CRCR Exam Prep VERIFIED SOLUTIONS 100%

CRCR Exam Prep VERIFIED SOLUTIONS 100% What are collection agency fees based on? - ANSWER A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - ANSWER Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - ANSWER Case rates What customer service improvements might improve the patient accounts department? - ANSWER Holding staff accountable for customer service during performance reviews What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - ANSWER Inform a Medicare beneficiary that Medicare may not pay for the order or service What type of account adjustment results from the patient's unwillingness to pay for a self-pay balance? - ANSWER Bad debt adjustment What is the initial hospice benefit? - ANSWER Two 90-day periods and an unlimited number of subsequent periods When does a hospital add ambulance charges to the Medicare inpatient claim? - ANSWER If the patient requires ambulance transportation to a skilled nursing facility How should a provider resolve a late-charge credit posted after an account is billed? - ANSWER Post a late-charge adjustment to the account an increase in the dollars aged greater than 90 days from date of service indicate what about accounts - ANSWER They are not being processed in a timely manner What is an advantage of a preregistration program? - ANSWER It reduces processing times at the time of service What are the two statutory exclusions from hospice coverage? - ANSWER Medically unnecessary services and custodial care What core financial activities are resolved within patient access? - ANSWER Scheduling, insurance verification, discharge processing, and payment of point-ofservice receipts What statement applies to the scheduled outpatient? - ANSWER The services do not involve an overnight stay How is a mis-posted contractual allowance resolved? - ANSWER Comparing the contract reimbursement rates with the contract on the admittance advice to identify the correct amount What type of patient status is used to evaluate the patient's need for inpatient care? - ANSWER Observation Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has received what? - ANSWER Medically necessary inpatient hospital services for at least 3 consecutive days before the skilled nursing care admission When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - ANSWER When the patient is the insured What are non-emergency patients who come for service without prior notification to the provider called? - ANSWER Unscheduled patients If the insurance verification response reports that a subscriber has a single policy, what is the status of the subscriber's spouse? - ANSWER Neither enrolled not entitled to benefits Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act, establishes what? - ANSWER Disclosure rules for consumer credit sales and consumer loans What is a principal diagnosis? - ANSWER Primary reason for the patient's admission Collecting patient liability dollars after service leads to what? - ANSWER Lower accounts receivable levels What is the daily out-of-pocket amount for each lifetime reserve day used? - ANSWER 50% of the current deductible amount What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as an RHC services? - ANSWER Inpatient care What code indicates the disposition of the patient at the conclusion of service? - ANSWER Patient discharge status code What are hospitals required to do for Medicare credit balance accounts? - ANSWER They result in lost reimbursement and additional cost to collect When an undue delay of payment results from a dispute between the patient and the third party payer, who is responsible for payment? - ANSWER Patient Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include: - ANSWER A valid CPT or HCPCS code With advances in internet security and encryption, revenue-cycle processes are expanding to allow patients to do what? - ANSWER Access their information and perform functions on-line What date is required on all CMS 1500 claim forms? - ANSWER onset date of current illness What does scheduling allow provider staff to do - ANSWER Review appropriateness of the service request What code is used to report the provider's most common semiprivate room rate? - ANSWER Condition code Regulations and requirements for coding accountable care organizations, which allows providers to begin creating these organizations, were finalized in: - ANSWER 2012 What is a primary responsibility of the Recover Audit Contractor? - ANSWER To correctly identify proper payments for Medicare Part A & B claims How must providers handle credit balances? - ANSWER Comply with state statutes concerning reporting credit balance Insurance verification results in what? - ANSWER The accurate identification of the patient's eligibility and benefits What form is used to bill Medicare for rural health clinics? - ANSWER CMS 1500 What activities are completed when a scheduled pre-registered patient arrives for service? - ANSWER Registering the patient and directing the patient to the service area In addition to being supported by information found in the patient's chart, a CMS 1500 claim must be coded using what? - ANSWER HCPCS (Healthcare Common Procedure Coding system) What results from a denied claim? - ANSWER The provider incurs rework and appeal costs Why does the financial counselor need pricing for services? - ANSWER To calculate the patient's financial responsibility What type of provider bills third-party payers using CMS 1500 form - ANSWER Hospital-based mammography centers How are disputes with nongovernmental payers resolved? - ANSWER Appeal conditions specified in the individual payer's contract The important message from Medicare provides beneficiaries with information concerning what? - ANSWER Right to appeal a discharge decision if the patient disagrees with the services Why do managed care plans have agreements with hospitals, physicians, and other healthcare providers to offer a rang