CRCR Exam With 100% Correct And Verified Answers, Exams of Advanced Education

Download CRCR Exam With 100% Correct And Verified Answers and more Exams Advanced Education in PDF only on Docsity! CRCR Exam With 100% Correct And Verified Answers Which of the following statements are true of HFMA's Patient Financial Communications Best Practices? - Correct Answer-The best practices were developed specifically to help patients understand the cost of services, their individual insurance benefits and their responsibility for balance after insurance if any The patient experience includes all of the following except: - Correct Answer-The average number of positive mentions received by the health system or practice and the public comments refuting unfriendly posts on social media sites Corporate compliance programs play an important role in protecting the integrity of operations and ensuring compliance with federal and state requirements. The Code of Conduct is: - Correct Answer-A critical tool to ensure the compliance with the organization's compliance standards and procedures, an essential and integral component of the organization's culture, fosters and environment where concerns and questions may be raised without fear of retaliation or retribution Specific to Medicare fee-for-service patients, which of the following payers have always been liable for payment? - Correct Answer-Public health service programs, federal grant programs, VA programs, black lung program services and workers comp claims Provider policies and procedures should be in plan to reduce the risk of ethics violations. Examples of ethics violations are: - Correct Answer-Financial misconduct, overcharging and miscoding claims, theft of property and falsifying records to boost reimbursement, financial misconduct and applying policies in an inconsistent manner Providers are now being reimbursed with a focus on the value of the services provided, rather than volume, which requires collaboration among providers. What is the intended outcome of collaborations made through an ACO delivery system for a population of patients? - Correct Answer-To eliminate duplicate services, prevent medical errors and ensure appropriateness of care What is the new terminology now employed in the calculation of net patient service revenues? - Correct Answer-Explicit price concessions and implicit price concessions What are the two KPIs used to monitor performance related to the production and submission of claims to third party payers and patients (self-pay)? - Correct Answer- Elapsed days from discharge to final bill and elapsed days from final bill to claim/bill submission What are the three traditional steps of the Revenue Cycle? - Correct Answer-Pre- service, time-of-service and post-service What are the steps during pre-service? - Correct Answer-1. The patient is scheduled and pre-registered for service 2. The encounter record is generated and the patient/guarantor information is obtained or updated 3. The requested service is screened for med necessity; insurance is verified and pre- auths obtained 4. The cost is identified and insurance benefits are used to calculate the price of the services to the patient 5. If the service is deemed not med necessary additional processing is done 6. The patient is notified of their financial responsibility including copay/deductible and their eligibility for financial assistance is assessed What happens for scheduled patients at the time of service? - Correct Answer-1. Pre- registration record is activated, consents are signed and copays/balances are collected 2. Positive patient identification is completed and an armband is given 3. Alternatively, scheduled patients can report to an express arrival desk What happens for unscheduled patients at the time of service? - Correct Answer- Comprehensive registration and financial processing is completed at the time-of- service. The process mirrors the work that was completed for scheduled patients prior to service What are the nine steps of time-of-service processing for unscheduled patients? - Correct Answer-1. Creation of the registration record 2. Order review to ensure compliance with the rules for what makes a complete order 3. Validation of the health plan and identification of any amount the patient is currently due 4. Completion of med necessity screening, if necessary 5. Review and completion of pre-cert requirements for the order 6. Identification of all charges related to the order and applied insurance benefits to calculate amount due 7. If a balance is due, financial conversation occurs 8. If all is well, patient gets service 9. Charges are entered as services are rendered What is the overview for the three steps of the revenue cycle? - Correct Answer-1. Pre- service: the patient is scheduled and registered for service; patient service costs are calculated 2. Time-of-service: case management and discharge planning services are provided; consents are signed 3. Post-service: Bill sent electronically to health plan, patient account is monitored for payment How does the physician