CRCR Certification Actual Exam Questions with Detailed Verified Answers, Exams of Nursing

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CRCR CERTIFICATION ACTUAL EXAM QUESTIONS WITH DETAILED VERIFIED ANSWERS Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - CORRECT ANSWER >>>>The Medicare Administrative Contractor (MAC) at the end of the hospice cap period Which of the following is required for participation in Medicaid - CORRECT ANSWER >>>>Meet Income and Assets Requirements In choosing a setting for patient financial discussions, organizations should first and foremost - CORRECT ANSWER >>>>Respect the patients privacy A nightly room charge will be incorrect if the patient's - CORRECT ANSWER >>>>Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can - CORRECT

ANSWER >>>>Purchase qualified health benefit plans regardless of insured's health status A portion of the accounts receivable inventory which has NOT qualified for billing includes: - CORRECT ANSWER >>>>Charitable pledges What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? - CORRECT ANSWER >>>>Revenue codes This directive was developed to promote and ensure healthcare quality and value and also to protect consumers and workers in the healthcare system. This directive is called - CORRECT ANSWER >>>>Patient bill of rights The activity which results in the accurate recording of patient bed and level of care assessment, patient transfer and patient discharge status on a real-time basis is known as - CORRECT ANSWER >>>>Case management Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? - CORRECT ANSWER >>>>Registration staff may routinely contact managed are plans for prior authorizations before the patient is seen by the on-duty physician HIPAA had adopted Employer Identification Numbers (EIN) to be used in standard transactions to identify the employer of an individual described in a transaction EIN's are assigned by - CORRECT ANSWER >>>>The Internal Revenue Service

Checks received through mail, cash received through mail, and lock box are all examples of - CORRECT ANSWER >>>>Control points for cash posting What are some core elements if a board-approved financial assistance policy? - CORRECT ANSWER >>>>Eligibility, application process, and nonpayment collection activities A recurring/series registration is characterized by - CORRECT ANSWER

The creation of one registration record for multiple days of service With the advent of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to - CORRECT ANSWER >>>>Assist patients in understanding their insurance coverage and their financial obligation The purpose of a financial report is to: - CORRECT ANSWER >>>>Present financial information to decision makers Patient financial communications best practices produce communications that are - CORRECT ANSWER >>>>Consistent, clear Registration staff may routinely contact managed are plans for prior authorizations before the patient is seen by the on-duty physician HIPAA had adopted Employer Identification Numbers (EIN) to be used in standard transactions to identify the employer of an individual described in a transaction EIN's are assigned by - CORRECT ANSWER >>>>The Internal Revenue Service Checks received through mail, cash received through mail, and lock box are all examples of - CORRECT ANSWER >>>>Control points for cash posting What are some core elements if a board-approved financial assistance policy? - CORRECT ANSWER >>>>Eligibility, application process, and nonpayment collection activities A recurring/series registration is characterized by - CORRECT ANSWER >>>>The creation of one registration record for multiple days of service With the advent of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to - CORRECT ANSWER >>>>Assist patients in understanding their insurance coverage and their financial obligation The purpose of a financial report is to: - CORRECT ANSWER >>>>Present financial information to decision makers Patient financial communications best practices produce communications that are - CORRECT ANSWER >>>>Consistent, clear and transparent Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish - CORRECT ANSWER >>>>What services or healthcare items are covered under Medicare Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with - CORRECT ANSWER >>>>The Provider Reimbursement Review Board

Concurrent review and discharge planning - CORRECT ANSWER

Occurs during service Duplicate payments occur: - CORRECT ANSWER >>>>When providers re-bill claims based on nonpayment from the initial bill submission An individual enrolled in Medicare who is dissatisfied with the

