crcr
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| show | TRUE
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| Which evaluation criteria demonstrates reputation expectations: | show 🗑
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| Which concept is NOT a contracted payment model? | show 🗑
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| True or False: The following statement represents an advantage of outsourcing: Impact on direct control of accounts receivable | show 🗑
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| Collection results are: | show 🗑
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| Sending the bill electronically to the health plan in a time-of-service activity. | show 🗑
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| What is the intended outcome of collaborations made through an ACO delivery system? | show 🗑
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| 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. | show 🗑
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| Which statement is NOT a unique billing rule specific to providers? | show 🗑
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| True or False: The following statement represents an advantage of outsourcing: Impact on customer service | show 🗑
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| True or False: The following statement represents an advantage of outsourcing: Vendor absorbs some financial risk based on “efficiency” factor | show 🗑
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| Which of the following are essential elements of an effective compliance program? | show 🗑
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| show | FALSE
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| show | Principles and standards by which organizations operate
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| The patient account is monitored for payment is a time-of-service activity. | show 🗑
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| show | FALSE
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| In what manner do case managers assist revenue cycle staff? | show 🗑
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| show | Telemedicine claims are not payable if the patient conducts the telemedicine visit from home.
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| show | Net patient service revenue is defined as the total incurred charges, less the explicit price concession, less any applicable implicit price concession(s) as applied to the specific portfolio of accounts.
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| show | Final coding of all services, preparation and submission of claims, payment processing and balance billing and resolution.
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| True or False: The following statement represents an advantage of outsourcing: Capitalizes on the economies of scale | show 🗑
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| show | Health Plan Contracting
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| show | The Correct Coding Initiative (CCI)
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| The patient is scheduled and registered for service is a time-of-service activity. | show 🗑
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| show | The ability to sensitively deal with patients or individuals while managing collection efficiency.
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| show | Key performance indicators, which set standards for accounts receivable (A/R) and provide a method of measuring the collection and control of A/R.
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| True or False: The following statement represents an advantage of outsourcing: Ineffective vendor results in increased costs | show 🗑
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| show | Distribute a RFP to solicit vendor capabilities, evaluate vendor’s expertise to provide outsourcing services, visit vendor locations, perform vendor reference checks, talk with vendor clients, interview vendor employees to assess experience level.
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| Agency fees are: | show 🗑
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| Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle initiative? | show 🗑
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| show | Coordinate the resolution of bad debt accounts with a law firm
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| What are claim edits? | show 🗑
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| show | Educate patients
Exercise moderate judgement when communicating with providers about scheduled services.
Be consistent in key aspects of account resolution.
Follow best practices for communication.
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| show | TRUE
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| show | Follow the contractual agreement between the agency and the provider as to how monies sent to the agency will be handled.
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| What is the objective of the HCAHPS initiative? | show 🗑
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| Collection agency reports should be provided: | show 🗑
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| show | Verification of the patient’s insurance eligibility and benefits
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| show | TRUE
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| In what manner do case managers assist revenue cycle staff? | show 🗑
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| Which of these statements describes the new methodology for the determination of net patient service revenue: | show 🗑
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| What happens during the post-service stage? | show 🗑
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| A day begins at midnight and ends 24 hours later, this is called the midnight-to-midnight method. | show 🗑
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| Applies to Rural Health Clinic; Hospice; Skilled Nursing Facility; Ambulance; and Hospital-Based Physicians | show 🗑
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| 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 | show 🗑
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| 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. | show 🗑
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| What is the sequential order for a Silent PPO scheme? | show 🗑
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| Credit balances may be created by any of the following activities except : | show 🗑
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| Which of the following statements represent common reasons for inpatient claim denials : | show 🗑
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| show | 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 and bill Medicare
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| show | A community needs assessments
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| show | Establish policies and ensure that they are followed .
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| Each hospital covered by the 501 ( r ) regulations is required to develop financial assistance policy . Which of the following elements is not required element of the policy ? | show 🗑
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| show | Out-of-network providers
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| Truth in Lending Act - establishes disclosure rules for consumer credit sales and consumer loans. The most important section is Regulation Z, which tells creditors how to comply with the law. | show 🗑
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| Restrictions on Garnishment- 25% of a worker’s disposable earnings per week, or The amount by which a worker’s weekly wage exceeds 30 times the federal minimum wage | show 🗑
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| Fair Credit Reporting Act - affects those who “issue or use reports on consumers in connection with the approval of credit.” This Act protects consumers’ rights and has exact standards that limits the use of consumer credit reports. T | show 🗑
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| Fair Debt Collection Practices Act (FDCPA) - Act of 1978 applies only to third-party collection agencies that collect consumer debt. As long as a hospital collects its own debts using its own name, it is not considered a debt collector under the Act. | show 🗑
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| Which option is NOT a bankruptcy type governed by the 1979 Bankruptcy Act? | show 🗑
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| Which function within the revenue cycle is NOT a good candidate for outsourcing? | show 🗑
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| Patient service costs are calculated in the pre-service process for scheduled patients. | show 🗑
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| show | False -Pre-service:
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| The 2020 OIG Work Plan tasks include the following: | show 🗑
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| show | Reconciliation of outlier payments.
Outpatient and inpatient stays under Medicare’s two-midnight rule.
Medicare costs associated with defective medical devices and credits for replacement medical devices.
Oversight of provider-based status and comparis
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| Days in A/R is calculated based on | show 🗑
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| show | can also be done for specific payers to evaluate the collection efficiency and payment progress on third-party payers or self-pay patients.
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| show | can help identify issues and areas for improvement.
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| show | it is important to calculate the difference between gross revenue and net revenue.
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| show | The charges for all the services that a patient has received is totaled.
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| To determine net revenue | show 🗑
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| show | from volume-based to value-based payments and increasing the types of alternative payment models which include value-based payments.
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| show | to reform the healthcare system into a system that rewards greater value, improves the quality of care and increases efficiency in the delivery of services.
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| show | which is considered to be actions that are the right thing to do, not just what is required by a law, regulation or rule, is very important in healthcare.
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| show | applies to actions that are hoped for and expected by each individual staff and management member within healthcare.
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| It is important for staff and management to | show 🗑
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| show | certain outpatient services that are provided within three days of the admission date, by hospitals or by entities wholly owned or controlled by hospitals, to be billed as part of an inpatient stay.
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| show | is to inform a Medicare beneficiary “before he or she receives specified items or services that might otherwise be paid for” that Medicare certainly or probably will not pay for those items or services on that particular occasion.
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| show | Working Aged
Accident or Other Liability
Disability
End-Stage Renal Disease (ESRD)
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| show | Health Plans & Payers
Physicians
Skilled Nursing Facilities
Durable Medical Equipment
Hospice
Assisted Living
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| show | Information Technology -
Clinical Services -
Finance-provides analysis and reporting to ensure compliance.
Health Plan Contracting
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| show | Patient Financial Communications
Price Transparency
Medical Account Resolution
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| show | after the patient is discharged) - Account activities occur after the patient is discharged until the account reaches a zero balance.
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| show | account review is completed for a scheduled patient prior to his/her arrival. Upon arrival, the patient is positively identified, the pre-registration record is activated, consents are signed, and co-payments or other agreed upon amounts are collected.
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| show | (for scheduled patients) - Scheduling and pre-access processing is completed. The patient is scheduled, pre-registered for service and the required data is collected.
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| There are three critical segments of the revenue cycle | show 🗑
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