HFMA CRCR EXAM QUESTIONS WITH 100% CORRECT ANSWERS 2024

HFMA CRCR EXAM QUESTIONS WITH 100% CORRECT ANSWERS 2024 What are collection agency fees based on? - ANSWERS A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - ANSWERS Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - ANSWERS Case rates What customer service improvements might improve the patient accounts department? - ANSWERS Holding staff accountable for customer service during performance reviews What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - ANSWERS 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? - ANSWERS Bad debt adjustment What is the initial hospice benefit? - ANSWERS Two 90-day periods and an unlimited number of subsequent periods When does a hospital add ambulance charges to the Medicare inpatient claim? - ANSWERS 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? - ANSWERS 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 - ANSWERS They are not being processed in a timely manner What is an advantage of a preregistration program? - ANSWERS It reduces processing times at the time of service What are the two statutory exclusions from hospice coverage? - ANSWERS Medically unnecessary services and custodial care What core financial activities are resolved within patient access? - ANSWERS Scheduling, insurance verification, discharge processing, and payment of point-ofservice receipts What statement applies to the scheduled outpatient? - ANSWERS The services do not involve an overnight stay How is a mis-posted contractual allowance resolved? - ANSWERS 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? - ANSWERS Observation Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has received what? - ANSWERS 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$? - ANSWERS When the patient is the insured What are non-emergency patients who come for service without prior notification to the provider called? - ANSWERS Unscheduled patients If the insurance verification response reports that a subscriber has a single policy, what is the status of the subscriber's spouse? - ANSWERS Neither enrolled not entitled to benefits Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act, establishes what? - ANSWERS Disclosure rules for consumer credit sales and consumer loans What is a principal diagnosis? - ANSWERS Primary reason for the patient's admission Collecting patient liability dollars after service leads to what? - ANSWERS Lower accounts receivable levels What is the daily out-of-pocket amount for each lifetime reserve day used? - ANSWERS 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? - ANSWERS Inpatient care What code indicates the disposition of the patient at the conclusion of service? - ANSWERS Patient discharge status code What are hospitals required to do for Medicare credit balance accounts? - ANSWERS 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? - ANSWERS Patient Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include: - ANSWERS A valid CPT or HCPCS code With advances in internet security and encryption, revenue-cycle processes are expanding to allow patients to do what? - ANSWERS Access their information and perform functions on-line What date is required on all CMS 1500 claim forms? - ANSWERS onset date of current illness What does scheduling allow provider staff to do - ANSWERS Review appropriateness of the service request What code is used to report the provider's most common semiprivate room rate? - ANSWERS Condition code Regulations and requirements for coding accountable care organizations, which allows providers to begin creating these organizations, were finalized in: - ANSWERS 2012 What is a primary responsibility of the Recover Audit Contractor? - ANSWERS To correctly identify proper payments for Medicare Part A & B claims How must providers handle credit balances? - ANSWERS Comply with state statutes concerning reporting credit balance Insurance verification results in what? - ANSWERS The accurate identification of the patient's eligibility and benefits What form is used to bill Medicare for rural health clinics? - ANSWERS CMS 1500 What activities are completed when a scheduled pre-registered patient arrives for service? - ANSWERS 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? - ANSWERS HCPCS (Healthcare Common Procedure Coding system) What results from a denied claim? - ANSWERS The provider incurs rework and appeal costs Why does the financial counselor need pricing for services? - ANSWERS To calculate the patient's financial responsibility What type of provider bills third-party payers using CMS 1500 form - ANSWERS Hospital-based mammography centers How are disputes with nongovernmental payers resolved? - ANSWERS Appeal conditions specified in the individual payer's contract The important message from Medicare provides beneficiaries with information concerning what? - ANSWERS 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 range of services to plan members? - ANSWERS To improve access to quality healthcare If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days, what is the SNF permitted to do? - ANSWERS Submit interim bills to the Medicare program. 90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims after what happens? - ANSWERS 120 days passes, but the claim then be withdrawn from the liability carrier What data are required to establish a new MPI entry? - ANSWERS The patient's full legal name, date of birth, and sex What should the provider do if both of the patient's insurance plans pay as primar