affect the revenue cycle? - Correct Answer-Physician writes the order and determines the need for service. The physician's office schedules appointments or provides info to schedule, obtains pre-auths and begins the process of the rev cycle on the right foot What is a SNF? - Correct Answer-Skilled nursing facility that provides skilled nursing care or rehab services What does a SNF need to be for the continuum of care? - Correct Answer-Be in a separate location; provide daily skilled services in an inpatient manner that is appropriate for the patient's illness; provide advance directives; have written transfer agreement with one or more hospitals What does a home health agency need to be for the continuum of care? - Correct Answer-Must furnish at least one of the qualifying services, provide supervision/policies by a physician or RN, maintain clinical records, are licensed by state/local law, follow additional conditions What are the two additional conditions for Medicare coverage of a home health service? - Correct Answer-1. A physician must certify a patient is confined to his/her home. This means leaving the home would be a considerable/taxing effort 2. A patient's place of residence may be their own dwelling, a relative's home, a home for the aged or some other type of institution What is the durable medical equipment for continuum of care? - Correct Answer- Medical equipment prescribed by a doctor that must be durable and primarily for medical purposes What is a hospice home? - Correct Answer-A home to terminally ill patients What is the Medicare coverage for hospice care? - Correct Answer-Two 90 day coverage periods and an unlimited number of periods that are up to 60 days What is an assisted living facility? - Correct Answer-an institution which provides the elderly with supervision or assistance with activities of daily living, coordination of services with outside healthcare providers, and overall monitoring of health, safety, and well-being Who covers the cost of assisted living? - Correct Answer-Some health plans but mostly individuals and families pay. Medicare does not pay What are the sixteen elements of the corporate compliance program? - Correct Answer- 1. Self-reporting: self-reporting may preempt or mitigate the need for sanctions 2. Corporate culture: a culture that encourages identification of potential or actual violations 3. Full support of the highest level of personnel and making a compliance officer 4. oversight of personnel by high-level personnel 5. Written procedures that promote the organizations' commitment to compliance 6. Development and implementation of a regular, comprehensive training and education program 7. Maintenance of a hotline or other mechanism to receive anonymous communications regarding potential compliance issues 8. Employment of excluded individuals 9. Reasonable methods to achieve compliance with standards 10. Established compliance standards and procedures 11. Written communication standards and procedures 12. An effective plan to communicate the above written standards and procedures internally to employees and agents 13. Discretionary authority vested in persons unlikely to engage in criminal conduct 14. Mechanisms for monitoring compliance, including independent evaluations 15. Appropriate and consistent disciplinary measures for employees violating procedures/ethics 16. Implementation of an audit plan What is an organization's code of conduct? - Correct Answer-The core activities to which the organization is committed What are the Office of inspector general's responsibilities? - Correct Answer-Identifying opportunities to improve program economy, efficiency and effectiveness Holding accountable those who do not meet program requirements or who violate federal laws What does the BAA stand for? - Correct Answer-Business Associate Agreements What is the 2020 OIG Work Plan Tasks? - Correct Answer-Medicare payments outside the hospice benefit Denials and Appeals in Medicare Part C and D Medicare Part B payments for ESRD services Review of Home Health claims for services with 5-10 skilled visits What are the ongoing OIG reviews? - Correct Answer-Reconciliation of outlier payments Outpatient/inpatient stays under Medicare's 2 midnight rule Medicare costs associated with defective medical devices and credits for replacement medical devices Oversight of provider-based status and comparison of provider-based and free-standing clinics Medicare payments during MS-DRG payment window What is the Medicare DRG three-day payment window? - Correct Answer-Outpatient services (preadmission diagnostic services and other preadmission services) must be billed as part of an inpatient stay if they occurred within 3 days of IP stay What does condition code 51 do? - Correct Answer-Shows that the outpatient services on the claim are not related to a patient's inpatient stay What are the three ABN types for Medicare? - Correct Answer-ABN for part B services: medicare deems an outpatient service to not meet med necessity and provides patient's options for the service SNFABN: Part A