CRCR HFMA EXAM PREP: CERTIFIED REVENUE CYCLE
REPRESENTATIVE QUESTIONS & ANSWERS.
In what situation(s) should a provider NOT use a modifier? -- Answer ✔✔ - CPT already
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
indicates 2-4 lesions _ _ _
- CPT indicates multiple extremities
_ _ _ _
What are other names for Three-Day Payment Window? -- Answer ✔✔ ALL OF THE
_ _ _ _ _ _ _ _ _ _ _ _ _ _
ABOVE _
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
_ _ _ _ _ _ _ _ _ _ _
What happens during the post-service stage? -- Answer ✔✔ Final coding, preparation
_ _ _ _ _ _ _ _ _ _ _ _
and submission of claims, payment processing, balance billing and resolution.
_ _ _ _ _ _ _ _ _
What are the below tasks part of?
_ _ _ _ _ _ _
- Educate patients
_ _
- Coordinate to avoid duplicate patient contacts
_ _ _ _ _ _
- Be consistent in key aspects of account resolution
_ _ _ _ _ _ _ _
- Follow best practices for communication -- Answer ✔✔ Best practices created by the
_ _ _ _ _ _ _ _ _ _ _ _ _ _
Medical Debt Task Force _ _ _
Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle
_ _ _ _ _ _ _ _ _ _ _ _ _
initiative? -- Answer ✔✔ Process Compliance _ _ _ _ _
Which option is NOT a continuum of care provider?
_ _ _ _ _ _ _ _
A. Physician
_
B. Health Plan Contracting
_ _ _
C. Hospice
_
D. Skilled Nursing Facility -- Answer ✔✔ B. Health Plan Contracting
_ _ _ _ _ _ _ _ _ _
,What is "implied certification"? -- Answer ✔✔ When it is implied that a provider met all
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
compliance standards before submitting a claim _ _ _ _ _
Which of the following are essential elements of an effective compliance program?
_ _ _ _ _ _ _ _ _ _ _
A. Established compliance standards and procedures.
_ _ _ _ _
B. Designation of a compliance officer employed within the Billing Department.
_ _ _ _ _ _ _ _ _ _
C. Oversight of personnel by high-level personnel.
_ _ _ _ _ _
D. Automatic dismissal of any employee excluded from participation in a federal
_ _ _ _ _ _ _ _ _ _ _ _
healthcare program. _
E. Reasonable methods to achieve compliance with standards, including monitoring
_ _ _ _ _ _ _ _ _ _
systems and hotlines. -- Answer ✔✔ A. Established compliance standards and
_ _ _ _ _ _ _ _ _ _ _
procedures.
C. Oversight of personnel by high-level personnel.
_ _ _ _ _ _
E. Reasonable methods to achieve compliance with standards, including monitoring
_ _ _ _ _ _ _ _ _ _
systems and hotlines. _ _
When was Health Information Technology for Economic and Clinical Health (HITECH)
_ _ _ _ _ _ _ _ _ _ _
Act signed into law? -- Answer ✔✔ FEB 17, 2009
_ _ _ _ _ _ _ _ _
When did HITECH Act become effective? -- Answer ✔✔ 2013
_ _ _ _ _ _ _ _ _
Annually, the OIG publishes a work plan of compliance issues and objectives that will be
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
focused on throughout the following year. Identify which option is NOT a work plan task
_ _ _ _ _ _ _ _ _ _ _ _ _ _
_mentioned in this course. _ _ _
A. Payments to Physicians for Co-Surgery Procedures
_ _ _ _ _ _
B. Denials and Appeals in Medicare Part D
_ _ _ _ _ _ _
C. Medicare Hospital Payments for Claims Involving the Acute- and Post-Acute-Care
_ _ _ _ _ _ _ _ _ _ _
Transfer Policies _
D. Standard Unique Employer Identifier -- Answer ✔✔ D. Standard Unique Employer
_ _ _ _ _ _ _ _ _ _ _ _
Identifier
,What Plan are the tasks below a part of?
