CRCR Examination with Answers: Healthcare Dollars & Sense Revenue Cycle Initiatives, Exams of Nursing

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1. CRCR EXAMINATION WITH

ANSWERS 2024 EDITION.

2. Which option is NOT a main HFMA Healthcare Dollars & Sense revenue cycle initiative? - Correct Ans ✔✔ Process Compliance
3. What is the objective of the HCAHPS initiative? - Correct Ans ✔✔ To provide a standardized method for evaluating patient's perspective on hospital care
4. Which option is NOT a department that supports and collaborates with the revenue cycle? - Correct Ans ✔✔ Assisted Living Services
5. Which option is NOT a continuum of care provider? - Correct Ans ✔✔ Health Plan Contracting
6. Which of the following are essential elements of an effective compliance program? - Correct Ans ✔✔ established compliance standards and procedures, oversight of personnel by high-level personnel, reasonable methods to achieve compliance with standards, including monitoring systems and hotlines
7. Annually, the OIG publishes a work plan of compliance issues and objects that will be focused on the throughout the following year.

Identify which option is NOT a work plan task mentioned in this course. - Correct Ans ✔✔ Standard Unique Employer Identifier

8. In order to promote the use of correct coding methods on a national basis and prevent payment errors due to improper coding, CMS developed what? - Correct Ans ✔✔ The Correct Coding Initiative(CCI)
9. What do business/organizational ethics represent? - Correct Ans ✔✔ Principles and standards by which organizations operate
10. What is the intended outcome of collaborations made through an ACO delivery system? - Correct Ans ✔✔ To ensure appropriateness of care, elimination of duplicate services, and prevention of medical errors for a population of patients
11. Which of these statements describes the new methodology for the determinations of net patient service revenue? - Correct Ans ✔✔ Net patient service revenue is defined a the total incurred charges, less the explicit price concession, less any applicable implicit price concession(s) as applied to the specific portfolio of accounts.
12. What are KPIs? - Correct Ans ✔✔ Key Performance Indicators, which set standards for accounts receivable (A/R) and provide a method of measuring the collection and control of A/R

13. Which patient types are typically considered acute care patient types? - Correct Ans ✔✔ Observation, newborn, Emergency(ED)
14. 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 Ans ✔✔ Full legal name, date of birth, sex and social security number
15. Pre-registration is defined as: - Correct Ans ✔✔ The collection of demographic information, insurance data, financial information, providing reminders, prep information, and identifying the potential need for financial assistance for scheduled patients.
16. Which of the following statements accurately describe the various Medicare benefit programs: - Correct Ans ✔✔ Medicare part A provides benefits for inpatient hospital services, skilled nursing care 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.
17. Which of the following statements about Medicaid eligibility is not true? - Correct Ans ✔✔ Medicaid categories are restricted to children, pregnant women, and elderly in nursing homes

18. Examples of managed care plans include: - Correct Ans ✔✔ HMO, PPO, EPO, POS, Concierge plans, Medicare Advantage plans, Direct contracting for specific services from specific providers (all of the above)
19. Patient Financial Communications best practices include all of the following activities except: - Correct Ans ✔✔ Collecting payment or initiating the process to immediately remove the patient from the service schedule.
20. Which statement includes the required components of an accurate pricing determination: - Correct Ans ✔✔ Insurance coverages and benefits, service or test involved, diagnosis and procedure codes, total estimated charges, adjudication calculations based on the patient's benefit package.
21. The value of a robust scheduling and pre-registration process includes all of the following except: - Correct Ans ✔✔ Identification of patients who are likely to be "no shows".
22. Which patients are considered scheduled? - Correct Ans ✔✔ Recurring/Series Patients
23. Name the guideline that Medicare established to determine which diagnoses, signs, or symptoms are payable. - Correct Ans ✔✔ Local Coverage Determination

24. What is the purpose of insurance verification? - Correct Ans ✔✔ To ensure accuracy of the health plan information.
25. Which option is federally-aided, state-operated program to provide health and long-term care coverage? - Correct Ans ✔✔ Medicaid
26. Which option is NOT a specific managed care requirement? - Correct Ans ✔✔ Preferred Provider Organization
27. What is the first component of a pricing determination? - Correct Ans ✔✔ Verification of the patient's insurance eligibility and benefits.
28. What is the purpose of financial counseling? - Correct Ans ✔✔ To educate the patient on his/her health plan coverage and financial responsibility for healthcare services
29. 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 Ans ✔✔ Patients are initially triaged by medical personnel... , identification and verification of insurance eligibility... , No additional registration may occur (all of the above)

