Actual Questions and Verified Answers,
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1. ThedisadvantagesofoutsourcingincludeallofthefollowingEXCEPT:
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a) The impact of customer service or patient relations
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b) Theimpactof lossof directcontrolof accountsreceivable services
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c) Increased costs due to vendor ineffectiveness r r r r r
d) Reducedinternalstaffingcostsandarelianceonoutsourcedstaff:
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ANSd) Reduced internal staffing costsand a reliance on outsourced staff
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2. TheMedicarefee-forserviceappealprocessforbothbeneficiariesand
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providers
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includesallofthefollowinglevelsEXCEPT:
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a) Medicalnecessityreviewbyanindependentphysician'spanel
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b) Judicialreviewbyafederaldistrictcourt r r r r r r
c) RedeterminationbythecompanythathandlesclaimsforMedicare r r r r r r r r
d) ReviewbytheMedicareAppealsCouncil(AppealsCouncil):
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r ANSb)Judicial review bya federal district court
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3. Businessethics,or organizational ethics represent: r r r r r
a) Theprinciplesandstandardsbywhichorganizationsoperate
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, b) Regulationsthatmustbefollowedbylaw r r r r r r
c) Definitionsofappropriatecustomer service r r r r
d) Thecodeofacceptableconduct:
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ANSa)Theprinciplesandstandardsbywhich organizations operate
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4. AportionoftheaccountsreceivableinventorywhichhasNOTqualifiedfor
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billing
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includes:
a) Charitablepledges r
b) Accountscreated during pre-registration but not activated r r r r r r
c) Accounts coded but held within the suspense period r r r r r r r
d) Accountsassigned toa pre-collection agency: r r r r r
ANSa) Charitable pledges r r r
5. LocalCoverageDeterminations(LCD)andNationalCoverageDetermina-
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tions (NCD) are
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Medicare established guideline(s) used to determine: r r r r r
a) MedicareandMedicaidprovidereligibility r r r r
b) Medicareoutpatientreimbursementrates r r r
c) Whichdiagnoses,signs,orsymptoms are reimbursabler r r r r r
d) WhatMedicarereimbursesandwhatshouldbereferredtoMedicaid: ANSc)
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Which diagnoses, signs, or symptoms are reimbursable
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6. DaysinA/R is calculated basedon thevalue of:
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a) Thetotalaccounts receivableon aspecific date
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b) Totalanticipatedrevenueminusexpensesr r r r
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, c) Thetime it takes to collect anticipated revenue
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d) Totalcashreceivedtodate: r r r r r
ANSc)Thetimeittakestocollectanticipatedrevenue r r r r r r r r r
7. Patientsarecontactinghospitalstoproactivelyinquireaboutcostsandfees prior r r r r r r r r r r r
to
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agreeingtoservice.Theproblemforhospitalsinprovidingsuchinformation is: r r r r r r r r r r r
a) Thathospitalsdon'twanttoestablishapricewithoutknowingif the
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patient has insurance and how much reimbursement can be expected
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b) Thefactthatchargemasterliststhetotalcharge,notnetcharges that
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reflect charges after a payer's contractual adjustment
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c) That hospitals don't want to be put in the position of
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"guaranteeing"pricewithouthavingroomforadditionalcharges
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that may arise in the course of treatment
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d) Theirreluctancetoshareproprietaryinformation: r r r r r r
ANSb)Thefactthatcharge master lists the total charge, notnet charges
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thatreflectchargesafterapayer'scontractualadjustment
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8. Acrossallcaresettings,ifapatientconsentstoafinancialdiscussion r r r r r r r r r r r
during a medical
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encountertoexpedite discharge,the HFMA best practice is to: r r r r r r r r r
a) Makesurethattheattendingstaffcananswerquestionsand r r r r r r r r r
assist in obtaining required patient financial data
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b) Have a patient responsibilities kit ready for the patient, containing
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alloftherequiredregistrationformsandinstructions
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c) Supportthatchoice,providingthatthediscussiondoesnot r r r r r r r r
interfere with patient care or disrupt patient flow
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d) Decline such request as finance discussions can disrupt patient care and r r r r r r r r r r
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, r patientflow: r
r ANSc)Supportthatchoice,providingthatthediscussiondoesnotinterfere with patient
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r care or disrupt patient flow
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9. Acomprehensive "Compliance Program"is defined as
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a) Annuallegalauditandreviewforadherencetoregulations
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b) Educating staff on regulations r r r
c) Systematicprocedurestoensurethattheprovisionsofregulationsim- r r r r r r r r r
posed by a government
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agencyarebeing met r r r
d) Thedevelopmentofoperationalpoliciesthatcorrespondtoregulations: ANSc)
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Systematicprocedures to ensure that the provisionsof regulations imposed by a
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government
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