The creation of one registration record for multiple days of service With the advent of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to - CORRECT ANSWER >>>>Assist patients in understanding their insurance coverage and their financial obligation The purpose of a financial report is to: - CORRECT ANSWER >>>>Present financial information to decision makers Patient financial communications best practices produce communications that are - CORRECT ANSWER >>>>Consistent, clear and transparent Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish - CORRECT ANSWER >>>>What services or healthcare items are covered under Medicare Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with - CORRECT ANSWER >>>>The Provider Reimbursement Review Board Concurrent review and discharge planning - CORRECT ANSWER >>>>Occurs during service Duplicate payments occur: - CORRECT ANSWER >>>>When providers re-bill claims based on nonpayment from the initial bill submission An individual enrolled in Medicare who is dissatisfied with the government's claim determination is entitled to reconsideration of the decision. This type of appeal is known as - CORRECT ANSWER >>>>A beneficiary appeal Insurance verification results in which of the following - CORRECT ANSWER >>>>The accurate identification of the patient's eligibility and benefits The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: - CORRECT ANSWER >>>>Judicial review by a federal district court Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the providermay not ask about a patient's insurance information if it would delay what? - CORRECT ANSWER >>>>Medical screening and stabilizing treatment Ambulance services are billed directly to the health plan for - CORRECT ANSWER >>>>Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility Key performance indicators (KPIs) set standards for accounts receivables (A/R) and - CORRECT ANSWER >>>>Provide a method of measuring the collection and control of A/R

he patient discharge process begins when - CORRECT ANSWER >>>>The physician writes the discharge orders The nightly room charge will be incorrect if the patient's - CORRECT ANSWER >>>>Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system. The soft cost of a dissatisfied customer is - CORRECT ANSWER >>>>The customer passing on info about their negative experience to potential pts or through social media channels An advantage of a pre-registration program is - CORRECT ANSWER

The opportunity to reduce the corporate compliance failures within the registration process It is important to have high registration quality standards because - CORRECT ANSWER >>>>Inaccurate or incomplete patient data will delay payment or cause denials Telemed seeks to improve a patient's health by - CORRECT ANSWER Permitting 2 - way real time interactive communication between the patient and the clinical professional Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a monthly fee is known as a - CORRECT ANSWER HMO Identifying the patient, in the MPI, creating the registration record, completing medical necessity screening, determining insurance eligibility and benefits resolving managed care, requirements and completing financial education/resolution are all - CORRECT ANSWER

The data collection steps for scheduling and pre-registering a patient Medicare Part B has an annual deductible, and the beneficiary is responsible for - CORRECT ANSWER >>>>A co-insurance payment for all Part B covered services The standard claim form used for billing by hospitals, nursing facilities, and other inpatient - CORRECT ANSWER >>>>UB- 04 Charges are the basis for - CORRECT ANSWER >>>>Separation of fiscal responsibilities between the patient and the health plan All of the following are forms of hospital payment contracting EXCEPT - CORRECT ANSWER >>>>Contracted Rebating The most common resolution methods for credit balances include all of the following EXCEPT: - CORRECT ANSWER >>>>Designate the overpayment for charity care Ambulance services are billed directly to the health plan for - CORRECT ANSWER >>>>The portion of the bill outside of the patient's self-pay A claim for reimbursement submitted to a third-party payer that has all the information and documentation required for the payer to make a decision on it is known as - CORRECT ANSWER >>>>A clean claim The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to - CORRECT ANSWER >>>>Medicare and Medicaid payments

The Correct Coding Initiative Program consists of - CORRECT ANSWER

Edits that are implemented within providers' claim processing systems To provide a patient with information that is meaningful to them, all of the following factors must be included EXCEPT - CORRECT ANSWER The actual physician reimbursement Which department supports/collaborates with the revenue cycle? - CORRECT ANSWER >>>>Information Technology Medicare Part B has an annual deductible and the beneficiary is responsible for - CORRECT ANSWER >>>>a co-insurance payment for all Part B covered services The two types of claims denial appeals are - CORRECT ANSWER Beneficiary and Provider Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) - CORRECT ANSWER Registration staff members routinely contact managed care plans for prior authorizations before the patient is seen by the on duty physician Rural Health Clinics (RHC) personnel can provide services in all of the following locations, EXCEPT - CORRECT ANSWER >>>>Providing inpatient services in the RHC The patient discharge process begins when - CORRECT ANSWER The physician writes the discharge order

