CRCR Exam Questions with Answers: Healthcare Revenue Cycle Management, Exams of Nursing

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An advantage of a pre-registration program is - Correct Ans ✔✔ The opportunity to reduce the corporate compliance failures within registration process All of the following are potential causes of credit balances except - Correct Ans ✔✔ A patient's choice to build up a credit against future medical bills A recurring series registration is characterized by - Correct Ans ✔✔ The creation of one registration record for multiple days of service Appropriate training for patient's financial counseling staff must cover all the following except - Correct Ans ✔✔ Documenting the conversation in the medical records All of the following information should be reviewed as part of scheduled finalization except - Correct Ans ✔✔ The results of any and all test All of the following are steps in safeguarding collections except - Correct Ans ✔✔ Issuing receipts

An originating site is - Correct Ans ✔✔ The location of the patient at the time the service is provided A large number of credit balances are not the result of over payments but of - Correct Ans ✔✔ Posting errors in the patient's accounting system At the end of each shift what must happen to cash checks and credit card transaction documents - Correct Ans ✔✔ They must be balanced According to the department of health and human services guidelines what is not considered income - Correct Ans ✔✔ Sale of property house or car An insurance company that provides for the delivery or payment of healthcare services - Correct Ans ✔✔ Indemnity insurance A restriction on payments for charges directly resulting from a pre- existing health conditions - Correct Ans ✔✔ Self insured An employer a union or an association that contracts with an insurance company for the healthcare plan it offers to eligible employees - Correct Ans ✔✔ Sub specialist

A healthcare professional who is recognized to have expertise in a specialty of medicine or surgery - Correct Ans ✔✔ Third-party reimbursement Business ethics or organizational ethic presents - Correct Ans ✔✔ The principles and standards by which organizations operate 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 - Correct Ans ✔✔ Monitor compliance Because 501 R regulations focus on identifying potential eligible financial assistance patients hospital must - Correct Ans ✔✔ How old financial conversations with patients as soon as possible Comprehensive compliance program is defined as - Correct Ans ✔✔ Systematic procedures to ensure that the provisions of regulations imposed by government agencies are being met Case management requires that a case manager be assigned - Correct Ans ✔✔ To a select patient group Claim is denied for the following reasons except - Correct Ans ✔✔ The submitted claim does not have the physician signature

Claims with dates of services received later than one calendar year beyond the date of service will be - Correct Ans ✔✔ Denied by Medicare Chapter 13 bankruptcy debtor rehabilitation is court proceeding - Correct Ans ✔✔ That re-organize a debtors holdings and instruct creditors to look to the debtors future earnings for payment Concurrent review and discharge planning - Correct Ans ✔✔ Occurs during service Checks receive through mail cash received through mail and lockbox are all examples of - Correct Ans ✔✔ Control points for cash posting Charges as the most appropriate measurement of utilization enables - Correct Ans ✔✔ Currency of expense and cost capture Charges are the basis of - Correct Ans ✔✔ Separation of fiscal responsibilities between the patient and the health plan Collecting patient liability dollars after service leads to what - Correct Ans ✔✔ Lower accounts receivable levels

Claims must be coded using what - Correct Ans ✔✔ HCPCS Healthcare common procedure coding system Coverage rules for Medicare beneficiaries received skilled nursing care require that the beneficiary has received what - Correct Ans ✔✔ Medically necessary inpatient hospital services for at least three consecutive days before the skilled nursing care admission Days In A/R is calculated based on the value of - Correct Ans ✔✔ The time it takes to collect anticipated revenue The total accounts receivable on a Specific date Duplicate payments occur - Correct Ans ✔✔ When providers re-bill claims based on non-payment from the essential bills submission Decision on whether a patient should be admitted as an inpatient or become an outpatient observation patient requires medical judgments based on all of the following except - Correct Ans ✔✔ The patient's home care coverage EFT (electronic funds transfer) is - Correct Ans ✔✔ An electronic transfer of funds from payer to payee Every patient who is new to the healthcare provider must be offered what - Correct Ans ✔✔ A printed copy of the provider's privacy notice

