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Certified Revenue Cycle Representative Exam
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- Annually, the OIG publishes a work plan of compliance issues and objec- tives that will be focused on throughout the following year. Identify which option is NOT a work plan task mentioned in this course. A. Payments to Physicians for Co-Surgery Procedures B. Denials and Appeals in Medicare Part D C. Standard Unique Employer Identifier D. Medicare Hospital Payments for Claims involving the Acute- and Post- Acute-Care Transfer Policies Ans>> Standard Unique Employer Identifier
- T/F: Consents are signed as part of the post-service process. : False
- T/F: Patient service costs are calculated in the pre-service process for scheduled patients.
: True
- T/F: The patient is scheduled and registered for service is a time-of-service activity. : False
- T/F: The patient account is monitored for payment is a time-of-service activity. : False
- T/F: Case management and discharge planning services are a post-service activity : False
- T/F: Sending the bill electronically to the health plan is a time-of-service activity. : False
- The following statements describe the best practices established by the Medical Debt Task Force. Select the True statements.
- What is the objective of the HCAHPS initiative? A. To provide a standardized method for evaluating patients' perspective on hospital care. B. To provide clear communication and good customer service, which will give the provider a competitive edge. C. To conduct evaluations concerning patients' perspective on hospital care. D. To make certain that during registration key information is verified by means of a picture ID and an insurance card. Ans>> To provide a standardized method for evaluating patients' perspective on hospital care.
- Which option is NOT a continuum of care provider? A. Physician B. Health Plan Contracting C. Hospice D. Skilled Nursing Facility Ans>> Health Plan Contracting
- Annually, the OIG published a work plan of compliance issues and ob- jectives that will be focused on throughout the following year. Identify which option is NOT a work plan task mentioned in this course. A. Payment to Physicians for Co-surgery procedures B. Denials and Appeals in Medicare Part D
C. Medicare Hospital Payments for Claims involving acute- and post-acute-care transfer policies D. Standard Unique Employer Identifier Ans>> 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? A. The Correct Coding Initiative (CCI) B. The Advance Beneficiary Notice of Noncoverage (ABN) C. The Medicare Secondary Payer (MSP) D. Modifiers Ans>> The Correct Coding Initiative
- T/F: 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. a financial misconduct. : True
- T/F: 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
- T/F: Several unauthorized claims are sent to a health plan with the wrong procedural codes. This is an example of overcharging. : True
- What do business/organizational ethics represent? A. Principles and standards by which organizations operate. B. A healthcare providers practices and principles. C. An employees actions influenced by experiences and value system D. The patient privacy standard within healthcare. Ans>> Principles and standards by which organizations operate
- What is the intended outcome of collaborations made through an ACO delivery system? A. To ensure appropriateness of case, elimination of duplicate services, and prevention of medical errors for a populations of patients. B. To create cost-containment provisions to reform the healthcare delivery system. C. To reform the healthcare system into a system that rewards greater value, improves the quality of care and increases efficiency in the delivery of ser- vices. D. To provide financial incentives to physicians for reporting quality data to CMS. Ans>> To ensure appropriateness of care, elimination of duplicate services, and prevention of medical errors for a population of patients.
- Which of these statements describes the new methodology for the deter- minations of net patient service revenue: A. Net patient services revenue is defined as the average payment amount for the
payer but not recorded until the end of the month processing is completed. B. Gross patient service revenue is recorded as net patient service revenue until such time as all payments are received. C. 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. D. Net patient service revenue is gross revenue minus any contractual adjust- ments applicable to the account. Any additional adjustments are not recorded until the account reaches a zero balance. E. Net patient services revenue is the sum of the balances of all charges and payments recorded in the accounting period. Ans>> 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.
- What are KPIs? A. Benchmarks which are used to compare Key Performance Indicators in an organization to an agreed upon average or expected standard within the same
A. To identify information that does not have to be collected from the patient. B. To ensure accuracy of the health plan information. C. To effectively complete the MSP screening process. D. To complete guarantor information if the guarantor is not the patient. Ans>> 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? A. Medicare B. Medicaid C. Self-Insured Plans D. Liability Coverage Ans>> Medicaid
- Which option is NOT a specific managed care requirement? A. Referrals B. Notification C. Preferred Provider Organization D. Discharge Planning Ans>> Preferred Provider Organization
- What is the first component of a pricing determination? A. Identify the service or test involved.
B. Verification of the patients insurance eligibility and benefits. C. Inform the patient that physician services are or are not included. D. Use a documented workflow or other tool for guidance in determining an estimate. Ans>> Verification of the patients insurance eligibility and benefits.
- What is the purpose of financial counseling? A. To address the most appropriate ways to conduct financial interactions at every point. B. To train staff on how to request payment and conduct conversations. C. To educate the patient on his/her health plan coverage and financial respon- sibility for healthcare services. D. To help the patient understand exactly how a contracted health plan will resolve their benefit package. Ans>> To educate the patient on his/her health plan coverage and financial responsibility for healthcare services.
- EMTALA prohibits inquiries about health plan or liability payer information if the inquiry will delay examination or treatment. What other requirements apply to the Emergency Department registration work? A. Patients are initially triaged by a medical personnel and a "quick" registra- tion initiated to allow electronic order entry and documentation. B. Identification and verification of insurance eligibility and benefits once the medical screening has been completed. C. No additional registration may occur until the patient is stabilized.
