CRCR final exam questions with correct answers 2024/2025, Exams of Community Corrections

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CRCR final exam questions with correct

answers 2024/

Agclaimgforgreimbursementgsubmittedgtogagthird- partygpayergthatghasgallgtheginformationgandgdocumentationgrequiredgforgthegpayergtogm akegagdecisiongongitgisgknowngasg-gCORRECTgANSWERg- **A.gAngauthorizedgrequestgforgrepayment B.gAgcorrectgclaim C.gAgcleangclaim D.gPayergacceptedgbilling AgfourgdigitgnumbergcodegestablishedgbygthegNationalgUniformgBillinggCommitteeg(NUB C)gthatgcategorizes/classifiesgaglinegitemgingthegchargegmastergisgknowngasg- gCORRECTgANSWERg-A.gCPTgcodes B.gICD- 10 gProceduralgcodes C.gHCPCsgcodes **D.gRevenuegcodes Agrecurring/seriesgregistrationgisgcharacterizedgbyg-gCORRECTgANSWERg- A.gThegcreationgofgonegregistrationgrecordgpergdiagnosisgpergvisit B.gThegcreationgofgmultiplegregistrationsgforgmultiplegservices **C.gThegcreationgofgonegregistrationgrecordgforgmultiplegdaysgofgservice D.gThegcreationgofgmultiplegpatientgtypesgforgonegdategofgservice Agroutinegpatientgfinancialgdiscussiongwouldgincludeg-gCORRECTgANSWERg- A.gGatheringgthegpatient'sgbankingginformation B.gDetermininggandgnotifyinggthegpatientgofgtheirgineligibilitygforgfinancialgassistancegduegt ogexistingginsurancegcoverage **C.gExplaininggthegbenefitsgidentifiedgthroughgverifyinggthegpatient'sginsurance

D.gRefundinggangoverpayment AllgofgthegfollowinggaregstepsgingsafeguardinggcollectionsgEXCEPTg-gCORRECTgANSWERg- A.gPlacinggcollectionsgingaglock-boxgforgpostinggreviewgthegnextgbusinessgday B.gPostinggthegpaymentgtogthegpatient'sgaccount **C.gIssuinggreceipts D.gCompletinggbalancinggactivities AllgofgthegfollowinggaregstepsgingverifyingginsurancegEXCEPTg-gCORRECTgANSWERg- A.gIdentifyinggandgdocumentinggthegpatient'sghealthgplangbenefits B.gConfirminggthegpatient'sgeligibilitygforgbenefits C.gThegpatientgsigninggthegstatementgofgfinancialgresponsibility D.gSequencinggplansginvolvedgingagcoordinationgofgbenefitsg(COB)gsituation Anygprovidergthatghasgfiledgagtimelygcostgreportgmaygappealgangadversegfinalgdecisiongrece ivedgfromgthegMedicaregAdministrativegContractorg(MAC).gThisgappealgmaygbegfiledgwit hg-gCORRECTgANSWERg-A.gThegProvidergReimbursementgReviewgBoard B.gThegDepartmentgofgHealthgandgHumangServicesgProvidergRelationsgDivision C.gAgcourtgappointedgfederalgmediator D.gThegOfficegofgthegInspectorgGeneral Applyinggthegcontractedgpaymentgamountgtogthegamountgofgtotalgchargesgyieldsg- gCORRECTgANSWERg-A.gAgpricinggagreement **B.gAngestimatedgpricegforgthegpatientsgresponsibility C.gAgservicegcostgguarantee D.gAgpricegjustifiedgrevenuegaccrual Appropriategtraininggforgpatientgfinancialgcounselinggstaffgmustgcovergallgofgthegfollowingg EXCEPTg-gCORRECTgANSWERg-A.gAvailablegpatientgfinancinggoptions **B.gDocumentinggthegconversationgingthegmedicalgrecord C.gFinancialgassistancegpolicies D.gPatientgfinancialgcommunicationsgbestgpracticesgspecificgtogstaffgrole