For scheduled patients important revenue cycle activities is the time of service stages do not include - Correct Ans ✔✔ Final bill is presented for payment Four digit code number code established by the national uniform billing community that categorizes classifies A line Item and the charge master is known as - Correct Ans ✔✔ Revenue code The disadvantages of outsourcing include all the following except - Correct Ans ✔✔ Reduce internal staffing costs in a reliance on outsourced staff The Medicare fee for service appeal process for both beneficiaries and providers include all the following levels except - Correct Ans ✔✔ Judicial review by a federal district court Local coverage determination and national coverage determination are Medicare established guidelines used to determine - Correct Ans ✔✔ Which diagnosis signs or symptoms are reimbursable Patients are contacting hospitals to proactively inquire about cost and fees prior to agreeing to service. The problem for hospitals in providing such information is - Correct Ans ✔✔ The fact that charge master was the total charge, not net charges that reflect charges after a payers contractual adjustment

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 customers to - Correct Ans ✔✔ Identify, compare, and choose providers that after they desired level of value In a Chapter 7 Straight Bankruptcy filing a) The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt b) The court liquidates the debtor's nonexempt property, pays creditors, and begins to pay off the largest claims first. All claims are paid some portion of the amount owed c) The court vacates all claims against a debtor with the understanding that the debtor may not apply for credit without court supervision d) The court establishes a creditor payment schedule with the longest outstanding claims paid first - Correct Ans ✔✔ The court liquidates the debtors non-exempt property, pays creditors, and discharge the debtor from the dept The core financial activities resolved within patient access include:

a) Scheduling, pre-registration, insurance verification and managed care processing b) Scheduling, insurance verification, clinical discharge processing and payment posting of point of service receipts c) Scheduling, registration, charge entry and managed care processing d) Scheduling, pre-registration, registration, medical necessity screening and patient refunds - Correct Ans ✔✔ Scheduling, pre- registration, insurance verification and managed-care processing Which of the following is not contained in a collection agency agreement - Correct Ans ✔✔ A mutual hold harmless clause 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) HIM staff d) Case Management - Correct Ans ✔✔ Case management

What is required for the UB - 04/837 - I used by rural health clinics to generate payment for Medicare - Correct Ans ✔✔ Revenue codes For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions - Correct Ans ✔✔ Should take place between the patient or guarantor and properly train provider representatives Purpose of financial reporting is to - Correct Ans ✔✔ Present financial information to decision-makers Which statement is an EMTALA (Emergency medical treatment and active labor act) violation - Correct Ans ✔✔ Registration staff may routinely contact manage are plans for prior authorization before the patient is seen by the on-duty physician The nuanced Data resulting from detailed ICD Dash 10 coding allows senior leadership to work with physicians to do all the following except

• Correct Ans ✔✔ Obtain higher compensation for physicians Do you affordable care act legislated the development of health insurance exchanges, where individuals and small businesses can - Correct Ans ✔✔ Purchased qualified health benefit plans regardless of insured health status

The most common resolution methods for credit balances include all the following except - Correct Ans ✔✔ Designate the overpayment for charity care Revenue cycle activities occurring at the point of service include all the following except - Correct Ans ✔✔ Providing charges to the third-party payer as they incurred Medicare beneficiaries remain in the same benefit period - Correct Ans ✔✔ Until the beneficiary is hospitalized and or skilled nursing facility free for60 consecutive days Key performance indicators set standards for account receivable (A/R) and - Correct Ans ✔✔ Provide a method of measuring the collection in control of the A/R Recognizing that healthcare is complicated and not all patients are able to navigate this terrain HFMA Best practices specify that - Correct Ans ✔✔ Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these decisions When there is a request for service, the scheduling staff member must confirm the patient's unique identification information to - Correct Ans

✔✔ Ensure that she/he accesses the correct information in the historical database Once the price is estimated in the pre-service stage, a providers financial best practice is to - Correct Ans ✔✔ Explain to the patient their financial responsibility and to determine the plan for payment What type of account adjustment results from the patient's unwillingness to pay a self-pay balance - Correct Ans ✔✔ Bad debt adjustment Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by: a) The Center for Medicare and Medicaid Services (CMS) b) Each state's Medicaid plan c) Medicare d) The Medicare Administrative Contractor (MAC) at the end of the hospice cap period - Correct Ans ✔✔ The Medicare administrative contractor at the end of the hospice cap period With the advent of the affordable care act health insurance market places and the expansion of Medicaid in some states it is more

important than ever for hospitals to - Correct Ans ✔✔ Assist patients in understanding their insurance coverage and their financial obligation 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 - Correct Ans ✔✔ Transfer from ICU to the medical/surgical floor is not reflected in the registration system Which of the following is required for participation In Medicaid - Correct Ans ✔✔ Meet income and assets requirements HFMA best practices call for patient financial discussions to be reinforced a) By issuing a new invoice to the patient b) By copying the provider's attorney on a written statement of

conversation c) By obtaining some type of collateral d) By changing policies to programs - Correct Ans ✔✔ By copying the providers attorney on a written statement of conversation Medicare part a benefit period begins - Correct Ans ✔✔ With admission as an inpatient 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 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 - Correct Ans ✔✔ Will be admitted as an inpatient

