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

Download CRCR Exam Questions with Answers: Healthcare Revenue Cycle Management and more Exams Nursing in PDF only on Docsity! 1 CRCR EXAM QUESTIONS WITH 100% CORRECT ANSWERS A+ VERIFIED. 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 2 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 5 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 6 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 7 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: 10 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 11 ✔✔ 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 12 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 15 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 16 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 17 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 20 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 21 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. 22 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 25 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 26 The benefit of Medicare vantage plan is - Correct Ans ✔✔ Patients generally have their Medicare coverage healthcare through the plan and do not need to worry about a part a or part B benefits Once the EMTALA requirements are satisfied a) Third-party payer information should be collected from the patient and the payer should be notified of the ED visit b) The patient then assumes full liability for services unless a third- party is notified or the patient applies for financial assistance with the first 48 hours c) The remaining registration processing is initiated at the bedside or in a registration area d) An initial registration records is completed so that the proper coding can be initiated - Correct Ans ✔✔ Third-party payer info should be collected from the patient and the payer should be notified of the ED visit The soft cost of a Dissatisfied customer is - Correct Ans ✔✔ The customer passing on info about the negative experience to potential patients or through social media channels Concurrent review and discharge planning - Correct Ans ✔✔ Occurs during service 27 In a self insured plan the cost of Medical care are - Correct Ans ✔✔ Born by the employer on a pay as you go basis In choosing a setting for patient financial discussions organizations should first and foremost - Correct Ans ✔✔ Respect the patients privacy Which option is a government sponsored healthcare program that is financed through taxes and general revenue funds - Correct Ans ✔✔ Medicare It is important to calculate reserve to ensure - Correct Ans ✔✔ Stable financial operations an accurate financial reporting Successful account resolution begins with - Correct Ans ✔✔ Collecting all deductibles and copayments during the pre-service stage Patient financial communications best practices produce communications that are - Correct Ans ✔✔ Consistent clear and transparent Can you performance indicators set standards for account receivables and - Correct Ans ✔✔ Provide a method of measuring the collection and control 30 d) The price of service to their covering health plan - Correct Ans ✔✔ The service providers that typically participate in the service radiologist pathologist etc. TeleMed seeks to improve a patient's health by - Correct Ans ✔✔ Permitting to buy real time interactive communication between the patient and the clinical professional Large number of credit balances are not the results of over payments but of - Correct Ans ✔✔ Posting errors in the patient's accounting system The office of Inspector General publishes a compliance work plan - Correct Ans ✔✔ Annually Regulation Z are the consumer credit protection act also known as the truth in leading at establish what - Correct Ans ✔✔ Disclosure rule for consumer credit sales and consumer loans What core financial activities are resolved within patient access? - Correct Ans ✔✔ Scheduling, insurance verification, discharge processing, and payment of point-of-service receipts What is the initial hospice benefit - Correct Ans ✔✔ Two 90-day periods and an unlimited number of subsequent periods 31 When does a hospital add ambulance charges to the Medicare inpatient plan - Correct Ans ✔✔ If the patient requires ambulance transportation to a skilled nursing facility How is a miss posted contract allowance resolved - Correct Ans ✔✔ Comparing the contract reimbursement rates with the contract on the admittance advice to identify the correct amount What type of patient status is used to evaluate the patients need for inpatient care - Correct Ans ✔✔ Observation When is the word same entered on the CMS 1500 billing form in field zero - Correct Ans ✔✔ When the patient is the insured What are non-emergency patients who come for service without prior notification to the provider called? - Correct Ans ✔✔ Unscheduled patients If the insurance verification response reports that a subscriber has a single policy what is the status of the scribers spouse - Correct Ans ✔✔ Neither enrolled not entitled to benefits What is a principal diagnosis - Correct Ans ✔✔ Primary reason for the patient's admission 32 What is the daily out-of-pocket amount for each lifetime reserve day used? - Correct Ans ✔✔ 50% of the current deductible amount What code indicates the disposition of the patient at the conclusion of service - Correct Ans ✔✔ Patient discharge status code What are hospitals required to do for Medicare credit balance accounts - Correct Ans ✔✔ They result in lost reimbursement and additional cost to collect When an undue delay of payment results from a dispute between the patient and the third-party