Departments that need to be included in charge master maintenance include all of the following EXCEPT - CORRECT ANSWER >>>>Quality Assurance The first thing a health plan does when processing a claim is - CORRECT ANSWER >>>>Check if the patient is a health plan beneficiary and what is the coverage Vital to accurate calculations of a patient's self-pay amount is - CORRECT ANSWER >>>> The most accurate way to validate patient information is to - CORRECT ANSWER >>>>require clinical staff to verify information at each treatment encounter In order for Regulation Z to apply, a hospital must - CORRECT ANSWER

All of the following are minimum requirements for new patients with no MPI number EXCEPT - CORRECT ANSWER >>>>Address A typical routine patient financial discussion would include - CORRECT ANSWER >>>>Explaining the benefits identified through verifying the patients insurance Components of financial education include informing the patient of the hospital's financial policies, assessing the patient's ability to pay and - CORRECT ANSWER >>>>Reviewing payment alternatives with the patient so appropriate resolution of the health care financial obligation is achieved

HFMA best practices indicate that the technology evaluation is conducted to - CORRECT ANSWER >>>>Continually align technology with processes rather than technology dictating processes Scheduler instructions are used to prompt the scheduler to - CORRECT ANSWER >>>>Complete the scheduling process correctly based on service requested When billing Rural Health Clinic services on a UB-04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521). Although codes are collapsed into a single revenue code, it is still important to list the appropriate CPT codes as part - CORRECT ANSWER >>>>These codes will be used to determine medical necessity and useful in determining what happened during the encounter What is likely to occur if credit balances are not identified separately from debit balances in accounts receivable? - CORRECT ANSWER

The accounts receivable level would be understated The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as - CORRECT ANSWER insurance verification and reimbursable charges Unless the patient encounter is an emergency, it is more efficient and effective to - CORRECT ANSWER >>>>Collect all information after the patient has been discharged Applying the contracted payment amount to the amount of total charges yields - CORRECT ANSWER >>>>A pricing agreement "Hard-coded" is the term used to refer to - CORRECT ANSWER Codes for services, procedures, and drugs automatically assigned by the charge master

The advantages to using a third-party collection agency include all of the following EXCEPT - CORRECT ANSWER >>>>Providers pay pennies on each dollar collected Which of the following is usually covered on a Conditions of Admission form - CORRECT ANSWER >>>>Release of information The 501(r) regulations require not-for-profit providers (501(c)(3) organizations) to do which of the following activities. - CORRECT ANSWER >>>>Complete a community needs assessment and develop a discount program for patient balances after insurance payment To be eligible for Medicaid, an individual must - CORRECT ANSWER

meet income and asset requirements Eliminating mail time and reducing data entry time, electronically monitoring the receipt of claims and online claim adjudication, more prompt payment are all benefits achieved by - CORRECT ANSWER The electronic submission of claims using electronic transfers There are unique billing requirements based on - CORRECT ANSWER The provider type The unscheduled "direct" admission represents a patient who: - CORRECT ANSWER >>>>Is admitted from a physician's office on an urgent basis In resolving medical accounts, a law firm may be used as: - CORRECT ANSWER >>>>A substitute for a collection agency

The legal authority to request and analyze provider claim documentation to ensure that - CORRECT ANSWER >>>>The Office of the U.S. Inspector General (OIG) The office of inspector general (OIG) publishes a compliance work plan - CORRECT ANSWER >>>>Annually Room and bed charges are typically posted - CORRECT ANSWER

From the midnight census All of the following information should be reviewed as part of schedule finalization EXCEPT: - CORRECT ANSWER >>>>The results of any and all test

Revenue cycle activities occurring at the point-of-service include all of the following EXCEPT: - CORRECT ANSWER >>>>Providing charges to the third-party payer as they are incurred HFMA's patient financial communications best practices specify that pts should be told about the - CORRECT ANSWER >>>>The service providers that typically participate in the service, e.g. radiologists ,pathologists, etc. The core financial activities resolved within patient access include: - CORRECT ANSWER >>>>Scheduling, pre-registration, insurance verification and managed care processing A decision on whether a patient should be admitted as an inpatient or become about patient observation patient requires medical judgments based on all of the following EXCEPT - CORRECT ANSWER >>>>The patient's home care coverage

Which option is a benefit of pre-registering a patient for services - CORRECT ANSWER >>>>The patient arrival process is expedited, reducing wait times and delays Days in A/R is calculated based on the value of - CORRECT ANSWER