services for SNF HINN: Part A notification that the care is not medically necessary or not delivered in the most appropriate setting What is the two midnight rule? - Correct Answer-Hospital admissions spanning two midnights qualify for an inpatient stay What are the providers always liable for Medicare claims? - Correct Answer-Worker's comp injuries, black lung program series, VA services, federal grant programs and public health service programs What are the qualifying factors for a working aged to be primary? - Correct Answer-The employer has more than 20 workers When is Medicare primary if the patient has a working aged plan? - Correct Answer-If the employer has fewer than 20 employees: 1. The group health plan does not qualify as the primary health plan 2. The patient is not required to accept the employer's insurance coverage 3. The employer is prohibited from offering a supplemental policy in place of the standard group health plan benefits offered to other employees When does a patient qualify for disability Medicare as secondary? - Correct Answer-1. Employer has more than 100 employees 2. Patient is under 65 3. Patient/spouse has current employment status with employer What is the correct coding initiative (CCI)? - Correct Answer-A program to ensure that the most comprehensive groups of codes rather than the component parts are billed What does a modifier do? - Correct Answer-Allows the hospital to indicate a specific circumstance that has affected a procedure or service without changing its definition or code What are level I modifiers? - Correct Answer-Usually provide info about performance of a procedure, although there are exceptions Apply to CPT codes Consist of two numbers What are level II modifiers? - Correct Answer-Provide additional detail about an anatomical location or about a procedure or service What is accrual accounting? - Correct Answer-Revenue is recorded when it is earned to permit the alignment of revenue with associate expenses What is cash accounting? - Correct Answer-you record when the payment is done What is fund accounting? - Correct Answer-Method to manage categories of net assets to ensure compliance with the restrictions on those funds What is gross revenue? - Correct Answer-Total incurred charges entered for all patients for the services they received What is net revenue? - Correct Answer-Gross revenue minus an estimate of the dollar amount of contractual, discount or other allowances What is an explicit price concession? - Correct Answer-The discounted contractual agreements between the provider and the payers which specify the payments due from the payers What is an implicit price concession? - Correct Answer-A concession applied to amounts that are to be paid by patients based on the expected payment results for a specific portfolio of receivables What are bad debts? - Correct Answer-The portion of patient liability which cannot be collected from the patient. These accounts represent a failure to pay and not an inability to pay on the part of the patient. What is charity care? - Correct Answer-Care provided to a patient who does not have the ability to pay for the services or portion of the services received What are key performance indicators? (KPI) - Correct Answer-Standards for A/R and provide a method of measuring the collection and control of A/R What are MAP Keys? - Correct Answer-Strategic KPIs that set the standard for patient- centric revenue cycle excellence in the healthcare industry What is the net A/R? - Correct Answer-The balance sheet divided by average daily net patient service revenue from the income statement What is cost to collect? - Correct Answer-Revenue cycle cost divided by total patient service cash collected What is net collection rate? - Correct Answer-how much cash was collected as a % of available to collect? What is point of service cash? - Correct Answer-the percentage of patient cash collected at or up to seven days after an encounter as a percentage of total self-pay cash collected for the period Which patient types are typically considered acute care patient types? - Correct Answer-Observation, newborn, emergency (ED) Accurate identification of the patient is the first step in the scheduling process. Identifiers used in various combination to achieve accurate patient identification include? - Correct Answer-Full legal name, date of birth, sex and social security number Pre-registration is defined as: - Correct Answer-The collection of demographic info, insurance data, financial info, providing reminders, prep info and identifying the potential need for financial assistance for scheduled patients Which of the following statements accurately describe the various Medicare benefit programs: - Correct Answer-Medicare Part A provides benefits for inpatient hospital services, SNF and home health care; Medicare Part B covers outpatient and professional services; Medicare Part C or Medicare Advantage plans are managed care plans combining Part A and Part B coverages; and Medicare Part D is the prescription drug coverage benefit Which of the following