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CRCR Prep 2
CRCR prep part 2
| Question | Answer |
|---|---|
| The following statements describe best practices established by the Medical Debt Task Force. Select the True statements. | Educate patients Coordinate to avoid duplicate patient contacts. Be consistent in key aspects of account resolution Follow best practices for communication. |
| Which option is NOT a main HFMA Healthcare Dollars & Sease revenue cycle initiative? | Process Compliance |
| What is the objective of the HCAHPS initiative? | To provide a standardized method for evaluating patients perspective on care. |
| Which option is NOT a department that supports and collaborates with the revenue cycle? | Assisted Living Services |
| Which option is NOT a continuum of care provider? | Health Plan Contracting |
| Which of the following are essential elements of an effective compliance program? | Established compliance standards and procedures Oversight of personnel by high-level personnel Reasonable methods to achieve compliance with standards, including monitoring systems and hotlines |
| 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. | Standard Unique Employer Identifier |
| In order to promote the use of correct coding methods on a national basis and prevent payment errors due to improper coding, CMS developed what? | The Correct Coding Initiative (CCI) |
| What do business/organizational ethics represent? | Principles and standards by which organizations operate |
| What is the intended outcome of collaborations made through an ACO delivery system? | To ensure appropriateness of care, elimination of duplicate services, and prevention of medical errors for a population of patients. |
| What are KPis? | Benchmarks which are used to compare Key Performance Indicators in an organization to an agreed upon average or expected standard within the same industry. |
| Which of these statements describes the new methodology for the determination of net patient service revenue: | Net patient service revenue is defined as the total incurred charges, less the explicit price concession, less any applicable implicit price concessions as applied to the specific portfolio of accounts. |
| Which patients are considered scheduled? | Recuning/Series Patients |
| Name the guideline that Medicare established to determine which diagnoses, signs, or symptoms are payable. | Local Coverage Determinations |
| What is the purpose of insurance verification? | To ensure accuracy of the health plan information |
| Which option is a federally-aided, state-operated program to provide health and long-term care coverage? | Medicaid |
| Which option is NOT a specific managed care requirement? | Preferred Provider Organization |
| What is the first component of a pricing determination? | Verification of the patient's insurance eligibility and benefits |
| What is the purpose of financial counseling? | To educate the patient on his/her health plan coverage and financial responsibility for healthcare services. |
| What does EMTALA require hospitals to do? | To provide a medical screening examination and stabilizing treatment to every person presenting to an ED and requesting medical evaluation or treatment |
| In what manner do case managers assist revenue cycle staff? | Providing assistance with written appeals to health plans related to utilization and other care issues. |
| What is the responsibility of HIM:? | To maintain all patient medical records |
| Why is it critical that a chargemaster is reviewed and updated regularly? | To ensure it supports and represents that services provided within the organization |
| What are claims edits? | Rules developed to verify the accuracy and completeness of claims based on each health plans policies. |
| Which statement is NOT a unique billing rule specific to providers? | A patient may be balance billed for whatever amount the non-contracting physician charges above the health plans reimbursement amount |
| Which of the following statements does not apply to billing during the COVID-19 public health emergency? | Telemedicine claims are not payable if the patient conducts the telemedicine visit from home |
| Which concept is NOT a contracted payment model? | Stop-Loss Provision |
| Sue Smith came into the hospital. Her insurance provider sent an EFT directly into the hospitals account at the bank. John, the hospital representative, receives an electronic Level 2 ERA. What should he do next? | Manually match the ERA to the patient account |
| What is EFT? | The electronic transfer of funds from payer to payee through the banking system |
| Which statement is false regarding credit balances? | There are no CMS hospital compliance requirements regarding credit balances |
| Which option is NOT a type of denial? | Contractual Adjustment |
| Which option is NOT a lien type? | Subrogation |
| Based on what you have just read, which activity is not conside.red when initiating self-pay follow-up and account resolution activities? | Patient Open Balance Billing |
| Which option is NOT a required component of a FAP? | Out-of-network providers |
| Which option is NOT a bankruptcy type governed by the 1979 Bankruptcy Act? | Creditor priority |