payer who is responsible for payment - Correct Ans ✔✔ patient Medicare guidelines require that when a test is ordered for a LCD or Ncd exist the information provided on the order must include - Correct Ans ✔✔ A valid CPT or HCPCS code With advances in internet security and encryption, revenue-cycle processes are expanding to allow patients to do what? - Correct Ans ✔✔ Access their information and perform functions on-line 35 Why do managed care plans have agreements with hospitals, physicians, and other healthcare providers to offer a range of services to plan members? - Correct Ans ✔✔ To improve access to quality healthcare If a patient remains an inpatient of and skilled nursing facility for more than 30 days what is the skilled nursing facility permitted to do - Correct Ans ✔✔ Submit intermin bills to Medicare program MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims after what happens? - Correct Ans ✔✔ 120 days passes but the claim then will be withdrawn from the liability carrier What data are required to establish a new MPI entry - Correct Ans ✔✔ The patient's full legal name, date of birth, and sex At the end of each shift, what must happen to cash, checks, and credit card transaction documents? - Correct Ans ✔✔ They must be balanced What will cause a CMS 1500 claim to be rejected - Correct Ans ✔✔ The provider is billing with a future date of service Under Medicare regulations which of the following is not included on a valid physicians order for service - Correct Ans ✔✔ The cost of the test 36 When is it not appropriate to use observation status - Correct Ans ✔✔ As a substitute for an inpatient admission What is a serious consequence for Miss identifying a patient and the MPI - Correct Ans ✔✔ The service will be documented in the wrong record When a patient reports directly to a clinical department for service what will the clinical department staff do - Correct Ans ✔✔ Redirect the patient to the patient access department for registration What process can be used to shorten claim turnaround time - Correct Ans ✔✔ Send high-dollar hard-copy claims with required attachments by overnight mail or registered mail How are patient reminder calls used - Correct Ans ✔✔ To make sure the patient follows the prep instructions and arrives at the scheduled time for service If a patient declares a straight bankruptcy what most providers do - Correct Ans ✔✔ Write off the account to the contractor adjustment account 37 According to the department of health and human services guidelines what is not considered income - Correct Ans ✔✔ Sale of property, house, or car The situation where neither the patient nor spouse is employed as described the patient using - Correct Ans ✔✔ A condition code What happens when a patient receives non-emergent service From an out of network provider - Correct Ans ✔✔ Patient payment responsibility is higher Every patient who is near to the healthcare provider must be offered - Correct Ans ✔✔ A printed copy of the providers privacy notice Hyppa How may a collection agency demonstrate it's performance - Correct Ans ✔✔ Calculate the rate of recovery What is true of the information the provider supplies to indicate that an authorization for service has been received from the patient's primary payer - Correct Ans ✔✔ It is posted on the Remittance advice by the payer What standard claim forms are currently used by healthcare industry to submit claims to third-party payers - Correct Ans ✔✔ The UB-04 and the CMS 1500 40 Healthcare professional who is recognized to have expertise in a specialty of medicine or surgery - Correct Ans ✔✔ Third-party administrative Provide services to employers or insurance companies for utilization review, claims and payments and benefit design - Correct Ans ✔✔ Third-party reimbursement General term used for healthcare benefit payments used to identify that for a benefit plans there are three parties in the transaction - Correct Ans ✔✔ Usual, customary, and reasonable (ucr) Health insurance plan reimbursement method that limits payments to the lower bill charges the provider customary charge or the prevailing charge for the service in the community - Correct Ans ✔✔ Utilization review Portion of the accounts receivable inventory which had not qualified for billing includes - Correct Ans ✔✔ Charity pledges Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite discharge the HFMA best practices is to - Correct Ans ✔✔ Support that choice providing that the discussion does not interfere with patient care or disrupt patient flow 41 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 - Correct Ans ✔✔ HMO Any provider that has build a timely cost report may appeal and adverse final decision received from the Medicare administrative contractor this appeal may be filled with - Correct Ans ✔✔ The provider reimbursement review board Ambulance services are billed directly to the health plan for - Correct Ans ✔✔ The portion of the bill outside of the patient self-pay...... services provided before a patient is admitted and for ambulance rides arrange to pick up the patient from the hospital after discharge to take him/her home or to another facility An individual enrolled in Medicare Who is dissatisfied with the governments claim determination is entitled to reconsideration of the decision this type of appeal is known as - Correct Ans ✔✔ A beneficiary appeal All of the following are conditions that disqualify a procedure or service from being paid for by Medicare except - Correct Ans ✔✔ Services and procedures that are custodial in nature All of the following are forms of hospital payment contracting except - Correct Ans ✔✔ Contracted rebating 42