CRCR Certification Exam Review Questions and Answers, Exams of Nursing

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Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - solution The Medicare Administrative Contractor (MAC) at the end of the hospice cap period Which of the following is required for participation in Medicaid - solution Meet Income and Assets Requirements In choosing a setting for patient financial discussions, organizations should first and foremost - solution Respect the patients privacy A nightly room charge will be incorrect if the patient's - solution 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 - solution Purchase qualified health benefit plans regardless of insured's health status

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A portion of the accounts receivable inventory which has NOT qualified for billing includes: - solution Charitable pledges What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? - solution 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 - solution 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 - solution Case management Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? - solution 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

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assigned by - solution The Internal Revenue Service Checks received through mail, cash received through mail, and lock box are all examples of - solution Control points for cash posting What are some core elements if a board-approved financial assistance policy? - solution Eligibility, application process, and nonpayment collection activities A recurring/series registration is characterized by - solution 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 - solution Assist patients in understanding their insurance coverage and their financial obligation The purpose of a financial report is to: - solution Present financial information to decision makers

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Patient financial communications best practices produce communications that are

• solution Consistent, clear and transparent Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish - solution 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 - solution The Provider Reimbursement Review Board Concurrent review and discharge planning - solution Occurs during service Duplicate payments occur: - solution 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 - solution A beneficiary appeal

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Insurance verification results in which of the following - solution 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: - solution 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? - solution Medical screening and stabilizing treatment Ambulance services are billed directly to the health plan for - solution 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

• solution Provide a method of measuring the collection and control of A/R he patient discharge process begins when - solution The physician writes the discharge orders

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The nightly room charge will be incorrect if the patient's - solution Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system. The soft cost of a dissatisfied customer is - solution 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 - solution The opportunity to reduce the corporate compliance failures within the registration process It is important to have high registration quality standards because - solution Inaccurate or incomplete patient data will delay payment or cause denials Telemed seeks to improve a patient's health by - solution 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 - solution HMO

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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 - solution The data collection steps for scheduling and pre-registering a patient Medicare Part B has an annual deductible, and the beneficiary is responsible for - solution A co-insurance payment for all Part B covered services The standard claim form used for billing by hospitals, nursing facilities, and other inpatient - solution UB- Charges are the basis for - solution Separation of fiscal responsibilities between the patient and the health plan All of the following are forms of hospital payment contracting EXCEPT - solution Contracted Rebating The most common resolution methods for credit balances include all of the following EXCEPT: - solution Designate the overpayment for charity care

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Ambulance services are billed directly to the health plan for - solution 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 - solution 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 - solution Medicare and Medicaid payments The Correct Coding Initiative Program consists of - solution 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 - solution The actual physician reimbursement

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Which department supports/collaborates with the revenue cycle? - solution Information Technology Medicare Part B has an annual deductible and the beneficiary is responsible for - solution a co-insurance payment for all Part B covered services The two types of claims denial appeals are - solution Beneficiary and Provider Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) - solution 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 - solution Providing inpatient services in the RHC The patient discharge process begins when - solution The physician writes the discharge order

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Departments that need to be included in charge master maintenance include all of the following EXCEPT - solution Quality Assurance The first thing a health plan does when processing a claim is - solution 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 - solution The most accurate way to validate patient information is to - solution require clinical staff to verify information at each treatment encounter In order for Regulation Z to apply, a hospital must - solution All of the following are minimum requirements for new patients with no MPI number EXCEPT - solution Address A typical routine patient financial discussion would include - solution Explaining the benefits identified through verifying the patients insurance

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Components of financial education include informing the patient of the hospital's financial policies, assessing the patient's ability to pay and - solution 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 - solution Continually align technology with processes rather than technology dictating processes Scheduler instructions are used to prompt the scheduler to - solution 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 - solution 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? - solution The accounts receivable level would be understated

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The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as - solution insurance verification and reimbursable charges Unless the patient encounter is an emergency, it is more efficient and effective to - solution Collect all information after the patient has been discharged Applying the contracted payment amount to the amount of total charges yields - solution A pricing agreement "Hard-coded" is the term used to refer to - solution 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 - solution Providers pay pennies on each dollar collected Which of the following is usually covered on a Conditions of Admission form - solution Release of information

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The 501(r) regulations require not-for-profit providers (501(c)(3) organizations) to do which of the following activities. - solution Complete a community needs assessment and develop a discount program for patient balances after insurance payment To be eligible for Medicaid, an individual must - solution 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 - solution The electronic submission of claims using electronic transfers There are unique billing requirements based on - solution The provider type The unscheduled "direct" admission represents a patient who: - solution Is admitted from a physician's office on an urgent basis In resolving medical accounts, a law firm may be used as: - solution A substitute for a collection agency

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The legal authority to request and analyze provider claim documentation to ensure that - solution The Office of the U.S. Inspector General (OIG) The office of inspector general (OIG) publishes a compliance work plan - solution Annually Room and bed charges are typically posted - solution From the midnight census All of the following information should be reviewed as part of schedule finalization EXCEPT: - solution The results of any and all test Revenue cycle activities occurring at the point-of-service include all of the following EXCEPT: - solution 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 - solution The service providers that typically participate in the service, e.g. radiologists ,pathologists, etc.