It is important to have high registration quality standards because - Correct Ans ✔✔ In accurate or incomplete patient data will delay a payment or cause denials Medicare will only pay for test and services that - Correct Ans ✔✔ Medicare determines are reasonable and necessary Room and bed charges are typically posted - Correct Ans ✔✔ From the midnight census The process of creating pre-registration record ensures - Correct Ans ✔✔ Accurate billing Once the EMTALA requirements are satisfied a) Third-party payer info should be collected from the pt and the payer should be notified of the ED visit b) An initial registration record is completed so that the proper coding can be initiated c) The pt then assumes full liability for services unless a third-party payer is notified or the pt applies for financial assistance within the first 48 hours d) The remaining registration processing is initiated either at the bedside or In a

registration area - Correct Ans ✔✔ The remaining registration processing is initiated either at bedside or in registration area 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 - Correct Ans ✔✔ Patient bill of rights A scheduled inpatient represents an opportunity for the provider to do which of the 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 c) Complete registration and insurance approval before service d) Register the patient after he or she is placed in a bed on that service

unit. - Correct Ans ✔✔ Complete registration and insurance approval before service The first and most critical step in registration a patient whether scheduled or unscheduled is - Correct Ans ✔✔ Verifying the patient's identification The legal authority to request and analyze provider claim documentation to ensure that IPPS Services were reasonable and necessary is given to - Correct Ans ✔✔ The office of the US inspector general (OIG) This concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits a) Third-party invoicing b) Account resolution c) Claims processing d) Billing - Correct Ans ✔✔ Claim processing The ACO investment model will test the use of pre-paid shared savings to

a) Raise quality ratings in designated hospitals. b) Encourage new ACOs to form in rural and underserved areas c) Attract physicians to participate in the ACO payment system d) Invest in treatment protocols that reduce costs to Medicare - Correct Ans ✔✔ Encouraging new ACO To form in rural and underserved areas HFMA's pt financial communications best practices specify that pts should be told about the types of services provided and a) An explanation of why a specific service is not provided b) The service providers that typically participate in the service, e.g.radiologists, pathologists, etc. c) A satisfaction survey regarding clinical service providers d) The price of service to their covering health plan - Correct Ans ✔✔ The service providers that typically participate in the service, e.g.radiologists, pathologists, etc. The important message from Medicare provides beneficiaries information concerning their - Correct Ans ✔✔ Right to appeal a discharge decision if the patient disagrees with the plan

Medicare part B has an annual deductible and the beneficiary is responsible for - Correct Ans ✔✔ A co- insurance payment for all part B covered services The importance of medical records being maintained by HIM Is that the patient records - Correct Ans ✔✔ Are the primary source for clinical data required for reimbursement for health plans and liability payers Decision on whether a patient should be admitted as an inpatient or become an outpatient observation patients required medical judgment based on all the following except - Correct Ans ✔✔ The patient's home care coverage Medicare has establish guidelines call the local coverage determination and national coverage determination that establish - Correct Ans ✔✔ What services or healthcare items are covered under Medicare What are some core elements of a board approved financial assistance policy - Correct Ans ✔✔ Eligibility application process and non- payment collection activities ICD-10 codes set and CPT/HCPCS codes set combines provide - Correct Ans ✔✔ The specificity and coding needed to support reimbursement claims

Under EMTALA Regulations the provider may not ask about a patient's insurance information if it will delay what - Correct Ans ✔✔ Medical screening and stabilizing treatment In resolving medical accounts, a law firm may be used as: a) An independent auditor of a financial assistance policy b) Legal counsel to patients regarding financing options c) An independent broker of patient financial assistance from banks d) A substitute for a collection agency - Correct Ans ✔✔ A substitute collection agency The unscheduled "direct" admission represents a patient who: a) Is admitted from a physician's office on an urgent basis b) Arrives at the hospital via ambulance for treatment in the emergency room c) Is an ambulatory patient who collapses in the hospital lobby d) Arrives on the medical helicopter for trauma services - Correct Ans ✔✔ Is admitted from the physicians office on urgent basis In the balance resolution process, providers should: a) Stress to the patient that serious consequences may result from refusal to pay

b) Remind the patient of their legal responsibility to pay the balance due c) Ask the patient if he or she would like to receive information about payment options and supportive financial assistance programs d) Tag the patients record for possible financial assistance for bad debt

