CRCR
HFMA patient financial communications best practices call for annual training for all staff EXCEPT
- ANS A. Patient access
B. Customer service representatives
**C. Nursing
D. Staff who engage in patient financial communications discussions
What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from
Medicare? - ANS Medical necessity documentation
B. The CMS 1500 Part B attachment
C. Correct Part A and B procedural codes
**D. Revenue codes
The most common resolution methods for credit balances include all of the following EXCEPT -
ANS A. Designate the overpayment for charity care
B. Determine the correct primary payer and notify incorrect payer of overpayment
C. Submit the corrected claim to the payer incorporating credits
D. Either send a refund or complete a takeback form as directed by the payer.
Net Accounts Receivable is - ANS A. The total bad debt
B. Total debt owed by an entity
**C. The amount an entity is reasonably confident of collecting from overall accounts receivable
D. The total claims amount billed to health plans
For routine scenarios, such as patients with insurance coverage or a known ability to pay,
financial discussions - ANS A. May take place between the patient and discharge planning
,**B. Should take place between the patient or guarantor and properly trained provider
representatives
C. Are optional
D. Are focused on verifying required third-party payer information
Scheduled procedures routinely include - ANS A. Physician's office contact information
B. Physician notification that scheduling is complete
C. The scheduler's name and contact information
**D. Patient preparation instructions
ICD-10-CM and ICD-10-PCS code sets are modifications of - ANS A. DRGs
B. CPT codes
C. ICD 9 codes
**D. The international ICD-10 codes as developed by the WHO (World Health Organization)
The Medicare Bundled Payments for Care Initiative (BCPI) is designed to - ANS A. Prevent
duplicate billing
B. "Stretch" the impact of patient self-pay by squeezing costs down through a lump-sum payment
to providers
**C. Align incentives between hospitals, physicians, and non-physician providers in order to
better coordinate patient care
D. Drive down physician fees by forcing physicians to share equitably in one payment
Which of the following is required for participation in Medicaid - ANS A. Be free of chronic
conditions
B. Meet a minimum yearly premium
C. Obtain a supplemental health insurance policy
**D. Meet income and assets requirements
, A four digit number code established by the National Uniform Billing Committee (NUBC) that
categorizes/classifies a line item in the charge master is known as - ANS A. CPT codes
B. ICD-10 Procedural codes
C. HCPCs codes
**D. Revenue codes
Checks received through mail, cash received through mail, and lock box are all examples of - ANS
A. Payment methods being phased out for more secure payment method option
**B. Control points for cash posting
C. Payment methods in which the majority of fraud occurs
D. Highly fraud prone processes
If further treatment can only be provided in a hospital setting, the patient's condition cannot be
evaluated and/or treated within 24 hours, or if there is not an anticipation of improvement in the
patient's condition within 24 hours, the patient - ANS A. Will remain in observation for up to 72
hours after which the patient is admitted as an inpatient
B. Will have his/her case reviewed by the attending physician, a consulting physician and the
primary care physician and a future course of care will then be determined
C. Will be discharged and if needed, designated to a priority one outpatient status
**D. Will be admitted as an inpatient
Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare
established guideline(s) used to determine - ANS A. Medicare and Medicaid provider eligibility
**B. What Medicare reimburses and what should be referred to Medicaid
C. Which diagnoses, signs, or symptoms are reimbursable
D. Medicare outpatient reimbursement rates
HFMA patient financial communications best practices call for annual training for all staff EXCEPT
- ANS A. Patient access
B. Customer service representatives
**C. Nursing
D. Staff who engage in patient financial communications discussions
What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from
Medicare? - ANS Medical necessity documentation
B. The CMS 1500 Part B attachment
C. Correct Part A and B procedural codes
**D. Revenue codes
The most common resolution methods for credit balances include all of the following EXCEPT -
ANS A. Designate the overpayment for charity care
B. Determine the correct primary payer and notify incorrect payer of overpayment
C. Submit the corrected claim to the payer incorporating credits
D. Either send a refund or complete a takeback form as directed by the payer.
Net Accounts Receivable is - ANS A. The total bad debt
B. Total debt owed by an entity
**C. The amount an entity is reasonably confident of collecting from overall accounts receivable
D. The total claims amount billed to health plans
For routine scenarios, such as patients with insurance coverage or a known ability to pay,
financial discussions - ANS A. May take place between the patient and discharge planning
,**B. Should take place between the patient or guarantor and properly trained provider
representatives
C. Are optional
D. Are focused on verifying required third-party payer information
Scheduled procedures routinely include - ANS A. Physician's office contact information
B. Physician notification that scheduling is complete
C. The scheduler's name and contact information
**D. Patient preparation instructions
ICD-10-CM and ICD-10-PCS code sets are modifications of - ANS A. DRGs
B. CPT codes
C. ICD 9 codes
**D. The international ICD-10 codes as developed by the WHO (World Health Organization)
The Medicare Bundled Payments for Care Initiative (BCPI) is designed to - ANS A. Prevent
duplicate billing
B. "Stretch" the impact of patient self-pay by squeezing costs down through a lump-sum payment
to providers
**C. Align incentives between hospitals, physicians, and non-physician providers in order to
better coordinate patient care
D. Drive down physician fees by forcing physicians to share equitably in one payment
Which of the following is required for participation in Medicaid - ANS A. Be free of chronic
conditions
B. Meet a minimum yearly premium
C. Obtain a supplemental health insurance policy
**D. Meet income and assets requirements
, A four digit number code established by the National Uniform Billing Committee (NUBC) that
categorizes/classifies a line item in the charge master is known as - ANS A. CPT codes
B. ICD-10 Procedural codes
C. HCPCs codes
**D. Revenue codes
Checks received through mail, cash received through mail, and lock box are all examples of - ANS
A. Payment methods being phased out for more secure payment method option
**B. Control points for cash posting
C. Payment methods in which the majority of fraud occurs
D. Highly fraud prone processes
If further treatment can only be provided in a hospital setting, the patient's condition cannot be
evaluated and/or treated within 24 hours, or if there is not an anticipation of improvement in the
patient's condition within 24 hours, the patient - ANS A. Will remain in observation for up to 72
hours after which the patient is admitted as an inpatient
B. Will have his/her case reviewed by the attending physician, a consulting physician and the
primary care physician and a future course of care will then be determined
C. Will be discharged and if needed, designated to a priority one outpatient status
**D. Will be admitted as an inpatient
Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare
established guideline(s) used to determine - ANS A. Medicare and Medicaid provider eligibility
**B. What Medicare reimburses and what should be referred to Medicaid
C. Which diagnoses, signs, or symptoms are reimbursable
D. Medicare outpatient reimbursement rates