The total accounts receivable on a specific date Case Management requires that a case manager be assigned - CORRECT ANSWER >>>>To a select patient group Which of the following is required for participation in Medicaid? - CORRECT ANSWER >>>>Meet income and assets requirements All of the following are steps in safeguarding collections EXCEPT - CORRECT ANSWER >>>>Issuing receipts The Electronic Remittance Advice (ERA) data set is : - CORRECT ANSWER A standardized form that provides third party payment details to providers All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT - CORRECT ANSWER Services and procedures that are custodial in nature Medicare beneficiaries remain in the same "benefit period" - CORRECT ANSWER >>>>Until the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days It is important to calculate reserves to ensure - CORRECT ANSWER Stable financial operations and accurate financial reporting

A claim is denied for the following reasons, EXCEPT: - CORRECT ANSWER >>>>The submitted claim does not have the physicians signature HFMA best practices call for patient financial discussions to be reinforced - CORRECT ANSWER >>>>By changing policies to programs Patients should be informed that costs presented in a price estimate may - CORRECT ANSWER >>>>Vary from estimates, depending on the actual services performed The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physicians to do all of the following EXCEPT: - CORRECT ANSWER >>>>Obtain higher compensation for physicians Charges as the most appropriate measurement of utilization enables - CORRECT ANSWER >>>>Accuracy of expense and cost capture Once the EMTALA requirements are satisfied - CORRECT ANSWER

The remaining registration processing is initiated at the bedside or in a registration area Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite discharge, the HFMA best practice is to: - CORRECT ANSWER >>>>Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow In Chapter 7 straight bankruptcy filling - CORRECT ANSWER >>>>The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt

Chapter 13 Bankruptcy, debtor rehabilitation is a court proceeding - CORRECT ANSWER >>>>That reorganizes a debtor's holdings and instructs creditors to look to the debtors' future earnings for payment This concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits - CORRECT ANSWER >>>>Claims processing The importance of Medical records being maintained by HIM is that the patient records: - CORRECT ANSWER >>>>Are the primary source for clinical data required for reimbursement When there is a request for service, the scheduling staff member must confirm the patient's unique identification information to - CORRECT ANSWER >>>>Ensure that she/he accesses the correct information in the historical database Maintaining routine contact with the health plan or liability payer, making sure all required information is provided and all needed approvals are obtained is the responsibility of: - CORRECT ANSWER

Case Management Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and - CORRECT ANSWER >>>>Provide a method of measuring the collection and control of A/R With any remaining open balances, after insurance payments have been posted, the account financial liability is - CORRECT ANSWER Potentially transferred to the patient Pricing transparency is defined as readily available information on the price of healthcare services, that together with other information, help define the value of those services and enable consumers to - CORRECT

ANSWER >>>>Identify, compare, and choose providers that offer the desired level of value All of the following are potential causes of credit balances EXCEPT - CORRECT ANSWER >>>>A patient's choice to build up a credit against future medical bills A comprehensive "Compliance Program" is defined as - CORRECT ANSWER >>>>Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met An originating site is - CORRECT ANSWER >>>>The location of the patient at the time the service is provided Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare established guideline(s) used to determine: - CORRECT ANSWER >>>>Which diagnoses, signs, or symptoms are reimbursable If further treatment can only be provided in a hospital setting, the patient's condition cannot be evaluated and/or treated within 24 hours, or if there is not an anticipation of improvement in the patient's condition with 24 hours, the patient - CORRECT ANSWER >>>>Will be admitted as an inpatient The benefit of Medicare Advantage Plan is - CORRECT ANSWER

Patients generally have their Medicare-coverage healthcare through the plan and do not need to worry about "part a" or "part b" benefits The process of creating the pre-registration record ensures - CORRECT ANSWER >>>>Accurate billing