Checksgreceivedgthroughgmail,gcashgreceivedgthroughgmail,gandglockgboxgaregallgexamples gofg-gCORRECTgANSWERg- A.gPaymentgmethodsgbeinggphasedgoutgforgmoregsecuregpaymentgmethodgoption **B.gControlgpointsgforgcashgposting C.gPaymentgmethodsgingwhichgthegmajoritygofgfraudgoccurs D.gHighlygfraudgpronegprocesses Claimsgwithgdatesgofgservicegreceivedglatergthangonegcalendargyeargbeyondgthegdategofgser vice,gwillgbeg-gCORRECTgANSWERg-A.gThegfullgresponsibilitygofgthegpatient B.gDeniedgbygMedicare C.gThegprovider'sgresponsibilitygbutgcangbegdeemedgcharitygcare D.gFullygpaidgwithginterest Duplicategpaymentsgoccurg-gCORRECTgANSWERg-A.gWhengprovidersgre- billgclaimsgbasedgongnonpaymentgfromgtheginitialgbillgsubmission B.gWhengservicegdepartmentsgdognotgprocessgchargesgwithgthegorganization'sgsuspensegda ys C.gWhengtheregaregotherghealthcaregclaimsgingprocessgandgtheganticipatedgdeductiblesgand gco-insurancegamountsgstillgshowgopengbutgwillgbegmetgbygthegin-processgclaims D.gWhengthegpayer'sgcoordinationgofgbenefitsgisgnotgcapturedgcorrectlygatgthegtimegofgpati entgregistration Duringgpre- registration,gagsearchgforgthegpatient'sgMPIgnumbergisginitiatedgusinggwhichgofgthegfollowin ggdatagsets?g-gCORRECTgANSWERg- **A.gPatient'sgfullglegalgnamegandgdategofgbirthgorgthegpatient'sgSocialgSecuritygnumber B.gPatient'sgfullglegalgnamegandgaddress C.gPatient'sgSocialgSecuritygnumbergandghomegaddress D.gPatient'sgfullglegalgnamegandghealthgplanggroupgnumbers

Eachgpatientgisgassignedgaguniquegnumber,gcommonlygcalledgtheg-gCORRECTgANSWERg- A.gMedicalgcasegnumber **B.gMastergPatientgIndexg(MPI)gnumber C.gPatientgIdentifier D.gPatientgClassification Eliminatinggmailgtimegandgreducinggdatagentrygtime;gelectronicallygmonitoringgthegreceipt gofgclaimsgandgonlinegclaimgadjudication;gmoregpromptgpaymentgaregallgbenefitsgachieved gbyg-gCORRECTgANSWERg- **A.gThegelectronicgsubmissiongofgclaimsgusinggelectronicgtransactions B.gRegulargchargemastergdescriptiongmaintenance C.gAccurategandgcompletegdocumentationgofgmedicalgrecordgbygcoders D.gWell-trainedgPatientgAccessgandgContractgManagementgstaff Forgroutinegscenarios,gsuchgasgpatientsgwithginsurancegcoveragegorgagknowngabilitygtogpay ,gfinancialgdiscussionsg-gCORRECTgANSWERg- A.gMaygtakegplacegbetweengthegpatientgandgdischargegplanning **B.gShouldgtakegplacegbetweengthegpatientgorgguarantorgandgproperlygtrainedgproviderg representatives C.gAregoptional D.gAregfocusedgongverifyinggrequiredgthird-partygpayerginformation Forgscheduledgpatients,gwhichgofgthegfollowinggaregNOTgimportantgrevenuegcyclegactiviti esgingthegtime-of-servicegstage?g-gCORRECTgANSWERg-A.gPre- registrationgrecordgisgactivated,gconsentsgaregsigned,gandgco-paymentgaregcollected B.gPre-processedgpatientsgaregdirectedgtogagdesignatedg"expressgarrival"gdesk C.gPositivegpatientgidentificationgisgcompleted,gandgthegpatientgisggivengangarmband **D.gFinalgbillgisgpresentedgforgpayment HealthgInformationgManagementg(HIM)gisgresponsiblegforg-gCORRECTgANSWERg- A.gThegmaintenancegofgallgsoftwaregapplications B.gCleangclaimsgbeinggfiled