- Case managers are involved from admission with the discharge planning process. The purpose of discharge planning is: A.To estimate how long the patient will be in the hospital, identify the expected outcome of the hospitalization and initiate any special requirements for ser- vices at or after the time of discharge. B. To obtain certification of payment from the patient's insurance plan prior to discharge. C. To ensure that the information necessary for the physicians office billing is collected prior to discharge. D. To schedule the days for which concurrent review must be completed and signed off by the attending and referring physicians. Ans>> To estimate how long the patient will be in the hospital, identify the expected outcome of the hospitalization and initiate any special requirements for services at or after the time of discharge.
- The chargemaster is basically a list of services, procedures, room accom- modations, supplies, drugs, tests, etc. typically associated with the billing for services rendered to patients. Challenges typically associated with the chargemaster include: A. Providing comprehensive education to end users in the service depart- ments. B. Omission of charges, obsolete or invalid codes, and the omission of re- quired modifiers. C. Incorporating specific payer requirements for bundled charges.
D. Revisions based on physician practice patterns. Ans>> Omission of charges, obsolete or invalid codes, and the omission of required modifiers.
- Ultimately, the services provided in the healthcare system are reduced to standard codes. The primary types of coding systems concurrently used in healthcare are: A. HIM; HCAPCS B. ICD-9/CPT/HCPCS codes C. ICD-10/ICD-10-PCS; CPT/HCPCS codes D. FASB; ASC 606 Ans>> ICD-10/ICD-10-PCS; CPT/HCPCS codes
- There are four code sets that provide health plans with additional informa- tion as they process claims. Those code sets are: A. Condition codes, occurrence codes, occurrence span codes, and value codes. B. Condition codes, revenue codes, occurrence codes, and value codes. C. Condition codes, HCPCS codes, value codes, and revenue codes. D. Condition codes, insurance codes, occurrence codes, and value codes. Ans>> Condition codes, occurrence codes, occurrence span codes, and value codes.
a set dollar amount, an outlier payment is added to the calculated payment. Ans>> 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. A payment scheme whereby the PPO pays a set percentage of charges. B. A discounting scheme where by health plans apply generic PPO rates to discount a providers claims, even though there is no contractual arrangement between the silent PPO and the provider. C. A discounting scheme where by the PPO sets a discount amount based on its internal calculations of the value of the care provided. D. A payment scheme which applies APC grouping to determine the cost to charge ration to be sued in paying claims. Ans>> A discounting scheme where by
health plans apply generic PPO rates to discount a providers claims, even though there is no contractual arrangement between the silent PPO and the provider.
- The concept of timely filing of claims is important to providers, payers and patients. Thus, providers are required to comply with timely claim filing rules. Which of the following statements are NOT true about timely filing limitations: A. Payers will waive timely filing denials for claims filed over a year from date of service. B.Traditional Medicare requires that a claim be filed within one year of the date of service. C. Managed care contracts may impose timely filing rules specific to a providers contract. D. States may set timely filing deadlines for health care claims. Ans>> Payers will waive timely filing denials for claims filed over a year from date of service.
- What does EMTALA require hospitals to do? A. To provide a medical screening examination and stabilizing treatment to every person presenting at an ED and requesting medical evaluation or treat- ment. B. To initially triage patients, where a "quick" registration record is generated to specifically allow order entry. C.To complete a standardized form signed by all patients that is used to inform patient about the admission and conditions which must be agreed upon. D. To confirm information that may be used to identify the patient in the provider's MPI, which includes the patients legal name, SSN, and DOB.
D. Because charge descriptions can vary greatly between providers. Ans>> To ensure it supports and represents the services provided within the organization.
- What is the responsibility of HIM? A. To maintain all patient medical records. B. To make information available instantly and secure to authorized users. C. To denote the medical procedures performed by a healthcare provider on a patient. D. To substantiate health insurance claims filed by the patient, the physician, and the provider. Ans>> To maintain all patient medical records.
- What are claim edits? A. Various data sources including Medicare and Medicaid bulletins and man- uals, individual health plan manuals. B. A multi-stake collaboration of more than 130 organizations- providers, health plans, vendors. C. Rules developed to verify the accuracy and completeness of claims based on each health plan's policies. D. The submission, receipt, and processing of automated claims, thereby eliminating mail time and reducing data entry time. Ans>> Rules developed to verify the accuracy and completeness of claims based on each health plan's policies.
- Which statement is NOT a unique billing rule specific to providers?
A. Overall aggregate payments made to a hospice are subject to a "cap amount", calculated by the MAC at the end of the hospice cap period. B. With the exception of physician services, Medicare reimbursement for hospice care is made at one of four pre-determined rates for each day of hospice care. C. When billing services on a UB-04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521). D. A patient may be balance billed for whatever amount the non-contracting physician charges above the health plans reimbursement amount. Ans>> 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: A. Hospitals may charge a sub-acute unit into an acute care unit without advanced approval from CMS. B.Telemedicine claims are not payable if the patient conducts the telemedicine visit from home. C. CMS developed the concept of hospitals without walls to increase ICU and med- surge inpatient capacity during pandemic.