statements about Medicaid eligibility is not true? - Correct Answer-Medicaid categories are restricted to children, pregnant women and elderly in nursing homes Examples of managed care plans include: - Correct Answer-HMO, PPO and EPO plans POS, Concierge plans, Medicare Advantage plans Direct contracting for specific services from specific provisions Patient Financial Communications best practices include all of the following activities except: - Correct Answer-Collecting payment or initiating the process to immediately remove the patient from the service schedule Which statement includes the required components of an accurate pricing determination: - Correct Answer-Insurance coverage and benefits, service or test involved, diagnosis and procedure codes, total estimated charges, adjudication calculations based on the patient's benefit package. The value of a robust scheduling and pre-registration process includes all of the following except: - Correct Answer-Identification of patients who are likely to be no shows What services to healthcare facilities normally schedule ahead of time? - Correct Answer-High-dollar services and those that require significant pre-processing to ensure appropriate reimbursement; other services are scheduled ahead of time to reduce wait times and maximize patient flow What is the most common type of unscheduled admissions? - Correct Answer-The emergency department What is direct or urgent admission? - Correct Answer-When a physician sends the patient directly to the hospital because the condition meets the need for an inpatient stay; if the doctor calls ahead they are considered scheduled What are the non-acute patient types? - Correct Answer-Skilled nursing, hospice, home health, durable medical equipment and clinic patients When does Medicare cover a SNF stay? - Correct Answer-When the patient was in the hospital for at least a 3 day inpatient stay What is a 270 transaction? - Correct Answer-The outbound inquiry from the provider to the health plan What is a 271 transaction? - Correct Answer-The response back to the provider's eligibility inquiry What are the Medicare Part A benefits? - Correct Answer-A beneficiary remains in the same "benefit period" until they are hospitalization/SNF free for 60 days A deductible is due at the beginning of each benefit period. Medicare will pay full benefits for 60 days in a benefit period. The full days renew with each benefit period. After the full 60 days in a benefit period, there are 30 coins days where the beneficiary pays a daily expense equal to 25% of the current deductible amount due. After the full 60 days and 30 coins days are used, a patient can opt to use lifetime reserve days. The daily out of pocket for each LTR is 50% of the current deductible amount. These are used once and never reviewed. Once the 60 full, 30 coins and 60 LTR used, the patient has no more Part A benefits and part B needs to be billed Who is eligible for Medicaid? - Correct Answer-Low income families, qualified pregnant women and children and individuals receiving supplemental security income What is Tricare Prime? - Correct Answer-An HMO type program where military treatment facilities are the principal source of health care with a point-of-service option. This covers active-duty military and their families What is Tricare Prime Remote (TPR)? - Correct Answer-A managed care option similar to Tricare Prime for active-duty service members and their eligible family members who live and work in designate remote duty stations in the US What are the steps for constructing a price estimate for uninsured patients? - Correct Answer-1. Verify the patient is not eligible for Medicaid or financial assistance 2. Obtain any total charges for the hospital and any other providers. Note their in/out of network status 3. Apply your organization's self-pay discount and financial assistance adjs if applicable 4. Share the results with the patient and explain the discount applied EMTALA prohibits inquiries about health plan or liability payer information if the inquiry will delay examination or treatment. What other requirements apply to the Emergency Department registration work? - Correct Answer-Patients are initially triaged by medical personnel and a quick registration initiated to allow electronic order entry and documentation Identification and verification of insurance eligibility and benefits once the medical screening has been completed No additional registration may occur until the patient is stabilized Typical activities which must be performed when an unscheduled patient arrives for service include: - Correct Answer-Initiation of a new MPI record, insurance verification if time permits, managed care screening, price estimation and financial counseling to achieve the appropriate account resolution The purpose of discharge planning is: - Correct Answer-To estimate how long the patient will be in the hospital, identify the expected outcome of the hospitalization and initiate any special requirements for services at or after the time of discharge. Challenges typically