C.gThegmaintenancegofgthegentiregtechnologyginfrastructure **D.gAllgpatientgmedicalgrecords HealthgPlangContractinggDepartmentsgdogallgofgthegfollowinggEXCEPTg- gCORRECTgANSWERg- A.gReviewgpaymentgschemesgtogensuregthatgtheghealthgplangandgprovidergunderstandgho wgreimbursementsgmustgbegcalculated B.gReviewgcontractsgtogensuregthegappealsgprocessgforgdeniedgclaimsgisgclearlygspecified **C.gEstablishgagglobalgreimbursementgrategtogusegwithgallgthird-partygpayers D.gReviewgallgmanagedgcaregcontractsgforgaccuracygforgloadinggcontractgtermsgintogthegpa tientgaccountinggsystem HFMAgpatientgfinancialgcommunicationsgbestgpracticesgcallgforgannualgtraininggforgallgstaf fgEXCEPTg-gCORRECTgANSWERg-A.gPatientgaccess B.gCustomergservicegrepresentatives **C.gNursing D.gStaffgwhogengagegingpatientgfinancialgcommunicationsgdiscussions HFMA'sgpatientgfinancialgcommunicationsgbestgpracticesgspecifygthatgpatientsgshouldgbegt oldgaboutgthegtypesgofgservicesgprovidedgandg-gCORRECTgANSWERg- A.gThegpricegofgservicegtogtheirgcoveringghealthgplan B.gAgsatisfactiongsurveygregardinggclinicalgservicegproviders C.gAngexplanationgofgwhygagspecificgservicegisgnotgprovided **D.gThegservicegprovidersgthatgtypicallygparticipategingthegservice,ge.g.,gradiologists,gpath ologists,getc. HIPAAghasgadoptedgEmployergIdentificationgNumbersg(EINs)gtogbegusedgingstandardgtran sactionsgtogidentifygthegemployergofgangindividualgdescribedgingagtransaction.gEINsgaregcre atedgandgassignedgbyg-gCORRECTgANSWERg- A.gThegUnitedgStatesgDepartmentgofgthegTreasury B.gThegUnitedgStatesgDepartmentgofgLabor **C.gThegInternalgRevenuegService

D.gThegSocialgSecuritygAdministration Hospitalsgcangonlygconvertganginpatientgcasegtogobservationgifgtheghospitalgutilizationgrevi ewgcommitteegdeterminesgthisgstatusgbeforegthegpatientgisgdischargedgandg- gCORRECTgANSWERg-A.gBeforegclosinggthegpatient'sgaccount B.gAfterganygbilling **C.gPriorgtogbilling,gthatgangobservationgsettinggwillgbegmoregappropriate D.gWithgthegconsentgofgthegthird- partygpayer'sgmedicalgdirectorgthatgangobservationgsettinggwillgbegmoregappropriate ICD- 10 - CMgandgICD- 10 - PCSgcodegsetsgaregmodificationsgofg-gCORRECTgANSWERg- A.gDRGs B.gCPTgcodes C.gICDg 9 gcodes D.gTheginternationalgICD- 10 gcodesgasgdevelopedgbygthegWHOg(WorldgHealthgOrganization) IdentifyinggthegpatientgingthegMPI,gcreatinggthegregistrationgrecord,gcompletinggmedicalgn ecessitygscreening,gdeterminingginsurancegeligibilitygandgbenefits,gresolvinggmanagedgcare grequirements,gandgcompletinggfinancialgeducation/resolutiongaregallg- gCORRECTgANSWERg-A.gThegdatagcollectiongstepsgforgschedulinggandgpre- registeringgagpatient B.gThegstepsgmandatedgforgbillinggMedicaregPartgA C.gRegistrationgstepsgthatgmustgbegcompletedgbeforeganygmedicalgservicesgaregprovided D.gThegprocessgofgclosinggangaccount Ifgfurthergtreatmentgcangonlygbegprovidedgingaghospitalgsetting,gthegpatient'sgconditiongcan notgbegevaluatedgand/orgtreatedgwithing 24 ghours,gorgifgtheregisgnotganganticipationgofgimp rovementgingthegpatient'sgconditiongwithing 24 ghours,gthegpatientg-gCORRECTgANSWERg- A.gWillgremaingingobservationgforgupgtog 72 ghoursgaftergwhichgthegpatientgisgadmittedgasgan ginpatient

