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Certified Revenue Cycle Representative Exam
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- The following statements best describe best practice established by the Medical debt task force.
A. Educate patients B. Coordinate to avoid duplicate patient contacts C. Exercise moderate judgment when communicating with providers about scheduled service D. Be consistent in key aspects of account resolution E. Report to healthcare plans when the patient's account is transferred to collection agency F. Follow best practice for communication Ans>> Educate patients B. Coordinate to avoid duplicate patient contacts
D. Be consistent in key aspects of account resolution F. Follow best practice for communication
- Which is Not a main HFMA healthcare Dollar & Sense revenue cycle Initiative? A.Patient Financial Communications B.Price Transparency C.Medical Account Resolution D.Process Compliance Ans>> Process compliance This option refers to a patient financial communications best practice. Annual
- Which of the following are essential elements of an effective compliance program? A. Established compliance standards and procedures. B. Designation of a compliance officer employed within the Billing Depart- ment. C.Oversight of personnel by high-level personnel. D. Automatic dismissal of any employee excluded from participation in a federal healthcare program. E. Reasonable methods to achieve compliance with standards, including mon- itoring systems and hotlines. Ans>>Established compliance standards and proce- dures. C.Oversight of personnel by high-level personnel. E.Reasonable methods to achieve compliance with standards, including monitoring systems and hotlines.
- Annually, the OIG publishes 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. Payments to Physicians for Co-Surgery Procedures
B. Denials and Appeals in Medicare Part D C. Medicare Hospital Payments for Claims Involving the Acute- and Post-Acute-Care Transfer Policies D. Standard Unique Employer Identifier Ans>> Standard Unique Employer Identifier
- A physician documents a fictitious epidural in a patient's medical record in an effort to receive additional payment. This is an example of miscoding claims. True or False: False
- Several unauthorized claims are sent to a health plan with the wrong procedure codes. This is an example of overcharging. True or a false: True
- What do business/organizational ethics represent? A. Principles and standards by which organizations operate B. A healthcare provider's practices and principles: C. An employee's 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 care, elimination of duplicate services, and prevention of medical errors for a population 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 services. 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- mination of net patient service revenue: A. Net patient service 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 explest price concession, less any applicable implicit price concession(s) 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 service 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
A. Patients in recovery from cardiac or pulmonary disease, stroke or neuro- logical disorders, or orthopedic surgery B. Observation, newborn, Emergency (ED)
C. Skilled nursing, hospice, home health and clinic D. People with pulmonary disease, cardiac disease, cancer, and conditions requiring IV therapy or tube feedings Correct Ans>> 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: A.Name, date of birth, address and telephone number B. Date of birth, social security number and sex C. Full legal name, date of birth, sex and social security number D. Full legal name, ordering physician, insurance identification number Ans>> Full legal name, date of birth, sex and social security number
- Pre-registration is defined as: A. The collection of demographic information, insurance data, financial infor- mation, providing reminders, prep information, and identifying the potential need for financial assistance for scheduled patients. B. Using information from the ordering physician's office, creating a new EHR record and visit for all scheduled patients.
sional services; Medicare Part C or Medicare Advantage plans are managed care plans combining Part A and Part B coverages; and Medicare Part D is the prescription drug coverage benefit. Ans>>Medicare Part A provides benefits for inpatient hospital services, skilled nursing care and home health care; Medicare Part B covers outpatient and professional services; Medicare Part C or Medicare Advantage plans are managed care plans combining Part A and Part B coverages; and Medicare Part D is the prescription drug coverage benefit.
- Which of the following statements about Medicaid eligibility is not true? A. Medicaid programs in states adopting the Medicaid expansion options under the Affordable Care Act are provided without regard to income levels for permanent residents of the state. B. Medicaid is a federally aided, state operated and administrated program to provide health and long-term care coverage for low income individuals and families. C. Medicaid categories are restricted to children, pregnant women and elderly in nursing homes. D. Medicaid is a federally funded program provided to states based on poverty guidelines. Ans>> Medicaid categories are restricted to children, pregnant women and elderly in nursing homeS
- Examples of managed care plans include: A. HMO, PPO and EPO plans B. POS, Concierge plans, Medicare Advantage plans C.Direct contracting for specific services from specific providers D. All of the above Ans>> HMO, PPO and EPO plans
- Patient Financial Communications best practices include all of the follow- ing activities except: A. Communicating the details of the patient's insurance coverage including eligibility and benefits. B. Collecting payment or initiating the process to immediately remove the patient from the service schedule. C. Discussing unpaid balances and providing financial assistance informa- tion, as appropriate. D. Providing financial counseling including assistance with potential Medicaid eligibility processing. Correct Ans>> Collecting payment or initiating the process to immediately remove the patient from the service schedule.
- Which statement includes the required components of an accurate pricing determination:
C. Opportunity to clarify arrival instructions and time for the day of service. D. Identification of patients who are likely to be "no shows". Ans>> Identification of patients who are likely to be "no shows".
- Review Your Knowledge Which patients are considered scheduled?
A. Observation Patients B. Emergency Department Patients C. Recurring/Series Patients D. Hospice Care Ans>> Recurring/Series Patients
- Name the guideline that Medicare established to determine which diag- noses, signs, or symptoms are payable.
A. Patient Identifiers B. Local Coverage Determination C. Advance Beneficiary Notice D. Scheduling Instructions Ans>> Local Coverage Determination
- What is the purpose of insurance verification?
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. Medicald C. Self-Insured Plans D. Liability Coverage Ans>> Medicald
- 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. 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. D. All of the above.: D All of the above
A.Patients are initially triaged by medical personnel and a "quick" registration initi- ated 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. D. All of the above.
- Typical activities which must be performed when an unscheduled patient arrives for service include:
A.Activation of the registration record based on the previous visit information, insurance verification and documentation of patient arrival time. B. "Quick registration" to expedite the arrival process and instructions to return to the registration desk upon completion of service to finalize the registration record and check out of the facility. C. Identification of patient in the MPI or initiation of a new MPI record, insur- ance verification of eligibility and benefits, managed care screening, medical necessity screening, price estimation and financial counseling to achieve the
appropriate account resolution. D. Initiation of a new MPI record, insurance verification if time permits, man- aged care screening, price estimation and financial counseling to achieve the appropriate account resolution. Incorrect Ans>> Identification of patient in the MPI or initiation of a new MPI record, insurance verification of eligibility and benefits, managed care screening, medical necessity screening, price estimation and financial counseling to achieve the appro- priate account resolution.
- 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 physician's office billing