associate with the chargemaster include: - Correct Answer- Omission of charges, obsolete or invalid codes, and the omission of required modifiers The primary types of coding systems currently used in healthcare are: - Correct Answer- ICD-10-CM/ICD-10-PCS; CPT/HCPC codes There are four code sets that provide health plans with additional info as they process claims. Those code sets are: - Correct Answer-Condition codes, occurrence codes, occurrence span codes and value codes For the SNF, care is covered if which of the following factors are present: - Correct Answer-The patient requires skilled services on a daily basis and those services can only be provided on an inpatient basis in a SNF DRG's are a system of classifying inpatients on the basis of diagnoses, procedures, and co-morbidities for purposes of payment to hospitals. Each DRG includes: - Correct Answer-A relative weight which is multiplied by the established base payment rate to calculate the reimbursement for a specific DRG. For exceptionally costly cases over a set dollar amount, an outlier payment is added to the calculated payment. PPO networks represent one form of discounting commonly used by commercial payers. The silent PPO represents: - Correct Answer-A discounting scheme whereby health plans apply generic PPO rates to discount a provider's claims, even though there is no contractual arrangement between the silent PPO and the provider The concept of timely filing of claims is important to providers, payers and patients. Thus, providers are required to comply with timely claim filing rules. Which of the following statements are NOT true about timely filing limitations: - Correct Answer-Payers will waive timely filing denials for claims filed over a year from DOS What is EMTALA? - Correct Answer-Hospitals need to provide medical screening exam and any needed stabilizing treatment to every person in an ED and requesting medical eval or treatment. What are EMTALA concerns in an ED? - Correct Answer-A sign must be posted that tells patients of their right to be seen Prior auth is not allowed for ED services before stabilizing treatment Women in active labor must receive service through delivery If an on-call physician refuses to treat a patient or fails to get there in a reasonable time, that must be reflected in the patient record Any treatment that is necessary for stabilization must be performed in the ED and any referrals before stabilization is called patient dumping The patient must be considered stable before they are transferred A patient must complete a full medical and full psychiatric screening A central log must be maintained that documents all patients in the ED seeking assistance What does occurrence code 72 do? - Correct Answer-Denotes the date span of contiguous OP services that preceded the IP admissionq What is bed control? - Correct Answer-Activity that results in the accurate recording of patient bed status and level-of-care assessment, patient transfer and patient discharge status on a real-time basis What are the basic steps of discharge? - Correct Answer-1. The physician must write the discharge order 2. Case management discharge planning must be finalized 3. Appropriate discharge instructions must be provided to the patient 4. Access services must review the patient's record to see if the patient qualifies for courtesy discharge, and if not, notification must be sent for the patient to see a financial counselor prior to discharge 5. When the patient leaves, the registration system must be updated to reflect the correct date and time of discharge and the correct disposition code What are the admission process forms? - Correct Answer-Consent to Treatment Conditions of Admission Privacy Notice Important Message from Medicare Advance Directives and Medical Power of Attorney Patient Bill of Rights What are the responsibilities of a case manager? - Correct Answer-1. Monitor the use of resources, review stays upon admission and throughout the stay, obtain continued stay approvals and coordinate the discharge planning process with social services and other providers 2. Gather info, including admission date and diagnosis, the type of hospital service to which the patient was admitted, the admitting physician, consultants, planned procedures, expected discharge date, needed discharge planning and any other info need to manage the patient's care 3. Manage and monitor the case throughout the course of the stay to ensure all services are provided on time and in the proper sequence, education for the patient is complete, and home services are ordered. What is discharge planning? - Correct Answer-Planning that includes an estimate of how long the patient will be in the hospital, what the expected outcome will be, whether there will be any special requirements on discharge, and what needs to be facilitated to effectively discharge the patient in an appropriately timely manner How does charge process work? - Correct Answer-Room and bed charges generally post at the midnight census Ancillary charges can be posted when the service is ordered or