B.gWillghaveghis/hergcasegreviewedgbygthegattendinggphysician,gagconsultinggphysiciangand gthegprimarygcaregphysiciangandgagfuturegcoursegofgcaregwillgthengbegdetermined C.gWillgbegdischargedgandgifgneeded,gdesignatedgtogagprioritygonegoutpatientgstatus **D.gWillgbegadmittedgasganginpatient Improvinggthegoverallgpatientgexperiencegrequiresgrevenuegcyclegleadershipgandgstaffgtogsi multaneouslygbeg-gCORRECTgANSWERg- **A.gCleargongpoliciesgandgconsistentgingapplyinggthegpolicies B.gResponsivegandgflexible C.gCarefulgingscreeninggpatientgdemands D.gMonitoringgthegcostsgandgchargesgthegpatientgincurs IngagChapterg 7 gStraightgBankruptcygfilingg-gCORRECTgANSWERg- A.gThegcourtgestablishesgagcreditorgpaymentgschedulegwithgtheglongestgoutstandinggclaimsg paidgfirst B.gThegcourtgliquidatesgthegdebtor'sgnonexemptgproperty,gpaysgcreditors,gandgbeginsgtogp aysgoffgtheglargestgclaimsgfirst.gAllgclaimsgaregpaidgsomegportiongofgthegamountgowed. **C.gThegcourtgliquidatesgthegdebtor'sgnonexemptgproperty,gpaysgcreditors,gandgdischarg esgthegdebtorgfromgthegdebt D.gThegcourtgvacatesgallgclaimsgagainstgagdebtorgwithgthegunderstandinggthatgthegdebtorgm aygnotgapplygforgcreditgwithoutgcourtgsupervision Ingagself-insuredg(orgself-funded)gplan,gthegcostsgofgmedicalgcaregareg- gCORRECTgANSWERg- A.gCreatedgbygagcombinationgofgemployergandgemployeegcontributions B.gMandatedgbygthegAffordablegCaregActgforgsmallgbusinessesgunablegtogobtaingcommerci algcoverage C.gBacked-upgbygstop-lossginsurancegagainstgagcatastrophicgclaim **D.gBornegbygthegemployergongagpay-as-you-gogbasis Ingchoosinggagsettinggforgpatientgfinancialgdiscussions,gorganizationsgshouldgfirstgandgfore mostg-gCORRECTgANSWERg-A.gHoldgthegdiscussiongingagbusinessgoffice