Claims with dates of service received later than one calendar year beyond the date of service, will be - CORRECT ANSWER >>>>Denied by Medicare A portion of the accounts receivable inventory which has NOT qualified for billing includes - CORRECT ANSWER >>>>Charitable pledges The standard claim form used for billing by hospitals, nursing facilities, and other in-patient - CORRECT ANSWER >>>>UB- 04 Once the price is estimated in the pre-service stage, a provider's financial best practice is to - CORRECT ANSWER >>>>Explain to the patient their financial responsibility and to determine the plan for payment Internal controls addressing coding and reimbursement changes are put in place to guard against - CORRECT ANSWER >>>>Compliance fraud by upcoding Health Plan Contracting Departments do all of the following EXCEPT - CORRECT ANSWER >>>>Establish a global reimbursement rate to use with all third-party payer For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: - CORRECT ANSWER

Should take place between the patient or guarantor and properly trained provider representatives What type of account adjustment results from the patient's unwillingness to pay a self-pay balance? - CORRECT ANSWER >>>>Bad debt adjustment

Most major health plans including Medicare and Medicaid, offer - CORRECT ANSWER >>>>Electronic and/or web portal verification The important Message from Medicare provides beneficiaries information concerning their - CORRECT ANSWER >>>>Right to appeal a discharge decision if the patient disagrees with the plan Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the provider may not ask about a patient's insurance information if it would delay what? - CORRECT ANSWER >>>>Medical screening and stabilizing treatment Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implement - CORRECT ANSWER >>>>Monitor compliance Medicare will only pay for tests and services that - CORRECT ANSWER

Medicare determines are "reasonable and necessary" The physician who wrote the order for an inpatient service and is in charge of the patients - CORRECT ANSWER >>>>The attending physician When primary payment is received, the actual reimbursement - CORRECT ANSWER >>>>Is compared to the expected reimbursement, the remaining contractual adjustments are posted, and secondary claims are submitted The ICD-10 codes set and CPT/HCPCS code sets combines provide - CORRECT ANSWER >>>>The specificity and coding needed to support reimbursement claims

In a self-insured (or self-funded) plan, the costs of medical care are - CORRECT ANSWER >>>>Borne by the employer on a pay-as-you-go basis Indemnity plans usually reimburse: - CORRECT ANSWER >>>>A certain percentage of the charges after the patient meets the policy's annual deductible The first and most critical step in registering a patient, whether scheduled or unscheduled, is - CORRECT ANSWER >>>>Verifying the patient's identification When Recovery Audit Contractors (RAC) identify improper payments as over payments, the - CORRECT ANSWER >>>>Send a demand letter to the provider to recover the over payment amount Across all care settings, if a patient consents to a financial discussion during a medical encounter - CORRECT ANSWER >>>>Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by: - CORRECT ANSWER >>>>Each state's Medicaid plan Medicare patients are NOT required to produce a physician order to receive which of these services - CORRECT ANSWER >>>>Screening Mammography, flu vaccine or pneumonia vaccine EFT (electronic funds transfer) is - CORRECT ANSWER >>>>An electronic transfer of funds from payer to payee

The importance of medical records being maintained by HIM is that the patient records - CORRECT ANSWER >>>>Are the primary source for clinical data required for reimbursement by health plans and liability payers Days in A/R is calculated based on the value of: - CORRECT ANSWER

The time it takes to collect anticipated revenue To maximize the value derived from customer complaints, all consumer complaints should be - CORRECT ANSWER >>>>Responded to within two business days A scheduled inpatient represents an opportunity for the provider to do which of the following? - CORRECT ANSWER >>>>Complete registration and insurance approval before service In the pre-service stage, the requested service is screened for medical necessity, health - CORRECT ANSWER >>>>Pre-authorization are Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by: - CORRECT ANSWER >>>>Each state's Medicaid plan Medicare patients are NOT required to produce a physician order to receive which of these services - CORRECT ANSWER >>>>Screening Mammography, flu vaccine or pneumonia vaccine EFT (electronic funds transfer) is - CORRECT ANSWER >>>>An electronic transfer of funds from payer to payee The importance of medical records being maintained by HIM is that the patient records - CORRECT ANSWER >>>>Are the primary source for clinical data required for reimbursement by health plans and liability payers Days in A/R is calculated based on the value of: - CORRECT ANSWER >>>>The time it takes to collect anticipated revenue To maximize the value derived from customer complaints, all consumer complaints should be - CORRECT ANSWER >>>>Responded to within two business days A scheduled inpatient represents an opportunity for the provider to do which of the following? - CORRECT ANSWER >>>>Complete registration and insurance approval before service In the pre-service stage, the requested service is screened for medical necessity, health - CORRECT ANSWER >>>>Pre-authorization are obtained Hospitals need which of the following information sets to assess a patient's financial status: - CORRECT ANSWER >>>>Patient and guarantor's income, expenses and assets Patients are contacting hospitals to proactively inquire about costs and fees prior to - CORRECT ANSWER >>>>The fact that charge master lists the total charge, not net charges that reflect charges after a payer's contractual adjustment HIPAA had adopted Employer Identification Numbers (EIN) to be used in standard transactions to identify the employer of an individual described in a transaction EIN's are assigned by - CORRECT ANSWER The Internal Revenue Service

