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CRCR Prep 1
CRCR prep part 1
| Question | Answer |
|---|---|
| Which of the following statements are true of HFMA' s Patient Financial Communications Best Practices? | The best practices were developed specifically to help patients understand the cost of services, their individual insurance benefits, and their responsibility for balances after insurance, if any. |
| The patient experience includes all of the following except: | The average number of positive mentions received by the health system or practice and the public comments refuting unfriendly posts on social media sites. |
| Corporate compliance programs play an important role in protecting the integrity of operations and ensuring compliance with federal and state requirements. The code of Conduct is: | A critical tool to ensure the compliance with the organization's compliance standards and procedures. An essential and integral component of the organization's culture. Fosters an environment where concerns may be raised without fear of retribution. |
| Specific to Medicare fee-for-service patients, which of the following payers have always been liable for payment? | Public health service programs, Federal grant programs, veteran affairs programs, black lung program services and work-related injuries and accidents (workers' compensation claims). |
| Provider policies and procedures should be in a place to reduce the risk of ethical violations. Examples of ethical violations include: | Financial misconduct, overcharging, and miscoding claims. Theft of property and falsifying records to boost reimbursement. Financial misconduct and applying policies in an inconsistent manner. |
| What is the intended outcome of collaborations made through an ACO delivery system for a population of patients? | To eliminate duplicate services, prevent medical e1rnrs, and ensure appropriateness of care. |
| What is the new terminology now employed in the calculation of net patient service revenues? | Explicit price concessions and implicit price concessions. |
| What are the two KPis used to monitor performance related to the production and submission of claim to third party payers and patients (self-pay)? | Elapsed days from payment receipt to payment posting for primary claims. |
| Which patient types are typically considered acute care patient types? | Observation, newborn, Emergency (ED) |
| Accurate identification of the patient is the first step in the scheduling process. Identifiers used in various combination to achieve accurate patient identification include: | Full legal name, DOB ( date of birth), sex, & social security number |
| Pre- registration is defined as: | The collection of demographic info, insurance data, financial info, providing reminders, prep info, & identifying the potential need for financial assistance for scheduled patients. |
| Which of the following statements accurately describes the various Medicare benefit programs? | MCR Part A provides benefits for inpatient hospital services; MCR Part B covers outpatient & professional services; MCR Part C are managed care plans combining Part A & Part B coverages; & Medicare Part D is the prescription drug coverage benefit |
| Which of the following statements about Medicaid eligibility is NOT true? | Medicaid categories are restricted to children, pregnant women, & elderly in nursing homes |
| Examples of managed care plans include: | HMO, PPO, & EPO plans. POS, Concierge plans, Medicare Advantage Plans Direct contracting for specific services from specific providers |
| Patient Financial Communications best practices include all of the following activities except: | Collecting payment or initiating the process to immediately remove the patient from the service schedule |
| Which statement includes the requires components of an accurate pricing determination: | Insurance coverage & benefits, service or test involved, diagnosis & procedure codes, total estimated charges, adjudication calculations based on the patient's benefit package |
| The value of a robust scheduling & pre-registration process includes all of the following except: | Identification of patient who are likely to be "no shows" |
| EMTALA prohibits inquiries about health plan or liability payer info if the inquiry will delay examination or treatment. What other requirements apply to the Emergency Department (ED)registration work? | Patients are triaged by medical personnel & a "quick" regist. initiated to allow elect. order entry and docs. Identif. & verif. of ins. elig. & benefits once medical screening is complete. No additional regis. may occur unitl the pt is stabilized. |
| Typical activities which must be performed when an unscheduled patient arrives for service include: | Identification of patient in MPI or initiation of a new MPI record, insurance verification of eligibility & benefits, managed care screening, med. necessity screening, price estimation & financial counseling to achieve the appropriate account resolution |
| Case managers are involved from admission with the discharge planning process. The purpose of discharge planning is: | To estimate how long the patient will be in the hospital, identify the expected outcome of the hospitalization & initiate any special requirements for services at or after the time of discharge |
| The chargemaster is basically a list of services, procedures, room accommodations, supplies, drugs, tests, etc. typically associated with the billing for services rendered to patients. Challenges typically associated with the chargemaster include: | Omission of charges, obsolete or invalid codes, & the omission of required modifiers |
| There are four code sets that provide health plans with additional info as they process claims. Those code sets are: | Condition: codes, occurrence codes, occurrence span codes, & value codes |
| Ultimately, the services provided in the healthcare system are reduced to standard codes. The primary types of coding systems currently used in healthcare are: | ICD-10-CM/ICD-10-PCS; CPT/HCPCS codes |
| Each type of service has unique billing rules which come into play during the provision of service. For the skilled nursing facility (SNF), care is covered if which of the following factors are present: | The patient requires skilled services on a daily basis & those service can only be provided on an inpatient basis in a SNF |
| DRG's are a system of classifying inpatients of the basis of diagnoses, procedures, & comorbidities for purposes of payment to hospitals. Each DRG includes: | A relative weight which is multiplied by the established base payment rate to calculate the reimbursement for a specific DRG. For exceptionally costly cases over a set dollar amount, an outlier payment is added to the calculated payment. |
| PPO networks represent one form of discounting commonly used by commercial payers. The silent PPO represents: | A discounting scheme whereby health plans apply generic PPO rates to discount a provider's claims, even though there is no contractual arrangement between the silent PPO & the provider |
| The concept of timely filing of claims is important to providers, payers, & patients. Thus, providers are required are required to comply with timely claim filing rules. Which of the following statements are NOT true about timely filing limitations: | Payers will waive timely filing denials for claims filed over a year from date of service |
| Credit balances may be created by any of the following activities except: | Credits to pharmacy charges posted before the claim final bills |
| Which of the following statements represent common reasons for inpatient claim denials: | Failure to obtain a required pre-authorization; failure to complete a continued stay authorization & services provided which were not medically necessary |
| A 68 year old patient, a Medicare beneficiary, was in a car accident. A medical insurance claim was filed with the auto insurance carrier. Six months later the claim remains unpaid. How can the provider pursue payment from Medicare? | The provider must first bill the auto insurer; however, after a period of 120 days, if the claim remains unpaid, the provider may cancel the liability claim & bill Medicare |
| The difference between bad debt & financial assistance (charity) is: | Bad debt represents a refusal to pay; charity represents inability to pay |
| In order to qualify for financial assistance, a patient or guarantor should: | Provide the following documents: prior year tax return, employment check stubs from the prior three months & bank statements from the prior three months |
| To comply with the requirements of Section 501 ® for tax-exempt hospitals chartered as 510 ©3 providers, the hospital must complete which of the following activities: | A community needs assessments |
| The three types of bankruptcy as defined in the 1979 Bankruptcy Act are: | Chapter 7 - Straight Bankruptcy, Chapter 11 - Debtor Reorganization, & Chapter 13 - Debtor Rehabilitation |
| Which of the following medical debt collection practices are recommended as part of HFMA's Best Practices for Medical Account Resolution: | Establish policies & ensure that they are followed |
| Organiz. may opt to contract with or outsource to specific vendors for some or all components of the revenue cycle processing. This practice has both advant. & disadvant. Which of the following stmnts is NOT an advant of utilizing an outsourcing vendor? | 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® regulations is required to develop a financial assistance policy. Which of the following elements is NOT a required element of the policy? | The notice that individuals eligible for financial assistance under this policy may be charged more than the amount generally billed (AGB) to insured patients |
Created by:
sstarcher
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