• Correct Ans ✔✔ Ask the patient if he or she would like to receive information about payment options and supported financial assistance programs Which of the following is not included in the standard quality measures
• Correct Ans ✔✔ Cost of service In the pre-service stage the requested service is screened for medical necessity health plan coverage benefits are verified and - Correct Ans ✔✔ Pre-authorizations are obtained Improving the overall patient experience requires revenue cycle leader ship and staff to simultaneously be - Correct Ans ✔✔ Clear on policies and consistent in applying the policies Hospitals need which of the following information sets to assess a patient's financial status - Correct Ans ✔✔ Patient and guarantors income expenses and assets

For scheduled patients important revenue cycle activities and the time of service stage do not include - Correct Ans ✔✔ Final bill is presented for payment The electric remittance advice data set is - Correct Ans ✔✔ A standardized form that providers third-party payment details to providers Indemnity plants usually reimburse - Correct Ans ✔✔ A certain percentage of the charges after the patient meets the policy annual deductible Which option is a benefit of pre-registering a patient for service - Correct Ans ✔✔ The patient arrival process is expedited reducing wait times and delays HIPAA has adopted employer identification numbers to be used in standard transactions to identify the employer of an individual described in a transactions are assigned by - Correct Ans ✔✔ The internal revenue service nightly room charge will be incorrect if the patient's a) Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system.

b) Pharmacy orders to the ICU have not been entered into the pharmacy system c) Condition has not been discussed during the shift change report meeting d) Discharge for the next day has not been charted - Correct Ans ✔✔ Transfer from ICU to the medical surgical floor is not reflected in the registration system With any remaining open balances, after insurance payments have been posted, the account financial liability is a) Written off as bad debt b) Potentially transferred to the patient c) Sold to a collection agency d) Treated as the cost of doing business - Correct Ans ✔✔ Potentially transferred to the patient When there is a request for service the scheduling staff member must confirm the patient's unique identification information to - Correct Ans ✔✔ Ensure that she/he accesses the correct information in the historical database Insurance verification results in which of the following - Correct Ans ✔✔ The accurate identification of the patient's eligibility and benefits

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 a) HCPCs codes b) ICD-10 Procedural codes c) CPT codes d) Revenue codes - Correct Ans ✔✔ Revenue codes The importance of a medical records being maintained by HIM Is that the patient records - Correct Ans ✔✔ Are the primary source for clinical data required for reimbursement by health plans and liability payers Medicare patients are not required to produce a physician order to receive which of these services - Correct Ans ✔✔ Screening mammography, flu vaccine or pneumonia vaccine Patients should be informed that cost presented in a price estimate may - Correct Ans ✔✔ Vary from estimates depending on the actual service performed In Chapter 7 straight bankruptcy filling

a) The court establishes a creditor payment schedule with the longest outstanding claims paid first b) The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt c) The court vacates all claims against a debtor with the understanding that the debtor may not apply for credit without court supervision d) The court liquidates the debtor's nonexempt property, pays creditors, and begins to pay off the largest claims first. All claims are paid some portions of the amount owed. - Correct Ans ✔✔ The court liquidates debtors non- exempt property pays creditors and discharges debtors from the debt The activity which resorts 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 - Correct Ans ✔✔ Case management Which of the following is required for participation in Medicaid - Correct Ans ✔✔ Meet income and assessed requirements When primary payment is received, the actual reimbursement a) Is compared to the expected reimbursement

b) Is recorded by Patient Accounting and the patient's account is the closed c) Is compared to the expected reimbursement, the remaining contractual adjustments are posted, and secondary claims are submitted d) Trigger that the secondary claims can then be prepared. - Correct Ans ✔✔ Its compared to the expected reimbursement the remaining contract or adjustments are posted and secondary claims are submitted The standard claim form used for billing by hospital nursing facilities and other inpatient service is called the - Correct Ans ✔✔ UB - 04 To maximize the value derived from customer complaints are consumer complaints should be - Correct Ans ✔✔ Responded to within two business days The HCAHPS (Hospital consumer assessment of healthcare providers and systems) initiative was launched to - Correct Ans ✔✔ Provide a standardize method for evaluating patients perspective on hospital care Health plan contracting department do all the following except - Correct Ans ✔✔ Establish a global reimbursement rate to use with all third-party payer