The HCAHPS (hospital consumer assessment of healthcare providers and systems) initiative - CORRECT ANSWER >>>>Provide a standardized method for evaluating patient's perspective on hospital care. A large number of credit balances are not the result of overpayments but of - CORRECT ANSWER >>>>Posting errors in the patient accounting system A Medicare Part A benefit period begins: - CORRECT ANSWER >>>>With admission as an inpatient Chapter 13 Bankruptcy, debtor rehabilitation, is a court proceeding - CORRECT ANSWER >>>>That reorganizes a debtor's holdings and instructs creditors to look to the debtor's future earnings for payment Which of the following in NOT included in the Standardized Quality Measures - CORRECT ANSWER >>>>Cost of services The disadvantages of outsourcing include all of the following EXCEPT: - CORRECT ANSWER >>>>Reduced internal staffing costs and a reliance on outsourced staff Improving the overall patient experience requires revenue cycle leadership and staff to simultaneously be: - CORRECT ANSWER

Clear on policies and consistent in applying the policies Because 501(r) regulations focus on identifying potential eligible financial assistants patients hospitals must: - CORRECT ANSWER Hold financial conversations with patients as soon as possible Which of the following is NOT contained in a collection agency agreement? - CORRECT ANSWER >>>>A mutual hold-harmless clause

HFMA best practices stipulate that a reasonable attempt should be made to have the financial - CORRECT ANSWER >>>>As early as possible, before a financial obligation is incurred Recognizing that health coverage is complicated and not all pts are able to navigate this terrain, HFMA best practices specify that - CORRECT ANSWER >>>>Patients should be given the opportunity to request a patient advocate, family member or other designee to help them In these discussions For scheduled patients, important revenue cycle activities In the Time of Service stage DO NOT INCLUDE: - CORRECT ANSWER >>>>Final bill is presented for payment HFMA's patient financial communication best practices specify that patients should be told about the types of services provided and - CORRECT ANSWER >>>>The service providers that typically participate in the service, e.g., radiologists, pathologists, etc. Successful account resolution begins with - CORRECT ANSWER

Collecting all deductibles and copayments during the pre-service stage Recognizing that health coverage is complicated and not all patients are able to navigate this terrain, HFMA best practices specify that - CORRECT ANSWER >>>>Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions In the balance resolution process, providers should: - CORRECT ANSWER >>>>Ask the patient if he or she would like to receive

information about payment options and supportive financial assistance programs Business ethics, or organizational ethics represent: - CORRECT ANSWER

The principles and standards by which organizations operate Which option is a government-sponsored health care program that is financed through taxes and general revenue funds - CORRECT ANSWER Medicare Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on; a monthly fee is known as a - CORRECT ANSWER HMO In a Chapter 7 Straight Bankruptcy filing - CORRECT ANSWER >>>>The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt When there is a request for service the scheduling staff member must confirm the patient's - CORRECT ANSWER >>>>Ensure that she/he accesses the correct information in the historical database A four digit number code established by the National Uniform Billing Committee (NUBC)that categorizes/classifies a line item in the charge Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions In the balance resolution process, providers should: - CORRECT ANSWER >>>>Ask the patient if he or she would like to receive information about payment options and supportive financial assistance programs Business ethics, or organizational ethics represent: - CORRECT ANSWER >>>>The principles and standards by which organizations operate Which option is a government-sponsored health care program that is financed through taxes and general revenue funds - CORRECT ANSWER >>>>Medicare Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on; a monthly fee is known as a - CORRECT ANSWER >>>>HMO In a Chapter 7 Straight Bankruptcy filing - CORRECT ANSWER >>>>The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt When there is a request for service the scheduling staff member must confirm the patient's - CORRECT ANSWER >>>>Ensure that she/he accesses the correct information in the historical database A four digit number code established by the National Uniform Billing Committee (NUBC)that categorizes/classifies a line item in the charge master is known as - CORRECT ANSWER >>>>Revenue codes Appropriate training for patient financial counseling staff must cover all of the following EXCEPT: - CORRECT ANSWER >>>>Documenting the conversation in the medical records