30. Typical activities which must be performed when an unscheduled patient arrives for service include: - Correct Ans ✔✔ Identification of patient in the MPI or initiation of a new MPI record, insurance verification of eligibility and benefits, managed care screening, medical necessity screening, price estimations and financial counseling to achieve the appropriate account resolution
31. Case managers are involved from admission with the discharge planning process. The purpose of discharge planning is: - Correct Ans ✔✔ 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
32. The chargemaster is basically a list of services, procedures, room accommodations, supplies, drugs, tests, etc, typically associated with the billing for services rendered to patients. Challenges typically associated with the chargemaster include: - Correct Ans ✔✔ Omission of charges, obsolete or invalid codes, and the omission of required modifiers
33. Ultimately, the services provided in the healthcare system are reduced to standard codes. The primary types of coding systems currently used in healthcare are: - Correct Ans ✔✔ ICD- 10 - CM/ICD- 10 - PCS;CPT/HCPCS codes

34. There are four code sets that provide health plans with additional information as they process claims. Those code sets are: - Correct Ans ✔✔ Condition codes, occurrence codes, occurrence span codes and value codes
35. Each type of service has unique billing rules which come into play during the provision of service. For the skilled nursing facility, care is covered if which of the following factors are present? - Correct Ans ✔✔ The patient required skilled services on a daily basis and those services can only be provided on an inpatient basis in a SNF.
36. DRG's are a system of classifying inpatients on the basis of diagnoses, procedures, and co-monitoring for purposes of payment to hospitals. Each DRG includes: - Correct Ans ✔✔ 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
37. PPO networks represent one form o discounting commonly used by commercial payers. The silent PPO represents: - Correct Ans ✔✔ 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.
38. The concept of timely filing of the 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 Ans ✔✔ Payers will waive timely filing denials for claims filed over a year from date of service

39. What does EMTALA require hospitals to do? - Correct Ans ✔✔ To provide a medical screening examination and stabilizing treatment to every person presenting at an ED and requesting medical evaluation or treatment
40. In what manner do case managers assist revenue cycle staff? - Correct Ans ✔✔ Providing assistance with written appeals to health plans related to utilization and other care issues.
41. Why is it critical that a chargemaster is reviewed and updated regularly? - Correct Ans ✔✔ To ensure it supports and represents the services provided within the organization
42. What are claim edits? - Correct Ans ✔✔ Rules developed to verify the accuracy and completeness of claims based on each health plan's policies
43. Which statement is NOT a unique billing rule specific to providers? - Correct Ans ✔✔ A patient may be balance billed for whatever amount the non-contracting physician charges above the health plan's reimbursement amount.

44. Which of the following statements does not apply to billing during the COVID-19 public health emergency? - Correct Ans ✔✔ Telemedicine claims are not payable if the patient conducts the telemedicine visit from home
45. Which concept is NOT a contracted payment model? - Correct Ans ✔✔ Stop-Loss Provision
46. Credit balances may be created by any of the following activities except: - Correct Ans ✔✔ Credits to pharmacy charges posted before the claim final bills.
47. Which of the following statements represent common reasons for inpatient claim denials: - Correct Ans ✔✔ Failure to obtain a required pre-authorization; failure to complete a continued stay authorization and service provided which were not medically necessary.
48. 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 Ans ✔✔ 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

49. The difference between bad debt and financial assistance (charity) is: - Correct Ans ✔✔ Bad debt represents a refusal to pay, charity represents an inability to pay.
50. In order to qualify for financial assistance, a patient or guarantor should: - Correct Ans ✔✔ Provide the following documents: prior year tax return, employment check stubs from the prior three months and bank statements from the prior three months
51. To comply with the requirements of Section 501(r) for tax-exempt hospitals chartered as 510(c)3 providers, the hospital must complete which of the following activities: - Correct Ans ✔✔ A community needs assessment
52. The three types of bankruptcy as defined in the 1979 Bankruptcy Act are: - Correct Ans ✔✔ Chapter 7- Straight Bankruptcy, Chapter 11 - Debtor Reorganization and Chapter 13- Debtor Rehabilitation
53. Which of the following medical debt collection practices are recommended as part of HFMA's Best Practices for medical account resolution: - Correct Ans ✔✔ Establish policies and ensure that they are followed
54. Organizations may opt to contract with or outsource to specific vendors for some or all components of revenue cycle processing.

