HFMA CRCR

Pre-Service activities ANSWER : 1. Requested service is screened for med necessity, health coverage/benefits verified, preauthorization obtained and estimate to patient oop costs generated within guidelines of NSA and state regulations. 2. Patient notified of financial responsibility including copayment and health plan deductibles, eligibility of financial assistance assessed. 3. Patient is scheduled 4. Encounter record is generated and patient and guarantor info is obtained and u...

What are collection agency fees based on? ANSWER : A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? ANSWER : Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? ANSWER : Case rates What customer service improvements might improve the patient accounts department? ANSWER : Holding staff accountable for customer servi...

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...