HFMA CRCR FINAL EXAM WITH DETAILED QUESTIONS AND
VERIFIED CORRECT ANSWERS/ ALREADY GRADED A++
Through what document does a hospital establish compliance standards? -
ANSWER code of conduct
What is the purpose OIG work plant? - ANSWER Identify Acceptable
compliance programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the
three-day DRG window rule? - ANSWER Non-diagnostic service provided
on Tuesday through Friday
What does a modifier allow a provider to do? - ANSWER Report a specific
circumstance that affected a procedure or service without changing the
code or its definition
IF outpatient diagnostic services are provided within three days of the
admission of a Medicare beneficiary to an IPPS (Inpatient Prospective
Payment System) hospital, what must happen to these charges - ANSWER
They must be billed separately to the part B Carrier
what is a recurring or series registration? - ANSWER One registration
record is created for multiple days of service
What are nonemergency patients who come for service without prior
notification to the provider called? - ANSWER Unscheduled patients
Which of the following statement apply to the observation patient type? -
ANSWER It is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock
patient - ANSWER Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? -
ANSWER Complete the scheduling process correctly based on service
requeste
,The Time needed to prepare the patient before service is the difference
between the patients arrival time and which of the following? - ANSWER
Procedure time
Medicare guidelines require that when a test is ordered for a LCD or NCD
exists, the information provided on the order must include: - ANSWER
Documentation of the medical necessity for the test
What is the advantage of a pre-registration program - ANSWER It reduces
processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry -
ANSWER The responsible party's full legal name, date of birth, and social
security number
Which of the following statements is true about third-party payments? -
ANSWER The payments are received by the provider from the payer
responsible for reimbursing the provider for the patient's covered services.
Which provision protects the patient from medical expenses that exceed
the pre-set level - ANSWER stop loss
what documentation must a primary care physician send to HMO patient to
authorize a visit to a specialist for additional testing or care? - ANSWER
Referral
Under EMTALA (Emergency Medical Treatment and Labor Act)
regulations, the provider may not ask about a patient's insurance
information if it would delay what? - ANSWER Medical screening and
stabilizing treatment
Which of the following is a step in the discharge process? - ANSWER Have
a case management service complete the discharge plan
The hospital has a APC based contract for the payment of outpatient
services. Total anticipated charges for the visit are $2,380. The approved
APC payment rate is $780. Where will the patients benefit package be
applied? - ANSWER To the approved APC payment rate
,A patient has met the $200 individual deductible and $900 of the $1000 co-
insurance responsibility. The co-insurance rate is 20%. The estimated
insurance plan responsibility is $1975.00. What amount of coinsurance is
due from the patient? - ANSWER $100.00
When is a patient considered to be medically indigent? - ANSWER The
patient's outstanding medical bills exceed a defined dollar amount or
percentage of assets.
What patient assets are considered in the financial assistance application?
- ANSWER Sources of readily available funds , vehicles, campers, boats
and saving accounts
If the patient cannot agree to payment arrangements, What is the next
option? - ANSWER Warn the patient that unpaid accounts are placed with
collection agencies for further processing
What core financial activities are resolved within patient access? -
ANSWER scheduling , pre-registration, insurance verification and managed
care processing
What is an unscheduled direct admission? - ANSWER A patient who
arrives at the hospital via ambulance for treatment in the emergency
department
When is it not appropriate to use observation status? - ANSWER As a
substitute for an inpatient admission
Patients who require periodic skilled nursing or therapeutic care receive
services from what type of program? - ANSWER Home health agency
Every patient who is new to the healthcare provider must be offered what?
- ANSWER A printed copy of the provider privacy notice
Which of the following statements apples to self insured insurance plans? -
ANSWER The employer provides a traditional HMO health plan
In addition to the member's identification number, what information is
recorded in a 270 transaction - ANSWER Name
, What process does a patient's health plan use to retroactively collect
payments from liability automobile or worker's compensation plan? -
ANSWER Subrogation
In what type of payment methodology is a lump sum of bundled payment
negotiated between the payer and some or all providers? - ANSWER
DRG/Case rate
What Restriction does a managed care plan place on locations that must
be used if the plan is to pay for the service provided? - ANSWER Site of
service limitation
Which of the following statements applies to private rooms? - ANSWER If
the medical necessity for a private room is documented in the chart. The
patients insurance will be billed for the differential
Which of the following is true about screening a beneficiary of possible
MSP(Medicare secondary payer) situations? - ANSWER It is necessary to
ask the patient each of the MSP questions
Which of the following is not true of Medicare Advantage Plans? -
ANSWER A patient must have both Medicare Part A and B benefits to be
eligible for a Medicare Advantage plan
Which of the following is a valid reason for a payer to deny a claim? -
ANSWER Failure to complete authorization
Which of the following statements is NOT a possible consequence of
selecting the wrong patient in the MPI(master patient index) - ANSWER
Claim is paid in full
Which of the following statements is true of a Medicare Advantage Plan? -
ANSWER This plan supplements Part A and Part B benefits
Which is the following is not a characteristic of Medicaid HMO plan? -
ANSWER Medicaid-eligible patients are never required to join a Medicaid