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The core financial activities resolved within patient access include: - solution 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 - solution The patient's home care coverage Which option is a benefit of pre-registering a patient for services - solution The patient arrival process is expedited, reducing wait times and delays Days in A/R is calculated based on the value of - solution The total accounts receivable on a specific date Case Management requires that a case manager be assigned - solution To a select patient group Which of the following is required for participation in Medicaid? - solution Meet income and assets requirements

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All of the following are steps in safeguarding collections EXCEPT - solution Issuing receipts The Electronic Remittance Advice (ERA) data set is : - solution 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 - solution Services and procedures that are custodial in nature Medicare beneficiaries remain in the same "benefit period" - solution Until the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days It is important to calculate reserves to ensure - solution Stable financial operations and accurate financial reporting A claim is denied for the following reasons, EXCEPT: - solution The submitted claim does not have the physicians signature

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HFMA best practices call for patient financial discussions to be reinforced - solution By changing policies to programs Patients should be informed that costs presented in a price estimate may - solution 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: - solution Obtain higher compensation for physicians Charges as the most appropriate measurement of utilization enables - solution Accuracy of expense and cost capture Once the EMTALA requirements are satisfied - solution 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: - solution Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow

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In Chapter 7 straight bankruptcy filling - solution 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 - solution 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 - solution Claims processing The importance of Medical records being maintained by HIM is that the patient records: - solution 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 - solution Ensure that she/he accesses the correct information in the historical database

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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: - solution Case Management Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and

• solution 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 - solution 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 - solution Identify, compare, and choose providers that offer the desired level of value All of the following are potential causes of credit balances EXCEPT - solution A patient's choice to build up a credit against future medical bills A comprehensive "Compliance Program" is defined as - solution Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met

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An originating site is - solution 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: - solution 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 - solution Will be admitted as an inpatient The benefit of Medicare Advantage Plan is - solution 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 - solution Accurate billing

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Claims with dates of service received later than one calendar year beyond the date of service, will be - solution Denied by Medicare A portion of the accounts receivable inventory which has NOT qualified for billing includes - solution Charitable pledges The standard claim form used for billing by hospitals, nursing facilities, and other in-patient - solution UB-04 Once the price is estimated in the pre-service stage, a provider's financial best practice is to - solution 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 - solution Compliance fraud by upcoding Health Plan Contracting Departments do all of the following EXCEPT - solution Establish a global reimbursement rate to use with all third-party payer

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For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: - solution 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? - solution Bad debt adjustment Most major health plans including Medicare and Medicaid, offer - solution Electronic and/or web portal verification The important Message from Medicare provides beneficiaries information concerning their - solution 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? - solution 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 - solution Monitor compliance

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Medicare will only pay for tests and services that - solution Medicare determines are "reasonable and necessary" The physician who wrote the order for an inpatient service and is in charge of the patients - solution The attending physician When primary payment is received, the actual reimbursement - solution 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 - solution The specificity and coding needed to support reimbursement claims In a self-insured (or self-funded) plan, the costs of medical care are - solution Borne by the employer on a pay-as-you-go basis Indemnity plans usually reimburse: - solution A certain percentage of the charges after the patient meets the policy's annual deductible

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The first and most critical step in registering a patient, whether scheduled or unscheduled, is - solution Verifying the patient's identification When Recovery Audit Contractors (RAC) identify improper payments as over payments, the - solution 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 - solution 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: - solution Each state's Medicaid plan Medicare patients are NOT required to produce a physician order to receive which of these services - solution Screening Mammography, flu vaccine or pneumonia vaccine EFT (electronic funds transfer) is - solution An electronic transfer of funds from payer to payee

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The importance of medical records being maintained by HIM is that the patient records - solution 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: - solution The time it takes to collect anticipated revenue To maximize the value derived from customer complaints, all consumer complaints should be - solution Responded to within two business days A scheduled inpatient represents an opportunity for the provider to do which of the following? - solution Complete registration and insurance approval before service In the pre-service stage, the requested service is screened for medical necessity, health - solution Pre-authorization are obtained Hospitals need which of the following information sets to assess a patient's financial status: - solution Patient and guarantor's income, expenses and assets