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Ensemble CRCR 2020
| Question | Answer |
|---|---|
| Scheduler instructions are used to prompt the scheduler to do what? | Complete the scheduling process correctly based on service requested. |
| What activities are completed when a schedule, pre-registered patient arrives for service? | Activating the record, obtaining signatures, and finalizing financial issues. |
| What does scheduling allow the provider staff to do? | Review the appropriateness of the service requested. |
| What activities are completed when a scheduled, pre-reg patient arrives for service? | Activating the record, obtaining signatures, finalize financial issues. |
| What are Non-emergency patients who come for service without prior notification to the provider called? | Unscheduled patient |
| The revenue cycle begins with scheduling a patient for service and ends with what? | The archiving of the fully resolved account. |
| One registration record is being created for multiple days of service is what type of scheduling? | Recurring or Series |
| The time needed to prepare the patient before service is the difference between the patient’s arrival time and which of the following? | Schedule time |
| What is the purpose of the initial step in the outpatient testing scheduling process? | Identify the correct patient in the providers data base or add the patient to the data base. |
| What type of information is typically collected during the scheduling contact? | Patients name dob, sex, diagnosis (dx), requested test, or procedure, preferred DOS , ordering physician, and physician’s telephone number. |
| A patient who is admitted from the physician’s office on an urgent basis is what type of admission? | Unscheduled |
| Why is it important to have high quality standards for registration? | Because quality failures affect the provider’s Joint Commission results on a review day. |
| What statement is NOT a possible consequence of selecting the wrong patient in the MPI (master patient index)? | Claim is paid in full. |
| In addition to the members identification #, what information is recorded in a 270 transaction? | Date of birth |
| What is the advantage of a preregistration program? | It reduces processing times at the time of service. |
| What data is required to establish a new MPI (master patient index) entry? | Patient’s full legal name, dob, sex |
| True or False: When screening a beneficiary for possible MSP (Medicare secondary payer) situations, it is necessary to ask the patient each of the MSP questions. | True |
| Comprehensive pre-reg data includes: | Complete insurance and emergency contact information |
| What process does a patient’s health plan use to retroactively collect payments from liability, auto or WC plans? | Subrogation |
| True or False: Patients who join the Medicare Advantage plan will not receive a health insurance card from the payer they select. | False |
| What type of plan restricts benefits for NON emergency care? | PPO (non emergency) |
| The portion of the adjudicated claim that is due from patient is called the | Self Pay Balance |
| True or False: Medicaid eligible patients are required to join a Medicaid HMO plan. | False |
| The patient is covered by their own insurance and their spouse's plan. Which plan is primary? | The patient's plan |
| What form is used to bill Medicare hospital claims? | UB-04 |
| What are two statutory exclusions from hospice coverage? | Medically unnecessary and custodial care |
| What are two requirements that Medicaid patients must meet for eligibility guidelines? | Income and expense |
| Managed Care plans do not permit balance billing except for in what circumstance? | Deductible and Co-payment |
| Every patient new to healthcare must be provided a copy of what? | HIPPA |
| What type of plan allows the subscriber to pay lower premium costs in return for higher deductibles? | Consumer Directed Health Plan |
| The Fixed amount due for a specific service is called a | Co-payment |
| What type of plan assumes the employer has direct responsibility and risk for healthcare claims? | Self Insured Claims |
| What is a document called that a PCP sends to an HMO pt to authorize visit to specialist? | Referral |
| True or False: Failure to complete authorization requirements is a valid reason for a payor to deny a claim. | True |
| Across all care settings, what is the HFMA best practice when a patient requests financial discussion during a medical encounter to expedite their discharge? | Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow. |
| There following are potential causes of credit balances except: | A patient's choice to build up a credit against future medical bills. |
| When a timely cost report is filed, a provider may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). Who could this report be filed with? | The Provider Reimbursement Review Board |
| What is the benefit of the Medicare Advantage Plan? | Patients generally have their Medicare coverage healthcare through the plan and do not need to worry about "Part A" or "Part B" benefits. |
| Which of the following is NOT a disadvantage of outsourcing? | Reduced internal staffing costs and a reliance on outsourced staff. |
| Of the following, what value is used when calculating days in A/R? | The time it takes to collect anticipated revenue. |
| The National Uniform Billing Committee (NUBC) established a 4-digit code to categorize/classify a line item in a charge master, commonly known as: | Revenue codes |
| HFMA's best practices for patient financial communications specify that patients should be told about the types of services provided and: | The service providers that typically participate in the service. |
| What are collection agency fees based on? | A percentage of dollars collected. |
| Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? | DOB |
| In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? | Case rates |
| What customer service improvements might improve the patient accounts departments? | Holding staff accountable for customer service during performance reviews. |
| What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? | Inform a Medicare beneficiary that Medicare may not pay for the order or service. |
| What type of account adjustment results from the patient's unwillingness to pay for a self-pay balance? | Bad debt adjustment |