when the result is reported. Usually through scanning a barcoded item. A charge audit is run to verify that all the charges are backed up against logs, schedules and medical records What are level I HCPCs? - Correct Answer-The American Medical Association's CPT-4 codes All CPT-4 codes are included within the HCPCs code listing These five digit HCPCs codes are numeric What are level II HCPCs? - Correct Answer-CMS-developed codes for classifying supplies and non-physician services Begin with a single letter (A-V) followed by four numeric digits What are Level III HCPCs? - Correct Answer-These codes are maintained by Medicare Administrative Contractors Begin with a letter (W-Z) followed by four numeric digits These codes are not common and are used basically to describe new procedures not yet developed in level I and II What is a Diagnosis Related Group contract? - Correct Answer-Payers pay a set amount based on a patient's principal diagnosis, surgical procedures, previous medical conditions and medical complications. Expensive cases are deemed outliers and hospitals are paid more for these special cases What is an ambulatory payment classification contract? - Correct Answer-A group of 600 outpatient procedures that pay an average amount of all of those procedures performed. What is fee schedule contract? - Correct Answer-Reimbursement is made based on a negotiated fee for the specific outpatient CPT or HCPC What is a case rate payment contract? - Correct Answer-A fixed price for specific procedures based on a negotiated rate. The provider covers all services the client needs for specific period of time What is a package pricing payment? - Correct Answer-A bundled payment is made for all of the services provided for a specific reason What is capitation? - Correct Answer-A monthly fee that the provider is paid regardless of the cost of care of the patient. What is fixed contracting payment? - Correct Answer-Providers recognize that over 60% of their revenue comes from fixed sources. I have no idea what this means. What is a stop-loss provision? - Correct Answer-Provides protection for expenses that exceed a reasonable amount. Allows providers to collect extra money on very expensive cases. How does a silent PPO work? - Correct Answer-The patient's claim is sent to the listed primary health plan. The patient's health plan (a silent PPO) runs the healthcare provider's tax ID number through a PPO discount database or provides a re-pricing company a copy of the claim. After a successful "hit", the claim is "re-priced" based on the PPO discounts that were accessed. After applying the discount, the silent PPO may state on the EOB that the healthcare provider agreed to reduce the bill based on the contract with the PPO. This is usually FALSE because the preferred provider contract, if the provider had one with that PPO, allowed only health plans with PPO policies or plans to access provider-specific discounts. The medical provider accepts the health plan's statement on the EOB and writes the discount off — never knowing that the discount was invalid. Credit balances may be created by any of the following activities except: - Correct Answer-Credits to pharmacy charges posted before the claim final bills Which of the following statements represent common reasons for impatient claim denials: - Correct Answer-Failure to obtain a required, pre-auth; failure to complete a continued stay auth and services provided which were not medically necessary A 68 year old patient, a Medicare beneficiary, was in a car accident. A medical insurance claim was filed with the auto insurance carrier. Six months later this claim remains unpaid. How can the provider pursue payment from Medicare? - Correct Answer-The provider must first bill the auto insurer; however, after a period of 120 days, if the claim remains unpaid, the provider may cancel the liability claim and bill Medicare The difference between bad debt and financial assistance (charity) is: - Correct Answer- Bad debt represents a refusal to pay; charity represents an inability to pay In order to qualify for financial assistance, a patient or guarantor should: - Correct Answer-Provide from following documents: prior year tax return, employment check stubs from the prior three months and bank statements from the prior three months To comply with the requirements of Section 501(r) for tax-exempt chartered as 510(c) 3 provider, the hospital must complete which of the following activities: - Correct Answer- A community needs assessments The three types of bankruptcy as defined in the 1979 Bankruptcy Act are: - Correct Answer-Chapter 7-Straight Bankruptcy, Chapter 11-Debtor Reorganization and Chapter 13-Debtor Rehabilitation Which of the following medical debt collection practices are recommended as part of HFMA's Best Practices for medical account resolution: - Correct Answer-Establish policies and ensure that they are followed Which of the following statements is not an advantage of utilizing an outsourcing vendor? - Correct Answer-The need for legal review if the outside vendor's staff