CRCR Certification questions and answers well illustrated.

CRCR Certification questions and answers well illustrated. Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - correct answer. The Medicare Administrative Contractor (MAC) at the end of the hospice cap period Which of the following is required for participation in Medicaid - correct answer. Meet Income and Assets Requirements In choosing a setting for patient financial discussions, organizations should first and foremost - correct answer. Respect the patients privacy A nightly room charge will be incorrect if the patient's - correct answer. Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can - correct answer. Purchase qualified health benefit plans regardless of insured's health status A portion of the accounts receivable inventory which has NOT qualified for billing includes: - correct answer. Charitable pledges What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? - correct answer. Revenue codes This directive was developed to promote and ensure healthcare quality and value and also to protect consumers and workers in the healthcare system. This directive is called - correct answer. Patient bill of rights The activity which results in the accurate recording of patient bed and level of care assessment, patient transfer and patient discharge status on a real-time basis is known as - correct answer. Case management Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? - correct answer. Registration staff may routinely contact managed are plans for prior authorizations before the patient is seen by the on-duty physician HIPAA had adopted Employer Identification Numbers (EIN) to be used in standard transactions to identify the employer of an individual described in a transaction EIN's are assigned by - correct answer. The Internal Revenue Service Checks received through mail, cash received through mail, and lock box are all examples of - correct answer. Control points for cash posting What are some core elements if a board-approved financial assistance policy? - correct answer. Eligibility, application process, and nonpayment collection activities A recurring/series registration is characterized by - correct answer. The creation of one registration record for multiple days of service With the advent of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to - correct answer. Assist patients in understanding their insurance coverage and their financial obligation The purpose of a financial report is to: - correct answer. Present financial information to decision makers Patient financial communications best practices produce communications that are - correct answer. Consistent, clear and transparent Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish - correct answer. What services or healthcare items are covered under Medicare Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with - correct answer. The Provider Reimbursement Review Board Concurrent review and discharge planning - correct answer. Occurs during service Duplicate payments occur: - correct answer. When providers re-bill claims based on nonpayment from the initial bill submission An individual enrolled in Medicare who is dissatisfied with the government's claim determination is entitled to reconsideration of the decision. This type of appeal is known as - correct answer. A beneficiary appeal Insurance verification results in which of the following - correct answer. The accurate identification of the patient's eligibility and benefits The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: - correct answer. Judicial review by a federal district court Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the providermay not ask about a patient's insurance information if it would delay what? - correct answer. Medical screening and stabilizing treatment Ambulance services are billed directly to the health plan for - correct answer. Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility Key performance indicators (KPIs) set standards for accounts receivables (A/R) and - correct answer. Provide a method of measuring the collection and control of A/R he patient discharge process begins when - correct answer. The physician writes the discharge orders The nightly room charge will be incorrect if the patient's - correct answer. Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system. The soft cost of a dissatisfied customer is - correct answer. The customer passing on info about their negative experience to potential pts or through social media channels An advantage of a pre-registration program is - correct answer. The opportunity to reduce the corporate compliance failures within the registration process It is important to have high registration quality standards because - correct answer. Inaccurate or incomplete patient data will delay payment or cause denials Telemed seeks to improve a patient's health by - correct answer. Permitting 2-way real time interactive communication between the patient and the clinical professional Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a monthly fee is known as a - correct answer. HMO Identifying the patient, in the MPI, creating the registration record, completing medical necessity screening, determining insurance eligibility and benefits resolving managed care, requirements and completing financial education/resolution are all - correct answer. The data collection steps for scheduling and pre-registering a patient Medicare Part B has an annual deductible, and the beneficiary is responsible for - correct answer. A co-insurance payment for all Part B covered services The standard claim form used for billing by hospitals, nursing facilities, and other inpatient - correct answer. UB-04 Charges are the basis for - correct answer. Separation of fiscal responsibilities between the patient and the health plan All of the following are forms of hospital payment contracting EXCEPT - correct answer. Contracted Rebating The most common resolution methods for credit balances include all of the following EXCEPT: - correct answer. Designate the overpayment for charity care Ambulance services are billed directly to the health plan for - correct answer. The portion of the bill outside of the patient's self-pay A claim for reimbursement submitted to a third-party payer that has all the information and documentation required for the payer to make a decision on it is known as - correct answer. A clean claim The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to - correct answer. Medicare and Medicaid payments The Correct Coding Initiative Program consists of - correct answer. Edits that are implemented within providers' claim processing systems To provide a patient with information that is meaningful to them, all of the following factors must be included EXCEPT - correct answer. The actual physician reimbursement Which department supports/collaborates with the revenue cycle? - correct answer. Information Technology Medicare Part B has an annual deductible and the beneficiary is responsible for - correct answer. a co-insurance payment for all Part B covered services The two types of claims denial appeals are - correct answer. Beneficiary and Provider Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) - correct answer. Registration staff members routinely contact managed care plans for prior authorizations before the patient is seen by the on duty physician Rural Health Clinics (RHC) personnel can provide services in all of the following locations, EXCEPT - correct answer. Providing inpatient services in the RHC The patient discharge process begins when - correct answer. The physician writes the discharge order Departments that need to be included in charge master maintenance include all of the following EXCEPT - correct answer. Quality Assurance The first thing a health plan does when processing a claim is - correct answer. Check if the patient is a health plan beneficiary and what is the coverage Vital to accurate calculations of a patient's self-pay amount is - correct answer. The most accurate way to validate patient information is to - correct answer. require clinical staff to verify information at each treatment encounter In order for Regulation Z to apply, a hospital must - correct answer. All of the following are minimum requirements for new patients with no MPI number EXCEPT - correct answer. Address A typical routine patient financial discussion would include - correct answer. Explaining the benefits identified through verifying the patients insurance Components of financial education include informing the patient of the hospital's financial policies, assessing the patient's ability to pay and - correct answer. Reviewing payment alternatives with the patient so appropriate resolution of the health care financial obligation is achieved HFMA best practices indicate that the technology evaluation is conducted to - correct answer. Continually align technology with processes rather than technology dictating processes Scheduler instructions are used to prompt the scheduler to - correct answer. Complete the scheduling process correctly based on service requested When billing Rural Health Clinic services on a UB-04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521). Although codes are collapsed into a single revenue code, it is still important to list the appropriate CPT codes as part -