_ _ _ _ _ _ _ _
- Medicare Payments Made Outside of the Hospice Benefit
_ _ _ _ _ _ _ _
- Denials and Appeals in Medicare Part C and Part D
_ _ _ _ _ _ _ _ _ _
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
_ _ _ _ _ _ _ _ _ _
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits -- Answer ✔✔
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
The 2020 OIG Work Plan
_ _ _ _
When was the Preservation of Access to Care for Medicare Beneficiaries and Pension
_ _ _ _ _ _ _ _ _ _ _ _ _
Relief Act signed into law? -- Answer ✔✔ JUNE 25 2010
_ _ _ _ _ _ _ _ _ _
What is the Medicare DRG Three-Day Payment Window? -- Answer ✔✔ All Diagnostic
_ _ _ _ _ _ _ _ _ _ _ _ _
services provided to a Medicare patient by a hospital on the Date of the patient's
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Inpatient admission or during the 3 calendar days (or in the case of a non-IPPS hospital: 1
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
calendar day) immediately BEFORE the Date of Admission are REQUIRED to be
_ _ _ _ _ _ _ _ _ _ _ _
included on the bill for the IP stay (unless there is no Part A coverage)
_ _ _ _ _ _ _ _ _ _ _ _ _ _
Do Outpatient Non-Diagnostic Services qualify for separate payments if provided with
_ _ _ _ _ _ _ _ _ _ _
the Three-Day Payment Window? -- Answer ✔✔ No
_ _ _ _ _ _ _
What is modifier 59? -- Answer ✔✔ Used to identify CPTs OTHER THAN E&M
_ _ _ _ _ _ _ _ _ _ _ _ _ _
services, NOT normally reported together, but are appropriate under the
_ _ _ _ _ _ _ _ _ _
circumstances. _
Documentation must support a different session, different procedure or surgery, _ _ _ _ _ _ _ _ _ _
different site or organ system, separate.
_ _ _ _ _
What is condition code 51? -- Answer ✔✔ Code noted on the separate UB-04 OP claim,
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
thus indicating the charge is unrelated to the admission.
_ _ _ _ _ _ _ _ _
What kind of hospitals are the following:
_ _ _ _ _ _ _
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's hospitals for
_ _ _ _ _ _ _ _ _ _ _
examples -- Answer ✔✔ Non-IPPS hospitals _ _ _ _ _
, What are the 3 types of medical necessity screenings and noncoverage notifications
_ _ _ _ _ _ _ _ _ _ _ _
required in the Medicare program? -- Answer ✔✔ 1. Advanced Beneficiary Notice of
_ _ _ _ _ _ _ _ _ _ _ _ _
Noncoverage (ABN) for Part B services. _ _ _ _ _
2. SNF ABN for Part A SNF services.
_ _ _ _ _ _ _
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
_ _ _ _ _ _ _ _
What is Medicare Part B ABN? -- Answer ✔✔ Used to explain to a Medicare patient that
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
the ordered test or services probably WILL NOT be covered by the Medicare b/c the
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
DX info provided by the Dr. does NOT support the need for these services.
_ _ _ _ _ _ _ _ _ _ _ _ _ _
****May also be used for voluntary notifications, in place of the Notice of Exclusion for
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Medicare Benefits (NEMB). _ _
What is the Two-Midnight Rule? -- Answer ✔✔ Hospital admissions spanning 2
_ _ _ _ _ _ _ _ _ _ _ _
midnights would be considered appropriate for payment under the IPPS rule
_ _ _ _ _ _ _ _ _ _
What are some MSP claims that require additional review by the OIG to ensure
_ _ _ _ _ _ _ _ _ _ _ _ _ _
compliance? -- Answer ✔✔ - W/C _ _ _ _ _
- Black Lung Program services
_ _ _ _
- Veterans Affairs (VA) services
_ _ _ _
- Federal grant programs
_ _ _
- Public Health Service programs (i.e. Medicaid)
_ _ _ _ _ _
What are some cases where Medicare is the Secondary Payer? -- Answer ✔✔ - Working
_ _ _ _ _ _ _ _ _ _ _ _ _ _
_Aged (commercial insurance is Primary)
_ _ _ _ _
- Accident or other liability (car/tort)
_ _ _ _ _ _
- End-Stage Renal Disease (ESRD)
_ _ _ _
- Disability
_
What code must be provided on UB-04 when billing Medicare as Primary for accident or
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
injury? -- Answer ✔✔ Occurrence Code 05 - ACCIDENT / NO MEDICAL OR
_ _ _ _ _ _ _ _ _ _ _ _ _
LIABILITY COVERAGE _
REPRESENTATIVE QUESTIONS & ANSWERS.