represents themselves as employees of the healthcare facility Each hospital covered by the 501(r) regulations is required to develop a financial assistance policy. Which of the following elements is NOT a required element of the policy? - Correct Answer-The notice that individuals eligible for financial assistance under this policy may be charged more that the amount generally billed (AGB) to insured patients What are the cash handling controls? - Correct Answer-1. The separation of cash handling procedures whereby the same person who opens and endorses the checks is not responsible for the deposit 2. The establishment of internal audits by personnel outside the involved department 3. The routine use of outside auditors to track cash flow 4. The routine reconciliation of daily cash against deposits, postings and write-offs 5. The use of multiple levels of authorization for refund checks, write-offs and disbursements What is the daily reconciliation process? - Correct Answer-1. Obtain totals of all payments-cash, check, credit card and debit card 2. Divide remits into batches and obtain a second total of the electronic remit advices by payment and contractual allowances 3. Endorse checks immediately 4. Prepare the bank deposit for all payments 5. Separate cash payments and contractual adjs into separate batches and use separate payment and adjs codes 6. Post unidentified payments to an unidentified cash account (deposit everything, do not hold unidentified payments) 7. Balance and post batches 8. Balance payments to the bank deposit 9. Balance the bank deposit to the general ledger What is the electronic fund transfer? - Correct Answer-Transfer of funds from payer to payee through the banking system. The bank informs the hospital of the amount received and issues a deposit. The hospital then balances the deposit to the electronic remittance advice received What is an ERA level 1? - Correct Answer-Electronic receipt of data only: An electronic remittance advice is received The info is printed The printout is then processed the same as a paper remittance advice What are the advantages of an ERA level I? - Correct Answer-Saving mail time for the remittance Standardized format for data entry What is an ERA level 2? - Correct Answer-Electronic receipt and electronic data entry: With this level, the electronic remittance is received Entered into the computer electronically Viewed on a terminal The data entry tasks are eliminated but there continues to be a manual matching of remit info to an individual account and reconciliation of charges to the amount paid What is an ERA level 3? - Correct Answer-Electronic receipt, data entry, reconciliation, posting and closing: Electronic remit is received and entered into a computer electronically The remit data is electronically posted by the patient accounting software, simultaneously updating the patient's account Standard adjs codes are established to automate payments, manual intervention is only needed if there is an error FAP-eligible patient would pay based on the amount that Medicare or Medicaid corresponding beneficiary would be required to pay for the same service. What are extraordinary collections actions (ECAs)? - Correct Answer-1. Legal actions, such as garnishments, liens or other actions requiring legal or judicial processes 2. Selling the debt to a third party 3. Reporting adverse info to credit bureaus or agencies 4. Deferring or denying medically necessary care because of nonpayment for previously provided care that is covered by the FAP What are reasonable efforts to collect? - Correct Answer-Widely publicizing the availability of financial assistance and copies of the FAP within the community Waiting at least 120 days from the date of the first post-discharge billing statement before initiating and ECA Providing written notification about the FAP, including a copy of the plain language summary of the FAP, a notice concerning any ECAs the hospital or designated party intend to initiate 30 days prior to initiating any ECAs Allow potentially FAP-eligible individuals to submit applications for at least 240 days from the date of the first post discharge billing statement Notify any individuals who submit an incomplete FAP application during the application period about how to complete their application and provide contact info to obtain assistance Process and eligibility determination for all completed applications submitted with the 240 day application period What happens if a patient submits an FAP application within the 240 days? - Correct Answer-The hospital is required to suspend any ECAs underway to collect payment The hospital must review the application and provide an eligibility determination in writing to the patient, including a description of any assistance if eligible If the patient does not qualify for 100% free care, the hospital must provide a billing statement indicating the amount owed and how it was calculated If the patient had already paid the hospital any amount in excess of the amount required by the FAP, the hospital must refund that