2024 CRCR Certification Exam Q&A - Healthcare Revenue Cycle Management, Exercises of Nursing

Download 2024 CRCR Certification Exam Q&A - Healthcare Revenue Cycle Management and more Exercises Nursing in PDF only on Docsity! CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS (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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 ✅ CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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) CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS 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 Examples of ethics violations that impact the revenue cycle include all of the following EXCEPT - correct answer ✅Seeking payment options for patient self-pay Scheduled procedures routinely include - correct answer ✅Patient preparation instructions CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS ICD-10-CM and ICD-10-PCS codes sets are modifications of - correct answer ✅The International ICD-10 codes as developed by the WHO (World Health Organization) The result of accurate census balancing on a daily basis is - correct answer ✅The correct recording of room charges All of the following are steps in verifying insurance EXCEPT - correct answer ✅The patient signing the statement of financial responsibility Health Information Management (HIM) is responsible for - correct answer ✅All patient medical records This form contains major items, subdivided into a total of 55 detailed items, and is used by professional service providers CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS and not hospitals for submitting claims for services to health plans this form is called - correct answer ✅The 1500 Which of the following is NOT a factor in self-pay follow-up? - correct answer ✅The type of patient (inpatient, out-patient) The Office of Inspector General (OIG) was created - correct answer ✅Detect and prevent fraud, waste, and abuse - correct answer ✅ CRCR CERTIFICATION EXAM QUESTIONS AND ANSWERS LATEST 2024 RATED A PLUS