| What is the initial hospice benefit? | Two 90-day periods and an unlimited number of subsequent periods. |
| When does a hospital add ambulance charges to the Medicare inpatient claim? | If the patient requires ambulance transportation to a skilled nursing facility. |
| How should a provider resolve a late-charge credit posted after an account is billed? | Post a late-charge adjustment to the account. |
| What is an advantage of a preregistration program? | It reduces processing times at the time of service. |
| What are the two statutory exclusions from hospice coverage? | Medically unnecessary services and custodial care. |
| What core financial activities are resolved within patient access? | Scheduling, insurance verification, discharge processing, and payment of point-of-service receipts. |
| What statement applies to the scheduled outpatient? | The services do not involve an overnight stay. |
| What type of patient status is used to evaluate the patient's need for inpatient care? | Observation |
| What are non-emergency patients who come for service without prior notification to the provider called? | Unscheduled patients |
| What is a principal diagnosis? | Primary reason for the patient's admission. |
| Collecting patient liability dollars after service leads to what? | Lower accounts receivable levels. |
| What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as an RHC services? | Inpatient care |
| What code indicates the disposition of the patient at the conclusion of service? | Patient discharge status code |
| Insurance verification results in what? | The accurate identification of the patient's eligibility and benefits. |
| What form is used to bill Medicare for rural health clinics? | CMS 1500 |
| What activities are completed when a scheduled pre-registered patient arrives for service? | Registering the patient and directing the patient to the service area |
| In addition to being supported by information found in the patient's chart, a CMS 1500 claim must be coded using what? | HCPCS (Healthcare Common Procedure Coding system) |
| Why does the financial counselor need pricing for services? | To calculate the patient's financial responsibility. |
| Because 501(r) regulations focus on identifying potentially eligible assistance patient's hospital must? | Build the necessary processes to handle the potentially lengthy payment schedules. |
| A Medicare Part A benefit period begins with what? | With admission as an impatient |
| Net Accounts Receivable is? | The amount an entity is reasonably confident of collecting from overall accounts receivable. |
| Successful account resolution begins with? | Educating patients on their estimated financial responsibility. |
| Which option is NOT a required component of a FAP? | Out-of-network providers |
| The ACO Investment model will test the use of pre-paid shared savings to? | Encourage new ACO's to form in rural and under-served areas. |
| Ambulance services are billed directly to the health plan for? | Transport deemed medically necessary by the attending paramedic-ambulance crew. |
| Days in A/R is calculated based on the value of? | The total accounts receivable on a specific date. |
| Which option is NOT a HFMA best practice? | Coordinate the resolution of bad debt accounts with a law firm. |
| The result of accurate census balancing on a daily basis is? | The overall accuracy of resource planning. |
| Charges are the basis for? | Third party and regulatory review of resources used. |
| What is the responsibility of HIM? | To maintain all patient medical records. |
| Internal controls addressing coding and reimbursement changes are put in place to guard against? | Compliance fraud by "upcoding" |
| Which is not a continuum of care provider? | Health Plan Contraction |
| CPT/HCPCS codes are used to do what? | Denote the medical procedure or test performed by a healthcare provider on a patient. |
| What does EMTALA require hospitals to do? | To provide a medical screening examination and stabilizing treatment to every person presenting at an ED and requesting medical evaluation of treatment . |
| Using HIPPA standardized transaction sets allows providers to? | Submit a standard transaction to any of the health plans with which it conducts business. |
| What is the purpose of insurance verification? | To ensure accuracy of the health plan information. |
| Indemnity plans usually reimburse? | A claim up to 80% of the charges. |
| What are KPIs? | Key Performance Indicators which set standards for accounts receivable (A/R) and provide a method of measuring the collection and control of A/R. |
| Which option is a federally-aided, state-operated program to provide health and long-term care coverage? | Medicaid |
| Name the guideline that Medicare established to determine which diagnosis, signs, or symptoms are payable? | Local Coverage Determinations |
| Each patient is assigned a unique number, commonly called the? | Master Patient Index (MPI) number. |
| Improving the overall patient experience requires revenue cycle leadership and staff to simultaneously be? | Inquisitive, responsive, innovative, and flexible |
| What is the first component of a pricing determination? | Verification of the patients' insurance eligibility and benefits. |
| Which of the following is NOT included in the Standardized Quality Measures? | Cost of Services |
| How are disputes with nongovernmental payers resolved? | Appeal conditions specified in the individual payer's contract. |
| The important message from Medicare provides beneficiaries with information concerning what? | Right to appeal a discharge decision if the patient disagrees with the services. |
| If a patient remains an inpatient of a skilled nursing facility (SNF)for more than 30 days, what is the SNF permitted to do? | Submit interim bills to the Medicare program. |
| What data is required to establish a new MPI entry? | The patient's full legal name, date of birth, and gender. |
| What do EMTALA regulations require on-call physicians to do? | Personally appear in the emergency department and attend to the patient within a reasonable time. |
| What is a benefit of pre-registering patients for service? | Patient arrival processing is expedited, reducing wait times and delays. |
| What is the definition of Accounts Receivable (A/R)? | Money owed to an organization for goods or services furnished. |
Created by:
lewi213