B.gAssessglocationsgforgcomfort C.gSelectgagpublicglocationgwheregthegdiscussiongwillgappeargcommon-place **D.gSelectglocationsgthatgprotectgthegpatient'sgprivacy IngordergforgRegulationgZgtogapply,gaghospitalgmustg-gCORRECTgANSWERg- A.gMeetgallgfivegofgthegconditionsgspecifiedgbygRegulationgZ **B.gMakegavailablegtogallgcreditors,gpatientgfinancialginformationgobtainedgingthegcreditg applicationgprocess C.gHavegagcreditggrantinggmechanismgingplace D.gObtaingcreditginsurancegingthegeventgofgagdebtorgcreditgdefault Ingresolvinggmedicalgaccounts,gaglawgfirmgmaygbegusedgasg-gCORRECTgANSWERg- A.gAngindependentgbrokergofgpatientgfinancialgassistancegfromgbanks B.gAngindependentgauditorgofgagFinancialgAssistancegPolicy C.gLegalgcounselgtogpatientsgregardinggfinancinggoptions **D.gAgsubstitutegforgagcollectiongagency Insurancegverificationgresultsgingwhichgofgthegfollowing?g-gCORRECTgANSWERg- A.gThegresolutiongofgmanagedgcaregandgbillinggrequirements **B.gThegaccurategidentificationgofgthegpatient'sgeligibility C.gThegconsistentgformattinggofgthegpatient'sgnamegandgidentificationgnumber D.gThegidentificationgofgphysiciangfeegschedulegamountsgandgthegNPIg(NationalgProvidergI dentifier)gnumbers Internalgcontrolsgaddressinggcodinggandgreimbursementgchangesgaregputgingplacegtogguard gagainstg-gCORRECTgANSWERg-A.gDenials **B.gCompliancegfraudgbyg"upcoding" C.gUnderpayments D.gChargegmastergerror

LocalgCoveragegDeterminationsg(LCD)gandgNationalgCoveragegDeterminationsg(NCD)gar egMedicaregestablishedgguideline(s)gusedgtogdetermineg-gCORRECTgANSWERg- A.gMedicaregandgMedicaidgprovidergeligibility **B.gWhatgMedicaregreimbursesgandgwhatgshouldgbegreferredgtogMedicaid C.gWhichgdiagnoses,gsigns,gorgsymptomsgaregreimbursable D.gMedicaregoutpatientgreimbursementgrates Medicaregbeneficiariesgmaygappealg-gCORRECTgANSWERg-A.gForgagwaivergfromgpre- authorizationgofgtreatmentgforgspecifiedgchronicgconditions B.gOnlygpaymentgissuesgseriouslygaffectinggthegpatient'sgaccessgtogcare C.gVirtuallyganygissuegrelatedgtogthegprovisiongandgpaymentgofgservices **D.gForgreclassificationgofgongoinggservicesgnotgcoveredgbygMedicaregasgagMedicaregChr onicgCaregExemption MedicareghasgestablishedgguidelinesgcalledgLocalgCoveragegDeterminationsg(LCD)gandgNa tionalgCoveragegDeterminationsg(NCD)gthatgestablishg-gCORRECTgANSWERg- A.gProvidergandgphysiciangreimbursementgforgspecificgdiagnosesgandgtests B.gProspectivegMedicaregpatientgfinancialgresponsibilitiesgforgaggivengdiagnosis C.gReasonablegandgcustomarygpricesgforgservicesgingaggivengarea **D.gWhatgservicesgorghealthcaregitemsgaregcoveredgundergMedicare MedicaregPartgAgbenefitsgprovidegcoveragegforg-gCORRECTgANSWERg- A.gPhysiciangofficegvisits B.gAllgmedicalgservicesgforgeligiblegbeneficiariesgovergthegagegofg 70 **C.gInpatientghospitalgservices,gskilledgnursinggcare,gandghomeghealthgcare D.gMedicalgservicesgforgindigentsgandgthoseglivinggbelowgthegpovertyglevel MedicaregPartgBghasgangannualgdeductible,gandgthegbeneficiarygisgresponsiblegforg- gCORRECTgANSWERg-A.gPhysiciansgofficegfees B.gPrescriptions C.gTestsgoutsidegofganginpatientgsetting **D.gAgco-insurancegpaymentgforgallgPartgBgcoveredgservices