overpayment to the patient If any ECAs have already been initiated, such as reporting to credit bureaus, those ECAs must be removed from the patient's credit report What is the Title I: Truth in Lending Act? - Correct Answer-Establishes disclosure rules for consumer credit sales and consumer loans What are the requirements a hospital must meet to apply for Regulation Z's disclosure? - Correct Answer-1. A collector enters into a written agreement with a debtor regarding the payment of a debt; and 2. The account relates to credit extended for personal, family or household purposes; and 3. During the preceding calendar year or in the calendar year to date, the collector has entered into agreements with debtors involving the addition of interest or finance charges or written agreements with debtors involving more than 4 installments more than 25 times; and 4. Payments are to be made in more than 4 installments; or the collector adds interest to an account to which interest was not previously charged or the original interest is increased; and 5. The agreement is not related to the court proceeding (such as a lawsuit) If the disclosure requirements are triggered for regulation Z what is disclosed? - Correct Answer-Annual percentage rate Amount of finance charge Amount financed Amount of payments Late payment charges Total of all payments Pre-payment arrangements Payment schedule including number of payments, amounts and timing An opportunity for debtor to receive an itemization of how the payments are to be applied What is title III: restrictions on garnishment? - Correct Answer-Maximizes limits for wage garnishments to either: 25% of a worker's disposable earnings per week or The amount by which a worker's weekly wage exceeds 30 times the federal minimum wage No employee can be fired because their wages are garnished What is title VI: Fair Credit reporting act? - Correct Answer-Protects consumers' rights and has exact standards that limits the use of consumer credit reports. It covers the type of info that must be removed from credit files and when that info is removed On dispute, an agency investigates and either reports the info or deletes the report What is section 804 of title VIII: Fair debt collection practices act? - Correct Answer- Governs the actions of debt collectors while attempting to identify an individual's location or rather skip tracing. What does section 805 do? - Correct Answer-Covers the most basic functions of a collector communication What does section 806 do? - Correct Answer-A debt collector may not engage in any conduct the natural consequence of which is to harass, oppress, or abuse any person in connection with the collection of debt What does section 807 do? - Correct Answer-A debt collector may not use any false, deceptive, or misleading representation or means in connection with the collection of any debt. It lays out the collector conduct violations What is bankruptcy? - Correct Answer-The legal process by which a person, business or corporation is declared to be insolvent and unable to pay creditors What is Chapter 7 straight bankruptcy? - Correct Answer-A court proceeding that liquidates the debtor's nonexempt property, pays creditors and discharges the debtor from his/her debt What is exempt property in bankruptcy? - Correct Answer-Any real personal property Disability, illness or unemployment benefits; life insurance from the person the bankrupt individual depended on; life insurance policy with loan value Alimony and child support Employee Retirement Income Security Act Personal Property: household items, jewelry, vehicles Public benefits Tools of trade Wages What are the 9 exceptions to discharge? - Correct Answer-1. Back taxes 2. Debts that arise from obtaining money under false pretenses 3. Debts that are not properly listed 4. Debts resulting from the bankrupt's misconduct 5. Unpaid alimony, maintenance or child support 6. Debts for personal injury caused by DUI 7. Government fines or penalties 8. Educational loans 9. Debts that could have been listed in a previous bankruptcy proceeding What does chapter 11 debtor reorganized do? - Correct Answer-Permits a debtor to work out a court-supervised plan with his/her creditors The court accepts if: 1. If it is satisfied that the proposal is in the best interests of the creditors 2. that the debtor will faithfully carry out the plan 3. that the plan provides for payment to creditors in the order of priority 4. The creditor have either accepted the plan or that they will receive/retain as much as they had with straight bankruptcy What is Chapter 13 Debtor Rehab? - Correct Answer-A court proceeding that serves to reorganize a debtor's holdings and instruct creditors to look to the debtor's future earnings for payment What is a secured creditor? - Correct Answer-A creditor who holds some monetary assurance of payment of debt. These creditors have the first right to payment What are the advantages of using a collection agency? - Correct Answer-Collection agencies have tools and technologies that are effective in pursuing aged self-pay accounts