| Which evaluation criteria demonstrates reputation expectations: | The employment of staff who have documented experience working in financial areas of healthcare. |
| Which function within the revenue cycle is NOT a good candidate for outsourcing? | Health Care Patient Services |
| Patient service costs are calculated in the pre-service process for scheduled patients. | True |
| Consents are signed as part of the post-service process. | False |
| The patient is scheduled and registered for service is a time-of-service activity. | False |
| The patient account is monitored for payment is a time-of-service activity. | False |
| Case management and discharge planning services are a post-service activity. | False |
| Sending the bill electronically to the health plan is a time-of-service activity. | False |
| A staff member receives cash in the mail and does not immediately report the cash to the manager for special handling. This is an example of financial misconduct. | True |
| A mother sees a charge on her hospital bill for a circumcision for a newborn girl. This is an example of falsifying medical records to boost reimbursement. | False |
| A patient access staff member takes several file folders and highlighters home for personal use. This is an example of theft of property. | True |
| A physician documents a fictitious epidural in a patients medical record in an effort to receive additional payment. This is an example of miscoding claims. | False |
| Responsible for providing federal health services to Native Americans. | Indian Health Service (IRS) |
| The costs of medical care are borne by the employer on a pay-as-you-go basis. | Self-Insured Plans |
| The nation's oldest and largest family of private health benefits companies. | Blue Cross/Blue Shield |
| Cover almost all services without authorization requirements. | Commercial Indemnity Plans |
| Attempt to reduce costs through contractual agreements with providers. | Managed Care Plans |
| A group of medical providers is identified to furnish services at lower than usual fees. | PPO |
| A health plan that provides comprehensive healthcare services, within a designated population, on a pre-payment basis. | HMO |
| Members can refer themselves outside th plan and still get some coverage. | POS |
| Subscriber agrees to a high initial deductible, in return for lower premiums. | CDHP |
| Providers typically submit a single claim for an inpatient or outpatient episode of care, or a series or recurring claim or repeat outpatient services for the same condition. | Outpatient Series |
| Applies to Rural Health Clinic; Hospice; Skilled Nursing Facility; Ambulance; and Hospital-Based Physicians. | Provider Type Billing Rule |
| Section 6404 of the Patient Protection and ACA states that claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service, will be denied by Medicare. | Time Limits for Billing |
| A day begins at midnight and ends 24 hours later, this is called the midnight-to-midnight method. | Counting Inpatient Days |
| Submit corrected claim to payer or remove credit charges from patients account. | Late charge credits processing |
| Determine overpayment amount; issue refund check to patient. | Inaccurate upfront collections· |
| Determine correct primary, notify incorrect payer of overpayment. | Primary and secondary payers both paying as primary |
| Notify payer, send refund or complete take back form as directed by payer. | Duplicate payments |
| Which list of practices that help to reduce or eliminate rejections and denials is correct? | Provide only ordered services Closely monitor patient services and verify that all services ordered and provided are clearly documented Code accurately based on documentation Communicate to the involved staff |
| Which items are required components of a financial assistance policy? Select all that apply. | A clearly defined financial assistance statement Guidelines for bad debt or previous unpaid accounts Installment arrangements guidelines Payment methods A concise statement of the hospitals mission |
| Restrictions on Garnishment | Title III |
| Fair Credit Reporting Act | Title VI |
| Truth in Lending Act | Title I |
| Fair Debt Collection Practices Act | Title VIII |
| The following statement represents an advantage of outsourcing: Access to qualified staff. | True |
| Vendor absorbs some financial risk based on "efficiency" factor | True |
| The following statement represents an advantage of outsourcing: Impact on direct control of accounts receivable | False |
| The following statement represents an advantage of outsourcing: Capitalizes on the economics of scale | True |
| The following statement represents an advantage of outsourcing: Limits internal staffing requirements | True |
| The following statement represents an advantage of outsourcing: Legal impact if vendor represents themselves as provider employees | False |
| The following statement represents an advantage of outsourcing: Ineffective vendor results in increased costs | False |
| The following statement represents an advantage of outsourcing: Impact on customer service | False |
Created by:
sstarcher
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