In what situation(s) should a provider NOT use a modifier? -- Answer ✔✔ - CPT already
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
indicates 2-4 lesions _ _ _
- CPT indicates multiple extremities
_ _ _ _
What are other names for Three-Day Payment Window? -- Answer ✔✔ ALL OF THE
_ _ _ _ _ _ _ _ _ _ _ _ _ _
ABOVE _
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
_ _ _ _ _ _ _ _ _ _ _
What happens during the post-service stage? -- Answer ✔✔ Final coding, preparation
_ _ _ _ _ _ _ _ _ _ _ _
and submission of claims, payment processing, balance billing and resolution.
_ _ _ _ _ _ _ _ _
What are the below tasks part of?
_ _ _ _ _ _ _
- Educate patients
_ _
- Coordinate to avoid duplicate patient contacts
_ _ _ _ _ _
- Be consistent in key aspects of account resolution
_ _ _ _ _ _ _ _
- Follow best practices for communication -- Answer ✔✔ Best practices created by the
_ _ _ _ _ _ _ _ _ _ _ _ _ _
Medical Debt Task Force _ _ _
Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle
_ _ _ _ _ _ _ _ _ _ _ _ _
initiative? -- Answer ✔✔ Process Compliance _ _ _ _ _
Which option is NOT a continuum of care provider?
_ _ _ _ _ _ _ _
A. Physician
_
B. Health Plan Contracting
_ _ _
C. Hospice
_
D. Skilled Nursing Facility -- Answer ✔✔ B. Health Plan Contracting
_ _ _ _ _ _ _ _ _ _
,What is "implied certification"? -- Answer ✔✔ When it is implied that a provider met all
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
compliance standards before submitting a claim _ _ _ _ _
Which of the following are essential elements of an effective compliance program?
_ _ _ _ _ _ _ _ _ _ _
A. Established compliance standards and procedures.
_ _ _ _ _
B. Designation of a compliance officer employed within the Billing Department.
_ _ _ _ _ _ _ _ _ _
C. Oversight of personnel by high-level personnel.
_ _ _ _ _ _
D. Automatic dismissal of any employee excluded from participation in a federal
_ _ _ _ _ _ _ _ _ _ _ _
healthcare program. _
E. Reasonable methods to achieve compliance with standards, including monitoring
_ _ _ _ _ _ _ _ _ _
systems and hotlines. -- Answer ✔✔ A. Established compliance standards and
_ _ _ _ _ _ _ _ _ _ _
procedures.
C. Oversight of personnel by high-level personnel.
_ _ _ _ _ _
E. Reasonable methods to achieve compliance with standards, including monitoring
_ _ _ _ _ _ _ _ _ _
systems and hotlines. _ _
When was Health Information Technology for Economic and Clinical Health (HITECH)
_ _ _ _ _ _ _ _ _ _ _
Act signed into law? -- Answer ✔✔ FEB 17, 2009
_ _ _ _ _ _ _ _ _
When did HITECH Act become effective? -- Answer ✔✔ 2013
_ _ _ _ _ _ _ _ _
Annually, the OIG publishes a work plan of compliance issues and objectives that will be
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
focused on throughout the following year. Identify which option is NOT a work plan task
_ _ _ _ _ _ _ _ _ _ _ _ _ _
_mentioned in this course. _ _ _
A. Payments to Physicians for Co-Surgery Procedures
_ _ _ _ _ _
B. Denials and Appeals in Medicare Part D
_ _ _ _ _ _ _
C. Medicare Hospital Payments for Claims Involving the Acute- and Post-Acute-Care
_ _ _ _ _ _ _ _ _ _ _
Transfer Policies _
D. Standard Unique Employer Identifier -- Answer ✔✔ D. Standard Unique Employer
_ _ _ _ _ _ _ _ _ _ _ _
Identifier
,What Plan are the tasks below a part of?