The ACO investment model will test the use of pre-paid shared savings to - CORRECT ANSWER >>>>Encourage new ACOs to form in rural and underserved areas When recovery audit contractors (RAC) identify improper payments as over payments the claims processing contractor must - CORRECT ANSWER >>>>Send a demand letter to the provider to recover the over payment amount The purpose of the ACA mandated Community Health Needs Assessment is - CORRECT ANSWER >>>>To identify significant health needs, prioritize those needs and identify resources to address them A balance sheet is - CORRECT ANSWER >>>>A statement of assets, liabilities, and capital for an organization at a specified point in time Hospitals can only convert an inpatient case to observation if the hospital utilization review committee determines this status before the patient is discharged and - CORRECT ANSWER >>>>Prior to billing, that an observation setting will be more appropriate During pre-registration, a search for the patients MPI number is initiated using which of the following data sets? - CORRECT ANSWER

Patient's full legal name and date of birth or the patient's Social Security number Because case managers document the clinical reasons for treatment, they are - CORRECT ANSWER >>>>A good resource when developing written appeals of denials The Truth in Lending Act establishes - CORRECT ANSWER Disclosure rules for consumer credit sales and consumer loans

What is Continuum of Care? - CORRECT ANSWER >>>>The coordination and linkage of resources needed to avoid the duplication of services and the facilitation of a seamless movement among care settings HIPAA privacy rules require covered entities to take all of the following actions EXCEPT - CORRECT ANSWER >>>>Use only designated software platforms to secure patient data The Two Midnight Rule allows hospitals to account for total hospital time when determining if an inpatient admission order should be written based on - CORRECT ANSWER >>>>A beneficiary needing a minimum of 48 hours of care Since passage of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to - CORRECT ANSWER >>>>Assist patients in understanding their insurance coverage and their financial obligation HFMA patient financial communications best practices call for annual training for all staff EXCEPT - CORRECT ANSWER >>>>Nursing The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as - CORRECT ANSWER

Insurance verification of reimbursable charges Net Accounts Receivable is - CORRECT ANSWER >>>>The amount an entity is reasonably confident of collecting from overall accounts receivable. ED patients should be informed that their ability to pay - CORRECT ANSWER >>>>Will not interfere with treatment of any emergency medical conditions

Providers are advised that it is best to establish patient financial responsibility and assistance policies and make sure they are followed internally and by - CORRECT ANSWER >>>>Business affiliates Incorrect data gathering can cause all of the following EXCEPT - CORRECT ANSWER >>>>The inability to discuss quality with physicians All Hospitals are required to establish a written financial assistance policy that applies to - CORRECT ANSWER >>>>All emergency and medically necessary care All of the following are reference resources used to help guide in the application of business ethics EXCEPT - CORRECT ANSWER

Consumer satisfaction reports Each patient is assigned a unique number, commonly called the - CORRECT ANSWER >>>>Master Patient Index (MPI) number HIPAA contains all of the following goals EXCEPT - CORRECT ANSWER To ensure proper coding across the continuum of care Which of the following is NOT included in the Standardized Quality Measures? - CORRECT ANSWER >>>> Account Receivable (A/R) Aging reports - CORRECT ANSWER >>>>Divide accounts receivable into 30, 60, 90 ,120 days past due categories Patients expect value for their healthcare dollar, including greater transparency of - CORRECT ANSWER >>>>Quality and price information The impact of denials on the revenue cycle includes all of the following EXCEPT - CORRECT ANSWER >>>>Patient outcomes