MedicaregpatientsgaregNOTgrequiredgtogproducegagphysician'sgordergtogreceivegwhichgofgt hesegservices?g-gCORRECTgANSWERg- **A.gScreeninggmammography,gflugvaccinegorgpneumoniagvaccine B.gDiagnosticgmammography,gflugvaccinegorgpneumoniagvaccine C.gScreeninggmammography,gflugvaccinegorgB- 12 gshots D.gDiagnosticgmammography,gflugvaccinegorgB- 12 gshots MostgmajorghealthgplansgincludinggMedicaregandgMedicaid,gofferg-gCORRECTgANSWERg- **A.gElectronicgand/orgwebgportalgverification B.gAggracegperiodgforgobtaininggverificationgwithing 72 ghoursgofgtreatment C.gTollgfreegverificationghotglines,gstaffedgaroundgthegclock D.gPatientg"verificationgofgbenefits"gcards NetgAccountsgReceivablegisg-gCORRECTgANSWERg-A.gThegtotalgbadgdebt B.gTotalgdebtgowedgbygangentity **C.gThegamountgangentitygisgreasonablygconfidentgofgcollectinggfromgoverallgaccountsgre ceivable D.gThegtotalgclaimsgamountgbilledgtoghealthgplans Overallgaggregategpaymentsgmadegtogaghospicegaregsubjectgtogagcomputedg"capgamount"g calculatedgbyg-gCORRECTgANSWERg- **A.gThegMedicaregAdministrativegContractorg(MAC)gatgthegendgofgtheghospicegcapgperio d B.gEachgstate'sgMedicaidgplan C.gMedicare D.gThegCentergforgMedicaregandgMedicaidgServicesg(CMS) Patientgfinancialgcommunicationsgbestgpracticesgproducegcommunicationsgthatgareg- gCORRECTgANSWERg-A.gCurrentgandgreportgthegstatusgofgagpatient'sgclaim **B.gConsistent,gcleargandgtransparent C.gTimely,gcomprehensivegandgspecifyinggnextgsteps

D.gTimelygandgremindgpatientsgofgtheirgfinancialgresponsibilities Revenuegcyclegactivitiesgoccurringgatgthegpoint-of- servicegincludegallgofgthegfollowinggEXCEPTg-gCORRECTgANSWERg- A.gThegprovisiongofgcasegmanagementgandgdischargegplanninggservices B.gThegmonitoringgofgcharges **C.gProvidinggchargesgtogthegthird-partygpayergasgtheygaregincurred D.gTheggenerationgofgcharges Scheduledgproceduresgroutinelygincludeg-gCORRECTgANSWERg- A.gPhysician'sgofficegcontactginformation B.gPhysiciangnotificationgthatgschedulinggisgcomplete C.gThegscheduler'sgnamegandgcontactginformation D.gPatientgpreparationginstructions ThegACOgInvestmentgmodelgwillgtestgthegusegofgpre-paidgsharedgsavingsgtog- gCORRECTgANSWERg-A.gEncouragegnewgACOsgtogformgingruralgandgunderservedgareas B.gAttractgphysiciansgtogparticipategingthegACOgpaymentgsystem C.gRaisegqualitygratingsgingdesignatedghospital D.gInvestgingtreatmentgprotocolsgthatgreducegcostsgtogMedicar Thegadvantagesgtogusinggagthird- partygcollectiongagencygincludegallgofgthegfollowinggEXCEPTg-gCORRECTgANSWERg- A.gProvidersgpaygpenniesgongeachgdollargcollected **B.gCollectiongagenciesgcangestablishgagcompletegdocumentationgrecordgthatgmaygbegcrit icalginglitigationgactivities C.gollectiongagenciesgmaygcollectgappropriatelygassignedgaccountsgfastergthangthegprovide r D.gCollectiongagenciesghavegtoolsgandgtechnologiesgthatgaregeffectivegingpursuinggagedgsel f-paygaccounts

