CRCR EXAM PREP CERTIFIED REVENUE CYCLE REPRESENTATIVE
LATEST HFMA PRACTICE MATERIALS
In what situation(s) should a provider NOT use a modifier?
- CPT already indicates 2-4 lesions
- CPT indicates multiple extremities
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
D. Standard Unique Employer Identifier
Patient Financial Communications best practices include all of the following activities EXCEPT:
A. Communicating the details of the patient's insurance coverage including eligibility and
benefits
B. Collecting payment or initiating the process to immediately remove the patient from the
service schedule
C. Discussing unpaid balances and providing financial assistance information, as appropriate
D. Providing financial counseling including assistance with potential Medicaid eligibility
processing
B. Collecting payment or initiating the process to immediately remove the patient from the
service schedule
Which statement includes the required components of an accurate pricing determination?
A. T/C and discounts, if any, that may be applicable
B. Insurance eligibility, DX and CPT codes, total estimated charges, adjudication calculations
based on average payments from the insurance carrier for the service
C. Insurance coverage and benefits, service or test involved, DX and CPT codes, total estimate
charges, adjudication calculations based on the patient's benefits package
,D. Chargemaster pricing less the provider's standard discounting amount(s) for hospital services
C. Insurance coverage and benefits, service or test involved, DX and CPT codes, total estimate
charges, adjudication calculations based on the patient's benefits package
Why is it critical that a chargemaster is reviewed and updated regularly?
A. To ensure it supports and represents the services provided within the organization.
B. To ensure the most appropriate measure of the utilization of resources.
C. So, the CPT databases can have the most current and accurate information.
D. Because charge descriptions can vary greatly between providers.
A. To ensure it supports and represents the services provided within the organization.
Which option is NOT a continuum of care provider?
A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility
B. Health Plan Contracting
What is the intended outcome of collaborations made through an ACO delivery system?
A. To ensure appropriateness of care, elimination of duplicate services, and prevention of
medical errors for a population of patients.
B. To create cost-containment provisions to reform the healthcare delivery system.
C. To reform the healthcare system into a system that rewards greater value, improves the quality
of care and increases efficiency in the delivery of services.
D. To provide financial incentives to physicians for reporting quality data to CMS.
A. To ensure appropriateness of care, elimination of duplicate services, and prevention of
medical errors for a population of patients.
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.
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.
Which of the following medical debt collection practices are recommended as part of HFMA's
Best Practices for medical account resolution:
A. Make bills comprehensive and provide complete detail using industry standard terminology
B. Spell out account resolution methods and apply to all situations, regardless of applicability
C. Report to credit bureaus only when accounts are placed for collections
D. Establish policies and ensure that they are followed
D. Establish policies and ensure that they are followed
Organizations may opt to contract with or outsource to specific vendors for some or all
components of revenue cycle processing. This practice has both advantages and disadvantages.
Which of the following statements is NOT an advantage of utilizing an outsourcing vendor?
A. The need for legal review if the outside vendor's staff represents themselves as employees of
the healthcare facility
B. The need for internal hiring, training, and supervising staff is limited
C. Access to technology that may not be cost-effective for an individual provider to purchase and
maintain
D. Economies of scale realized by handling A/R in a centralized location for a number of groups
A. The need for legal review if the outside vendor's staff represents themselves as employees of
the healthcare facility
Each hospital covered by the 501(r) regulations is required to develop a financial assistance
policy. Which of the following elements is NOT a required element of the policy?
, A. Eligibility criteria which must be met for each type and level of financial assistance, including
all available discounts and free care
B. The notice that individuals eligible for financial assistance under this policy may be charged
more than the amount generally billed (AGB) to insured patients
C. A listing of all providers, specifying who is covered by the FAP and who is not
D. A prohibition on billing FAP-eligible individuals gross charges; the AGB applies only to the
amount for which the patient is responsible
B. The notice that individuals eligible for financial assistance under this policy may be charged
more than the amount generally billed (AGB) to insured patients
What are other names for Three-Day Payment Window?
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?
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
Best practices created by the Medical Debt Task Force
Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle initiative?
Process Compliance
What is "implied certification"?
When it is implied that a provider met all compliance standards before submitting a claim
When was Health Information Technology for Economic and Clinical Health (HITECH) Act
signed into law?
