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1. The disadvantages of outsourcing include all of the following EXCEPT: The impact of customer service or patient relations The impact of loss of direct control of accounts receivable services Increased costs due to vendor ineffectiveness Reduced internal staffing costs and a reliance on outsourced staff - D 2.The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: Medical necessity review by an independent physician's panel Judicial review by a federal district court Redetermination by the company that handles claims for Medicare d) Review by the Medicare Appeals Council (Appeals Council) - B 3. Business ethics, or organizational ethics represent: b. The principles and standards by which organizations operate Regulations that must be followed by law Definitions of appropriate customer service The code of acceptable conduct - A 4. A portion of the accounts receivable inventory which has NOT qualified for billing includes: a. b. Charitable pledges Accounts created during pre-registration but not activated adjustment c) That hospitals don't want to be put in the position of "guaranteeing" price without having room for additional charges that may arise in the course of treatment d) Their reluctance to share proprietary information - B 8. 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: a. Make sure that the attending staff can answer questions and assist in obtaining required patient financial data b) Have a patient financial responsibilities kit ready for the paticnt, containing all of the required registration forms and instructions c) Support that choice, providing that the discussion docs not interfere with paticnt care or disrupt patient flow d) Decline such request as finance discussions can disrupt paticnt care and patient flow - C 9. A comprehensive "Compliance Program" is defined as a. Annual legal audit and review for adherence to regulations b. Educating staff on regulations c. Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met d) The development of operational policies that correspond to regulations - C 10. Case Management requires that a case manager be assigned a. To patients of any physician requesting case b. management c. To a select patient d. group To every patient To specific cases designated by third party contractual agreement - B 11. 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 a. Identify, compare, and choose providers that offer the desired level of value b) Customize health care with a personally chosen mix of providers c) Negotiate the cost of health plan premiums d) Verify the cost of individual clinicians - A Any healthcare insurance plan that provides or cnsures comprehensive health maintenance and treatment services for an enrolled group of persons based on a 12. monthly fee is known as a a. MSO b. HMO c. PPO d. GPO-B b) Specific language as to who will pay legal fees, if needed c) An annual renewal clause d) A mutual hold-harmless clause - D 16. 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: a. Patient Accounts b. Managed Care Contract Staff c. TTTM staff d. Case Management - D 17. What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? a. Revenue codes b. Correct Part A and B procedural codes The CMS 1500 Part B attachment i} d. Medical necessity documentation - A 18. Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implement procedures for identifying and processing accounts: a. Monitor compliance b. Have the account triaged for any partial payment possibilitics c. Assist in arranging for a commercial bank loan d. Obtain the patients income tax statements from the prior 2 years - A 19. For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: a. Are optional b. Should take place between the patient or guarantor and properly trained provider representatives c) May take place between the paticnt and discharge planning d) Are focused on verifying required third-party payer information - B 20. The purpose of a financial report is to: ยฉ Provide a public record, if reqluested b. Present financial information to decision makers 2 Prepare tax documents d. Monitor expenses - B 21. Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? a. Registration staff may routinely contact managed are plans for prior authorizations before the patient is seen by the on-duty physician b) Initial registration activities may occur so long as these activities do not delay treatment or suggest that treatment with not be provided to uninsured individuals a. All pre-admission emergency transports b. 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 c) The portion of the bill outside of the patient's self-pay d) Transports deemed medically necessary by the attending paramedic- ambulance crew - C 26. 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 a A beneficiary b. appeal c. A Medicare supplemental d. review A payment 27.The nuanced data resulting from detailed review ICD-10 coding allow: ior leadershi A Medicare determination appeal - โโโโโโโโโE A work with physicians to do all of the following EXCEPT: to a. Drive significant improvements in the areas of quality and the patient experience b) Embrace new reimbursement models c) Improve outcomes d) Obtain higher compensation for physicians - D 28. Duplicate payments occur: a. When providers re-bill claims based on nonpayment from the initial bill submission b) When service departments do not process charges with the organization's suspense days c) When the payer's coordination of benefits is not captured correctly at the time of patient registration d) โWhen there are other healthcare claims in process and the anticipated deductibles and co-insurance amounts still show open but will be met by the in-process claims - a 29. The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can a. Purchase qualified health benefit plans regardless of insured's health status b) Obtain price estimates for medical services c) Negotiate the price of medical services with providers d) Meet federal mandates for insurance coverage and obtain the corresponding tax deduction - A 30. The most common resolution methods for credit balances include all of the following EXCEPT: a. Designate the overpayment for charity care b. Submit the corrected claim to the payer incorporating credits c. Either send a refund or complete a takeback form as directed by the payer Provide a method of measuring the collection and control ofb.c. d. A/R Establish productivity targets Make allowance for accurate revenue forecasting -B 35. Recognizing that health coverage is complicated and not all patients are able to navigate this terrain, HFMA best practices specify that a. The patient accounts staff have someone assigned to research coverage on behalf of patients b) Paticnts should be given the opportunity to request a paticnt advocate, family member, or other designee to help them in these discussions c) Paticnt coverage education may need to be provided by the health plan d) A representative of the health plan be included in the paticnt financial responsibilitics discussion - B 36. When there is a request for service, the scheduling staff member must confirm the patient's unique identification information to a. Check if there is any patient balance due b. Verify the patient's insurance coverage if the patient is a returning customer c) Confirm that physician orders have been received d) Ensure that she/he accesses the correct information in the historical database - D 37. Once the price is estimated in the pre-service stage, a provider's financial best practice is to a. Explain to the patient their financial responsibility and to determine the plan for payment b) Allow the patient time to compare prices with other providers c) Lock-in the prices d) Have another employee double check the price estimate - A 38. What type of account adjustment results from the patient's unwillingness to pay a self- pay balance? a. Charity adjustment b. Bad debt adjustment (. Contractual adjustment d. Administrative adjustment - B 39. All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT c. Collect patient's self-pay and deductibles in the first encounter d. Assist patients in understanding their insurance coverage and their financial obligation - D 43. A nightly room charge will be incorrect if the patient's a. Discharge for the next day has not been charted b. Condition has not been discussed during the shift change report meeting c) Pharmacy orders to the ICU have not been entered in the pharmacy system d) Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system -D 44. Which of the following is required for participation in Medicaid? a. Meet income and assets requirements b. Meet a minimum yearly premium c. Be free of chronic conditions d. Obtain a health insurance policy - A 45. TIFMA best practices call for patient financial discussions to be reinforced a. By issuing a new invoicc to the paticnt b. By copying the provider's attorncy on a written statement of conversation c) By obtaining some type of collateral d) By changing policies to programs - B 46. A Medicare Part A benefit period begins: a. With admission as an inpatient b. The first day in which an individual has not been a hospital inpatient not in a skilled nursing facility for the previous 60 days c) Upon the day the coverage premium is paid d) Immediately once authorization for treatment is provided by the health plan - A 47. Tf 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 a. Will remain in observation for up to 72 hours after which the patient is admitted as an inpatient b) Will be admitted as an inpatient c) Will be discharged and if needed, designated to a priority one outpatient status d) Will have his/her case reviewed by the attending physician, a consulting physician and the primary care physician and a future course of care will then be determined - B 48. It is important to have high registration quality standards because a. Incomplete registrations will trigger cxclusion from Medicare participation b) Incomplete registrations will raise satisfaction scores for the hospital c) Inaccurate registration may cause discharge before full treatment is obtained d) Tnaccurate or incomplete patient data will delay payment or cause denials - D d) An initial registration records is completed so that the proper coding can be initiated - C 53. 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 a. Payer quality monitoring b. Medicare patient and staff safety standards c. Joint Commission for Accreditation of Healthcare Organizations (JCAHO) safety d) Patient bill of rights - D 54. A scheduled inpatient represents an opportunity for the provider to do which of the 55. following? a. Refer the patient to another location with the health system b. Comply with EMTALA (Emergency Medical Treatment and Labor Act) requirements before service Complete registration and insurance approval before service d) Register the patient after he or she is placed in a bed on that service unit. - C 56.The first and most critical step in registering a paticnt, whether scheduled or unscheduled, is a. Having the patient initial the HIPAA privacy statement b. Verifying insurance to activate the patient medical record c. Verifying the patient's identification d. Check the schedule for treatment availability - C 57. The legal authority to request and analyze provider clam documentation to ensure that IPPS services were reasonable and necessary is given to a. Recovery Audit Contractors (RAC) b. The Office of the U.S. Inspector General (OIG) c. All health plans d. State insurance commissioners - B 58. An advantage of a pre-registration program is a. The opportunity to reduce processing times at the time of service b. The ability to eliminate no-show appointments c. The opportunity to reduce the corporate compliance failures within the registration process d. The marketing value of such a program - C 59, Claims with dates of service received later than one calendar year beyond the date of service, will be a. Denied by Medicare b. The provider's responsibility but can be deemed charity care c. Fully paid with interest d. The full responsibility of the patient. - A 
