HFMA CRCR Exam with precise detailed answers || || || || || ||
Through what document does a hospital establish compliance standards? - ✔✔code of
|| || || || || || || || || || || ||
conduct
What is the purpose OIG work plant? - ✔✔Identify Acceptable compliance programs in
|| || || || || || || || || || || || ||
various provider setting || ||
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG
|| || || || || || || || || || || || || || ||
window rule? - ✔✔Non-diagnostic service provided on Tuesday through Friday
|| || || || || || || || ||
What does a modifier allow a provider to do? - ✔✔Report a specific circumstance that
|| || || || || || || || || || || || || || ||
affected a procedure or service without changing the code or its definition
|| || || || || || || || || || ||
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 - ✔✔They must be billed separately to the part B Carrier
|| || || || || || || || || || || || || || ||
what is a recurring or series registration? - ✔✔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? - ✔✔Unscheduled patients || || || ||
Which of the following statement apply to the observation patient type? - ✔✔It is used to
|| || || || || || || || || || || || || || || ||
evaluate the need for an inpatient admission
|| || || || || ||
,which services are hospice programs required to provide around the clock patient -
|| || || || || || || || || || || || ||
✔✔Physician, Nursing, Pharmacy || ||
Scheduler instructions are used to prompt the scheduler to do what? - ✔✔Complete the
|| || || || || || || || || || || || || ||
scheduling process correctly based on service requeste || || || || || ||
The Time needed to prepare the patient before service is the difference between the patients
|| || || || || || || || || || || || || ||
arrival time and which of the following? - ✔✔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: - ✔✔Documentation of the medical || || || || || || || || || || || ||
necessity for the test || || ||
What is the advantage of a pre-registration program - ✔✔It reduces processing times at the
|| || || || || || || || || || || || || || ||
time of service || ||
What date are required to establish a new MPI(Master patient Index) entry - ✔✔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? - ✔✔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 -
|| || || || || || || || || || || || || ||
✔✔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? - ✔✔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? - ✔✔Medical
|| || || || || || || || || || || || || || ||
screening and stabilizing treatment || || ||
Which of the following is a step in the discharge process? - ✔✔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? - ✔✔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? - ✔✔$100.00
|| || || || || || || || || || ||
When is a patient considered to be medically indigent? - ✔✔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? - ✔✔Sources of
|| || || || || || || || || || || || ||
readily available funds , vehicles, campers, boats and saving accounts
|| || || || || || || || ||
If the patient cannot agree to payment arrangements, What is the next option? - ✔✔Warn
|| || || || || || || || || || || || || || ||
the patient that unpaid accounts are placed with collection agencies for further processing
|| || || || || || || || || || || ||
What core financial activities are resolved within patient access? - ✔✔scheduling , pre-
|| || || || || || || || || || || ||
registration, insurance verification and managed care processing || || || || || ||
What is an unscheduled direct admission? - ✔✔A patient who arrives at the hospital via
|| || || || || || || || || || || || || || ||
ambulance for treatment in the emergency department || || || || || ||
Through what document does a hospital establish compliance standards? - ✔✔code of
|| || || || || || || || || || || ||
conduct
What is the purpose OIG work plant? - ✔✔Identify Acceptable compliance programs in
|| || || || || || || || || || || || ||
various provider setting || ||
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG
|| || || || || || || || || || || || || || ||
window rule? - ✔✔Non-diagnostic service provided on Tuesday through Friday
|| || || || || || || || ||
What does a modifier allow a provider to do? - ✔✔Report a specific circumstance that
|| || || || || || || || || || || || || || ||
affected a procedure or service without changing the code or its definition
|| || || || || || || || || || ||
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 - ✔✔They must be billed separately to the part B Carrier
|| || || || || || || || || || || || || || ||
what is a recurring or series registration? - ✔✔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? - ✔✔Unscheduled patients || || || ||
Which of the following statement apply to the observation patient type? - ✔✔It is used to
|| || || || || || || || || || || || || || || ||
evaluate the need for an inpatient admission
|| || || || || ||
,which services are hospice programs required to provide around the clock patient -
|| || || || || || || || || || || || ||
✔✔Physician, Nursing, Pharmacy || ||
Scheduler instructions are used to prompt the scheduler to do what? - ✔✔Complete the
|| || || || || || || || || || || || || ||
scheduling process correctly based on service requeste || || || || || ||
The Time needed to prepare the patient before service is the difference between the patients
|| || || || || || || || || || || || || ||
arrival time and which of the following? - ✔✔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: - ✔✔Documentation of the medical || || || || || || || || || || || ||
necessity for the test || || ||
What is the advantage of a pre-registration program - ✔✔It reduces processing times at the
|| || || || || || || || || || || || || || ||
time of service || ||
What date are required to establish a new MPI(Master patient Index) entry - ✔✔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? - ✔✔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 -
|| || || || || || || || || || || || || ||
✔✔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? - ✔✔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? - ✔✔Medical
|| || || || || || || || || || || || || || ||
screening and stabilizing treatment || || ||
Which of the following is a step in the discharge process? - ✔✔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? - ✔✔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? - ✔✔$100.00
|| || || || || || || || || || ||
When is a patient considered to be medically indigent? - ✔✔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? - ✔✔Sources of
|| || || || || || || || || || || || ||
readily available funds , vehicles, campers, boats and saving accounts
|| || || || || || || || ||
If the patient cannot agree to payment arrangements, What is the next option? - ✔✔Warn
|| || || || || || || || || || || || || || ||
the patient that unpaid accounts are placed with collection agencies for further processing
|| || || || || || || || || || || ||
What core financial activities are resolved within patient access? - ✔✔scheduling , pre-
|| || || || || || || || || || || ||
registration, insurance verification and managed care processing || || || || || ||
What is an unscheduled direct admission? - ✔✔A patient who arrives at the hospital via
|| || || || || || || || || || || || || || ||
ambulance for treatment in the emergency department || || || || || ||