FEB 17, 2009
When did HITECH Act become effective?
LATEST HFMA PRACTICE MATERIALS
In what situation(s) should a provider NOT use a modifier?
- CPT already indicates 2-4 lesions
- CPT indicates multiple extremities
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
D. Standard Unique Employer Identifier
Patient Financial Communications best practices include all of the following activities EXCEPT:
A. Communicating the details of the patient's insurance coverage including eligibility and
benefits
B. Collecting payment or initiating the process to immediately remove the patient from the
service schedule
C. Discussing unpaid balances and providing financial assistance information, as appropriate
D. Providing financial counseling including assistance with potential Medicaid eligibility
processing
B. Collecting payment or initiating the process to immediately remove the patient from the
service schedule
Which statement includes the required components of an accurate pricing determination?
A. T/C and discounts, if any, that may be applicable
B. Insurance eligibility, DX and CPT codes, total estimated charges, adjudication calculations
based on average payments from the insurance carrier for the service
C. Insurance coverage and benefits, service or test involved, DX and CPT codes, total estimate
charges, adjudication calculations based on the patient's benefits package
,D. Chargemaster pricing less the provider's standard discounting amount(s) for hospital services
C. Insurance coverage and benefits, service or test involved, DX and CPT codes, total estimate
charges, adjudication calculations based on the patient's benefits package
Why is it critical that a chargemaster is reviewed and updated regularly?
A. To ensure it supports and represents the services provided within the organization.
B. To ensure the most appropriate measure of the utilization of resources.
C. So, the CPT databases can have the most current and accurate information.
D. Because charge descriptions can vary greatly between providers.
A. To ensure it supports and represents the services provided within the organization.
Which option is NOT a continuum of care provider?
A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility
B. Health Plan Contracting
What is the intended outcome of collaborations made through an ACO delivery system?
A. To ensure appropriateness of care, elimination of duplicate services, and prevention of
medical errors for a population of patients.
B. To create cost-containment provisions to reform the healthcare delivery system.
C. To reform the healthcare system into a system that rewards greater value, improves the quality
of care and increases efficiency in the delivery of services.
D. To provide financial incentives to physicians for reporting quality data to CMS.
A. To ensure appropriateness of care, elimination of duplicate services, and prevention of
medical errors for a population of patients.
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.
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.
Which of the following medical debt collection practices are recommended as part of HFMA's
Best Practices for medical account resolution:
A. Make bills comprehensive and provide complete detail using industry standard terminology
B. Spell out account resolution methods and apply to all situations, regardless of applicability
C. Report to credit bureaus only when accounts are placed for collections
D. Establish policies and ensure that they are followed
D. Establish policies and ensure that they are followed
Organizations may opt to contract with or outsource to specific vendors for some or all
components of revenue cycle processing. This practice has both advantages and disadvantages.
Which of the following statements is NOT an advantage of utilizing an outsourcing vendor?
A. The need for legal review if the outside vendor's staff represents themselves as employees of
the healthcare facility
B. The need for internal hiring, training, and supervising staff is limited
C. Access to technology that may not be cost-effective for an individual provider to purchase and
maintain
D. Economies of scale realized by handling A/R in a centralized location for a number of groups
A. The need for legal review if the outside vendor's staff represents themselves as employees of
the healthcare facility
Each hospital covered by the 501(r) regulations is required to develop a financial assistance
policy. Which of the following elements is NOT a required element of the policy?
, A. Eligibility criteria which must be met for each type and level of financial assistance, including
all available discounts and free care
B. The notice that individuals eligible for financial assistance under this policy may be charged
more than the amount generally billed (AGB) to insured patients
C. A listing of all providers, specifying who is covered by the FAP and who is not
D. A prohibition on billing FAP-eligible individuals gross charges; the AGB applies only to the
amount for which the patient is responsible
B. The notice that individuals eligible for financial assistance under this policy may be charged
more than the amount generally billed (AGB) to insured patients
What are other names for Three-Day Payment Window?
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?
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
Best practices created by the Medical Debt Task Force
Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle initiative?
Process Compliance
What is "implied certification"?
When it is implied that a provider met all compliance standards before submitting a claim
When was Health Information Technology for Economic and Clinical Health (HITECH) Act
signed into law?
FEB 17, 2009
When did HITECH Act become effective?
