCR MULTIPLE CHOICE FINAL EXAM QUESTIONS AND ANSWERS|WELL
STRUCTURE| 100 % PASS
The disadvantages of outsourcing in-
clude all of the following EXCEPT:
a) The impact of customer service or pa-
tient relations
b) The impact of loss of direct control of
D
accounts receivable services
c) Increased costs due to vendor ineffec-
tiveness
d) Reduced internal staffing costs and a
reliance on outsourced staff
The Medicare fee-for service appeal
process for both beneficiaries and
providers
includes all of the following levels EX-
CEPT:
a) Medical necessity review by an inde-
pendent physician's panel B
b) Judicial review by a federal district
court
c) Redetermination by the company that
handles claims for
Medicare
d) Review by the Medicare Appeals
Council (Appeals Council)
Business ethics, or organizational ethics
represent:
a) The principles and standards by which
organizations operate
A
b) Regulations that must be followed by
law
c) Definitions of appropriate customer
service
d) The code of acceptable conduct
A portion of the accounts receivable
inventory which has NOT qualified for
billing
,includes:
a) Charitable pledges
b) Accounts created during pre-registra-
tion but not activated A
c) Accounts coded but held within the
suspense period
d) Accounts assigned to a pre-collection
agency
Local Coverage Determinations (LCD)
and National Coverage Determinations
(NCD) are
Medicare established guideline(s) used
to determine:
a) Medicare and Medicaid provider eligi-
bility C
b) Medicare outpatient reimbursement
rates
c) Which diagnoses, signs, or symptoms
are reimbursable
d) What Medicare reimburses and what
should be referred to
Medicaid
Days in A/R is calculated based on the
value of:
a) The total accounts receivable on a
specific date
b) Total anticipated revenue minus ex- C
penses
c) The time it takes to collect anticipated
revenue
d) Total cash received to date
Patients are contacting hospitals to
proactively inquire about costs and fees
prior to
,agreeing to service.The problem for hos-
pitals in providing such information is:
a) That hospitals don't want to establish
a price without knowing if
the patient has insurance and how much
reimbursement can be
expected
b) The fact that charge master lists the
total charge, not net charges
B
that reflect charges after a payer's con-
tractual adjustment
c) That hospitals don't want to be put in
the position of
"guaranteeing" price without having
room for additional charges
that may arise in the course of treatment
d) Their reluctance to share proprietary
information
Across all care settings, if a patient con-
sents 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 finan-
cial data
b) Have a patient financial responsibili- C
ties 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 pa-
tient flow
d) Decline such request as finance dis-
cussions can disrupt patient
care and patient flow
, A comprehensive "Compliance Pro-
gram" is defined as
a) Annual legal audit and review for ad-
herence to regulations
b) Educating staff on regulations
c) Systematic procedures to ensure that C
the provisions of
regulations imposed by a government
agency are being met
d) The development of operational poli-
cies that correspond to
regulations
Case Management requires that a case
manager be assigned
a) To patients of any physician request-
ing case management B
b) To a select patient group
c) To every patient
d) To specific cases designated by third
party contractual agreement
Pricing transparency is defined as read-
ily available information on the price of
healthcare services, that together with
other information, help define the value
of those
services and enable consumers to
a) Identify, compare, and choose
A
providers that offer the desired
level of value
b) Customize health care with a person-
ally chosen mix of providers
c) Negotiate the cost of health plan pre-
miums
d) Verify the cost of individual clinicians
STRUCTURE| 100 % PASS
The disadvantages of outsourcing in-
clude all of the following EXCEPT:
a) The impact of customer service or pa-
tient relations
b) The impact of loss of direct control of
D
accounts receivable services
c) Increased costs due to vendor ineffec-
tiveness
d) Reduced internal staffing costs and a
reliance on outsourced staff
The Medicare fee-for service appeal
process for both beneficiaries and
providers
includes all of the following levels EX-
CEPT:
a) Medical necessity review by an inde-
pendent physician's panel B
b) Judicial review by a federal district
court
c) Redetermination by the company that
handles claims for
Medicare
d) Review by the Medicare Appeals
Council (Appeals Council)
Business ethics, or organizational ethics
represent:
a) The principles and standards by which
organizations operate
A
b) Regulations that must be followed by
law
c) Definitions of appropriate customer
service
d) The code of acceptable conduct
A portion of the accounts receivable
inventory which has NOT qualified for
billing
,includes:
a) Charitable pledges
b) Accounts created during pre-registra-
tion but not activated A
c) Accounts coded but held within the
suspense period
d) Accounts assigned to a pre-collection
agency
Local Coverage Determinations (LCD)
and National Coverage Determinations
(NCD) are
Medicare established guideline(s) used
to determine:
a) Medicare and Medicaid provider eligi-
bility C
b) Medicare outpatient reimbursement
rates
c) Which diagnoses, signs, or symptoms
are reimbursable
d) What Medicare reimburses and what
should be referred to
Medicaid
Days in A/R is calculated based on the
value of:
a) The total accounts receivable on a
specific date
b) Total anticipated revenue minus ex- C
penses
c) The time it takes to collect anticipated
revenue
d) Total cash received to date
Patients are contacting hospitals to
proactively inquire about costs and fees
prior to
,agreeing to service.The problem for hos-
pitals in providing such information is:
a) That hospitals don't want to establish
a price without knowing if
the patient has insurance and how much
reimbursement can be
expected
b) The fact that charge master lists the
total charge, not net charges
B
that reflect charges after a payer's con-
tractual adjustment
c) That hospitals don't want to be put in
the position of
"guaranteeing" price without having
room for additional charges
that may arise in the course of treatment
d) Their reluctance to share proprietary
information
Across all care settings, if a patient con-
sents 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 finan-
cial data
b) Have a patient financial responsibili- C
ties 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 pa-
tient flow
d) Decline such request as finance dis-
cussions can disrupt patient
care and patient flow
, A comprehensive "Compliance Pro-
gram" is defined as
a) Annual legal audit and review for ad-
herence to regulations
b) Educating staff on regulations
c) Systematic procedures to ensure that C
the provisions of
regulations imposed by a government
agency are being met
d) The development of operational poli-
cies that correspond to
regulations
Case Management requires that a case
manager be assigned
a) To patients of any physician request-
ing case management B
b) To a select patient group
c) To every patient
d) To specific cases designated by third
party contractual agreement
Pricing transparency is defined as read-
ily available information on the price of
healthcare services, that together with
other information, help define the value
of those
services and enable consumers to
a) Identify, compare, and choose
A
providers that offer the desired
level of value
b) Customize health care with a person-
ally chosen mix of providers
c) Negotiate the cost of health plan pre-
miums
d) Verify the cost of individual clinicians