_ _ _ _ _ _ _ _
- Medicare Payments Made Outside of the Hospice Benefit
_ _ _ _ _ _ _ _
- Denials and Appeals in Medicare Part C and Part D
_ _ _ _ _ _ _ _ _ _
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
_ _ _ _ _ _ _ _ _ _
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits -- Answer ✔✔
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
The 2020 OIG Work Plan
_ _ _ _
When was the Preservation of Access to Care for Medicare Beneficiaries and Pension
_ _ _ _ _ _ _ _ _ _ _ _ _
Relief Act signed into law? -- Answer ✔✔ JUNE 25 2010
_ _ _ _ _ _ _ _ _ _
What is the Medicare DRG Three-Day Payment Window? -- Answer ✔✔ All Diagnostic
_ _ _ _ _ _ _ _ _ _ _ _ _
services provided to a Medicare patient by a hospital on the Date of the patient's
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Inpatient admission or during the 3 calendar days (or in the case of a non-IPPS hospital: 1
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
calendar day) immediately BEFORE the Date of Admission are REQUIRED to be
_ _ _ _ _ _ _ _ _ _ _ _
included on the bill for the IP stay (unless there is no Part A coverage)
_ _ _ _ _ _ _ _ _ _ _ _ _ _
Do Outpatient Non-Diagnostic Services qualify for separate payments if provided with
_ _ _ _ _ _ _ _ _ _ _
the Three-Day Payment Window? -- Answer ✔✔ No
_ _ _ _ _ _ _
What is modifier 59? -- Answer ✔✔ Used to identify CPTs OTHER THAN E&M
_ _ _ _ _ _ _ _ _ _ _ _ _ _
services, NOT normally reported together, but are appropriate under the
_ _ _ _ _ _ _ _ _ _
circumstances. _
Documentation must support a different session, different procedure or surgery, _ _ _ _ _ _ _ _ _ _
different site or organ system, separate.
_ _ _ _ _
What is condition code 51? -- Answer ✔✔ Code noted on the separate UB-04 OP claim,
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
thus indicating the charge is unrelated to the admission.
_ _ _ _ _ _ _ _ _
What kind of hospitals are the following:
_ _ _ _ _ _ _
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's hospitals for
_ _ _ _ _ _ _ _ _ _ _
examples -- Answer ✔✔ Non-IPPS hospitals _ _ _ _ _
, What are the 3 types of medical necessity screenings and noncoverage notifications
_ _ _ _ _ _ _ _ _ _ _ _
required in the Medicare program? -- Answer ✔✔ 1. Advanced Beneficiary Notice of
_ _ _ _ _ _ _ _ _ _ _ _ _
Noncoverage (ABN) for Part B services. _ _ _ _ _
2. SNF ABN for Part A SNF services.
_ _ _ _ _ _ _
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
_ _ _ _ _ _ _ _
What is Medicare Part B ABN? -- Answer ✔✔ Used to explain to a Medicare patient that
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
the ordered test or services probably WILL NOT be covered by the Medicare b/c the
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
DX info provided by the Dr. does NOT support the need for these services.
_ _ _ _ _ _ _ _ _ _ _ _ _ _
****May also be used for voluntary notifications, in place of the Notice of Exclusion for
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Medicare Benefits (NEMB). _ _
What is the Two-Midnight Rule? -- Answer ✔✔ Hospital admissions spanning 2
_ _ _ _ _ _ _ _ _ _ _ _
midnights would be considered appropriate for payment under the IPPS rule
_ _ _ _ _ _ _ _ _ _
What are some MSP claims that require additional review by the OIG to ensure
_ _ _ _ _ _ _ _ _ _ _ _ _ _
compliance? -- Answer ✔✔ - W/C _ _ _ _ _
- Black Lung Program services
_ _ _ _
- Veterans Affairs (VA) services
_ _ _ _
- Federal grant programs
_ _ _
- Public Health Service programs (i.e. Medicaid)
_ _ _ _ _ _
What are some cases where Medicare is the Secondary Payer? -- Answer ✔✔ - Working
_ _ _ _ _ _ _ _ _ _ _ _ _ _
_Aged (commercial insurance is Primary)
_ _ _ _ _
- Accident or other liability (car/tort)
_ _ _ _ _ _
- End-Stage Renal Disease (ESRD)
_ _ _ _
- Disability
_
What code must be provided on UB-04 when billing Medicare as Primary for accident or
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
injury? -- Answer ✔✔ Occurrence Code 05 - ACCIDENT / NO MEDICAL OR
_ _ _ _ _ _ _ _ _ _ _ _ _
LIABILITY COVERAGE _