Thegbestgpracticegingbillinggisgtoggenerategbillsgthatgareg-gCORRECTgANSWERg- A.gDirectgingsummarizinggchargesgandgingrequestinggpromptgpayment B.gComprehensivegandgall-inclusive **C.gClear,gconcise,gcorrect,gandgpatient-friendly D.gTimelygandgspecifiesgthegpatient'sgnextgsteps Thegconsumers'grightgtogrevokegconsentgtogreceivegauto- dialedgcallsgandgtextgmessagesgisgregulatedgbyg-gCORRECTgANSWERg- A.gThegPatientgProtectiongandgAffordablegCaregActg(PPACA) **B.gThegTelephonegConsumergProtectiongActg(TCPA) C.gThegInterstate-CommercegCommission D.gHealthgInsurancegProtectiongandgPortabilitygActg(HIPAA) Thegfirstgandgmostgcriticalgstepgingregisteringgagpatient,gwhethergscheduledgorgunscheduled ,gisg-gCORRECTgANSWERg-A.gHavinggthegpatientginitialgthegHIPAAgprivacygstatement **B.gVerifyinggthegpatient'sgidentification C.gVerifyingginsurancegtogactivategthegpatientgmedicalgrecord D.gCheckgthegschedulegforgtreatmentgavailability ThegHCAHPSg(HospitalgConsumergAssessmentgofgHealthcaregProvidersgandgSystems)giniti ativegwasglaunchedgtog-gCORRECTgANSWERg- A.gProvidegdatagforgbuildinggsharedgsavingsgreimbursementgforgqualitygprocedures. B.gCreategagnationalgdatabasegongphysiciangquality. **C.gProvidegagstandardizedgmethodgforgevaluatinggpatients'gperspectivegonghospitalgcare . D.gGathergnationalgdatagongoverallgtrustgingthegnation'sghealthgcaregsystem. Theghealthcaregindustrygisgvulnerablegtogcompliancegissues,ginglargegpartgduegtogthegcompl exitygofgthegstatutesgandgregulationsgpertaininggtog-gCORRECTgANSWERg- A.gPatientgfinancialgobligationsgforgthegentiregcostgofgtreatment **B.gMedicaregandgMedicaidgpayments C.gCommercialgthird-partygpayers

D.gUnregulatedgmarketgactivitygforgthird-partygpayers ThegimportancegofgmedicalgrecordsgbeinggmaintainedgbygHIMgisgthatgthegpatientgrecordsg- gCORRECTgANSWERg-A.gAregthegevidencegcitedgingqualitygreview **B.gAregthegprimarygsourcegforgclinicalgdatagrequiredgforgreimbursementgbyghealthgplansg andgliabilitygpayer C.gAregevidencegusedgingassessinggthegqualitygofgcare D.gAregthegstrongestgevidencegandgdefensegingthegeventgofgagMedicaregaudit ThegMedicaregBundledgPaymentsgforgCaregInitiativeg(BCPI)gisgdesignedgtog- gCORRECTgANSWERg-A.gPreventgduplicategbilling B.g"Stretch"gthegimpactgofgpatientgself-paygbygsqueezinggcostsgdowngthroughgaglump- sumgpaymentgtogproviders **C.gAligngincentivesgbetweenghospitals,gphysicians,gandgnon- physiciangprovidersgingordergtogbettergcoordinategpatientgcare D.gDrivegdowngphysiciangfeesgbygforcinggphysiciansgtogsharegequitablygingonegpayment Thegmostgaccurategwaygtogvalidategpatientginformationgisgtog-gCORRECTgANSWERg- A.gRequiregclinicalgstaffgtogverifyginformationgatgeachgtreatmentgencounter **B.gRequestgthatgthegpatientgprovidegcertain,gspecificgdemographicgdatagatgeachgencount er C.gReadgitgslowlygtogthegpatientgnotingganygcorrections D.gProvidegaghard- copygofgdemographicgdatagtogthegpatientgforgreview,gupdategandgsignature ThegmostgcommongresolutiongmethodsgforgcreditgbalancesgincludegallgofgthegfollowinggEX CEPTg-gCORRECTgANSWERg-A.gDesignategthegoverpaymentgforgcharitygcare B.gDeterminegthegcorrectgprimarygpayergandgnotifygincorrectgpayergofgoverpayment C.gSubmitgthegcorrectedgclaimgtogthegpayergincorporatinggcredits D.gEithergsendgagrefundgorgcompletegagtakebackgformgasgdirectedgbygthegpayer.