This practice has both advantages and disadvantages. Which of the following statements is not an advantage of utilizing an outsourcing vendor? - Correct Ans ✔✔ The need for legal review if the outside vendor's staff represents themselves as employees of the healthcare facility

55. 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 Ans ✔✔ The notice that individuals eligible for financial assistance under this policy may be charged more than the amount generally billed (AGB) to insured patients
56. Sue Smith came into the hospital. Her insurance provider sent an EFT directly into the hospital's account at the bank. John, the hospital representatives, receives an electronic Level 2 ERA. What should he do next? - Correct Ans ✔✔ Manually match the ERA in the patient account
57. What is EFT - Correct Ans ✔✔ The electronic transfer of funds from payer to payee through the banking system
58. Which statement is false regarding credit balances? - Correct Ans ✔✔ There are no CMS hospital compliance requirements regarding credit balances

59. Which option is NOT a type of denial? - Correct Ans ✔✔ Contractual Adjustment
60. Which option is NOT a lien type? - Correct Ans ✔✔ Subrogation
61. Based on what you have just read, which activity is not considered when initiating self-pay follow-up and account resolution activities? - Correct Ans ✔✔ Patient Open Balance Billing
62. Which option is NOT a required component of a FAP? - Correct Ans ✔✔ Out-of-network providers
63. Which option is NOT a bankruptcy type governed by th 1979 Bankruptcy Act? - Correct Ans ✔✔ Creditor priority
64. Agency fees are: - Correct Ans ✔✔ The cost to the provider for collection agency monies offset by the return on baddebt accounts
65. The correct way to handle the retention and payment of agency fee is: - Correct Ans ✔✔ Follow the contractual agreement between the agency and the provider as to how monies sent to the agency will be handled

66. Patient relations include: - Correct Ans ✔✔ The ability to sensitively deal with patients or individuals while managing collection efficiency
67. Collection agency reports should be provided: - Correct Ans ✔✔ In at least two formats regarding accounts assigned on a routine basis
68. Collection results are: - Correct Ans ✔✔ Accurately calculated to demonstrate the actual recovery percentage rate
69. Which option is NOT a HFMA best practice? - Correct Ans ✔✔ Coordinate the resolution of bad debt accounts with a law firm
70. Which function within the revenue cycle is NOT a good candidate for outsourcing? - Correct Ans ✔✔ Health Care Patient Services
71. What are the steps that the hospital needs to take to establish and ensure a successful vendor relationship? - Correct Ans ✔✔ Distributes a RFP to solicit vendor capabilities, evaluate vendor's expertise to provide outsourcing services, visit vendor locations, perform vendor reference checks, talk with vendor clients, interview vendor employees to assess experience level
72. Which of the following statements are true of HFMA's Patient Financial Communications Best Practices? - Correct Ans ✔✔ The best practices were developed specifically to help patients

understand the cost of services, their individual insurance benefits, and their responsibility for balances after insurance, if any.

73. The patient experience includes all of the following except: - Correct Ans ✔✔ Recognition that revenue cycle processes must be patient-centric and efficient. This is especially true in the areas of scheduling, registration, admitting, financial counseling and account resolution conversation with patients.
74. 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 Ans ✔✔ A critical tool to ensure compliance, essential and integral component, fosters an environment, (all of the above)
75. Specific to Medicare free-for-service patients, which of the following payers have always been liable for payment? - Correct Ans ✔✔ Black lung service programs, veteran affairs program, working aged programs, ESRD, and disability
76. Provider policies and procedures should be in place to reduce the risk of ethics violations. Examples include: - Correct Ans ✔✔ financial misconduct, theft of property, applying policies in inconsistent manner (all of the above)

77. What is the intended outcome of collaborations made through an ACO delivery system for a population of patients? - Correct Ans ✔✔ To eliminate duplicate services, prevent medical errors and ensure appropriateness of care
78. What is the new terminology now employed in the calculation of net patient service revenues? - Correct Ans ✔✔ explicit price concessions and implicit price concessions
79. 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 Ans ✔✔ Elapsed days from discharge to final bill and elapsed days from final bill to claim/bill submission
80. What happens during the post-service stage? - Correct Ans ✔✔ Final coding of all services, preparation and submission of claims, payment processing and balance billing and resolution.
81. The following statements describe best practices established by the Medicaid Debt Task Force. Select true statements. - Correct Ans ✔✔ educate patients, coordinate to avoid duplicate patient contacts, be consistent in key aspects of account resolution, follow best practices for communication