HMO plan
VERIFIED CORRECT ANSWERS/ ALREADY GRADED A++
Through what document does a hospital establish compliance standards? -
ANSWER code of conduct
What is the purpose OIG work plant? - ANSWER Identify Acceptable
compliance programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the
three-day DRG window rule? - ANSWER Non-diagnostic service provided
on Tuesday through Friday
What does a modifier allow a provider to do? - ANSWER Report a specific
circumstance that affected a procedure or service without changing the
code or its definition
IF outpatient diagnostic services are provided within three days of the
admission of a Medicare beneficiary to an IPPS (Inpatient Prospective
Payment System) hospital, what must happen to these charges - ANSWER
They must be billed separately to the part B Carrier
what is a recurring or series registration? - ANSWER One registration
record is created for multiple days of service
What are nonemergency patients who come for service without prior
notification to the provider called? - ANSWER Unscheduled patients
Which of the following statement apply to the observation patient type? -
ANSWER It is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock
patient - ANSWER Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? -
ANSWER Complete the scheduling process correctly based on service
requeste
,The Time needed to prepare the patient before service is the difference
between the patients arrival time and which of the following? - ANSWER
Procedure time
Medicare guidelines require that when a test is ordered for a LCD or NCD
exists, the information provided on the order must include: - ANSWER
Documentation of the medical necessity for the test
What is the advantage of a pre-registration program - ANSWER It reduces
processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry -
ANSWER The responsible party's full legal name, date of birth, and social
security number
Which of the following statements is true about third-party payments? -
ANSWER The payments are received by the provider from the payer
responsible for reimbursing the provider for the patient's covered services.
Which provision protects the patient from medical expenses that exceed
the pre-set level - ANSWER stop loss
what documentation must a primary care physician send to HMO patient to
authorize a visit to a specialist for additional testing or care? - ANSWER
Referral
Under EMTALA (Emergency Medical Treatment and Labor Act)
regulations, the provider may not ask about a patient's insurance
information if it would delay what? - ANSWER Medical screening and
stabilizing treatment
Which of the following is a step in the discharge process? - ANSWER Have
a case management service complete the discharge plan
The hospital has a APC based contract for the payment of outpatient
services. Total anticipated charges for the visit are $2,380. The approved
APC payment rate is $780. Where will the patients benefit package be
applied? - ANSWER To the approved APC payment rate
,A patient has met the $200 individual deductible and $900 of the $1000 co-
insurance responsibility. The co-insurance rate is 20%. The estimated
insurance plan responsibility is $1975.00. What amount of coinsurance is
due from the patient? - ANSWER $100.00
When is a patient considered to be medically indigent? - ANSWER The
patient's outstanding medical bills exceed a defined dollar amount or
percentage of assets.
What patient assets are considered in the financial assistance application?
- ANSWER Sources of readily available funds , vehicles, campers, boats
and saving accounts
If the patient cannot agree to payment arrangements, What is the next
option? - ANSWER Warn the patient that unpaid accounts are placed with
collection agencies for further processing
What core financial activities are resolved within patient access? -
ANSWER scheduling , pre-registration, insurance verification and managed
care processing
What is an unscheduled direct admission? - ANSWER A patient who
arrives at the hospital via ambulance for treatment in the emergency
department
When is it not appropriate to use observation status? - ANSWER As a
substitute for an inpatient admission
Patients who require periodic skilled nursing or therapeutic care receive
services from what type of program? - ANSWER Home health agency
Every patient who is new to the healthcare provider must be offered what?
- ANSWER A printed copy of the provider privacy notice
Which of the following statements apples to self insured insurance plans? -
ANSWER The employer provides a traditional HMO health plan
In addition to the member's identification number, what information is
recorded in a 270 transaction - ANSWER Name
, What process does a patient's health plan use to retroactively collect
payments from liability automobile or worker's compensation plan? -
ANSWER Subrogation
In what type of payment methodology is a lump sum of bundled payment
negotiated between the payer and some or all providers? - ANSWER
DRG/Case rate
What Restriction does a managed care plan place on locations that must
be used if the plan is to pay for the service provided? - ANSWER Site of
service limitation
Which of the following statements applies to private rooms? - ANSWER If
the medical necessity for a private room is documented in the chart. The
patients insurance will be billed for the differential
Which of the following is true about screening a beneficiary of possible
MSP(Medicare secondary payer) situations? - ANSWER It is necessary to
ask the patient each of the MSP questions
Which of the following is not true of Medicare Advantage Plans? -
ANSWER A patient must have both Medicare Part A and B benefits to be
eligible for a Medicare Advantage plan
Which of the following is a valid reason for a payer to deny a claim? -
ANSWER Failure to complete authorization
Which of the following statements is NOT a possible consequence of
selecting the wrong patient in the MPI(master patient index) - ANSWER
Claim is paid in full
Which of the following statements is true of a Medicare Advantage Plan? -
ANSWER This plan supplements Part A and Part B benefits
Which is the following is not a characteristic of Medicaid HMO plan? -
ANSWER Medicaid-eligible patients are never required to join a Medicaid
HMO plan