Thegmostgeffectivegpaymentgplangprogramsg-gCORRECTgANSWERg- A.gAregrigorousgingpatientgfollow-up B.gScreengpatientsgtogdeterminegifgtheygaregcapablegofgpaying C.gDognotgallowgmissedgpayments D.gAregturnedgovergtogagcollectiongagency ThegnuancedgdatagresultinggfromgdetailedgICD- 10 gcodinggallowsgseniorgleadershipgtogworkgwithgphysiciansgtogdogallgofgthegfollowinggEX CEPTg-gCORRECTgANSWERg-A.gObtainghighergcompensationgforgphysicians B.gEmbracegnewgreimbursementgmodels C.gDrivegsignificantgimprovementsgingthegareasgofgqualitygandgthegpatientgexperience D.gImprovegoutcomes Thegprocessgofgverifyingghealthginsurancegcoverage,gidentifyinggcontractgterms,gandgobtai ninggtotalgchargesgisgknowngasg-gCORRECTgANSWERg-A.gPatientgself-paygidentification **B.gInsurancegverificationgofgreimbursablegcharges C.gPricegestimation D.gAccountsgresolution Thegresultgofgaccurategcensusgbalancinggongagdailygbasisgisg-gCORRECTgANSWERg- **A.gThegoverallgaccuracygofgresourcegplanning B.gImprovedgabilitygtogplangnursinggstaffgsupportgservices C.gThegincreasedgefficiencygingtreatment D.gThegcorrectgrecordinggofgroomgcharges Thegsoftgcostgofgagdissatisfiedgcustomergisg-gCORRECTgANSWERg- A.gPotentiallygnegativegtreatmentgoutcomesgleadinggtogexpandingglength-of-stay **B.gThegcustomergpassinggonginformationgaboutgtheirgnegativegexperiencegtogpotentialg patientsgorgthroughgsocialgmediagchannels C.gLoweredgqualitygoutcomesgforgthegdissatisfiedgpatient D.gTheg"cost"gofgstaffgprovidinggextragattentiongingtryinggtogperformgservicegrecovery

ThegTruthgingLendinggActgestablishesg-gCORRECTgANSWERg- A.gConsumergdisclosuregrequirementsgtogobtaingcredit B.gRepaymentgandginterestgrategschedules C.gConditionsgundergwhichgagnon-profitgentitygmaygextendgcredit **D.gDisclosuregrulesgforgconsumergcreditgsalesgandgconsumergloans ThegTwogMidnightgRulegallowsghospitalsgtogaccountgforgtotalghospitalgtimegincludingg- gCORRECTgANSWERg- A.gCostsgoutsidegofgwhatgisgregulargandgcustomarygoccurringgwithingthegfirstg 48 ghoursgofgin patientgcare B.gAttendinggphysiciang"on-call"gtime C.gOffgsitegancillarygservices **D.gOutpatientgtimegdirectlygprecedinggtheginpatientgadmission ThegTwogMidnightgRulegallowsghospitalsgtogaccountgforgtotalghospitalgtimegwhengdetermi ninggifganginpatientgadmissiongordergshouldgbegwrittengbasedgong-gCORRECTgANSWERg- A.gAgbeneficiarygneedinggagminimumgofg 48 ghoursgofgcare B.gThegexpectationgthatgthegbeneficiarygwillgstaygingtheghospitalgforgtwogorgmoregmidni ghtsgreceivinggmedicallygnecessarygcare C.gThegexpectationgthatgthegbeneficiarygwillgreceivegallgmedicallygnecessarygcaregwithingag 48 ghourgperiod D.gThegbeneficiarygreceivinggmedicallygnecessarygcaregandgtheghospitalgreceivinggallgrequir edgpre-authorizations Thisgdirectivegwasgdevelopedgtogpromotegandgensureghealthcaregqualitygandgvaluegandgal sogtogprotectgconsumersgandgworkersgingtheghealthcaregsystem.gThisgdirectivegisgcalledg- gCORRECTgANSWERg-A.gPatientgbillgofgrights B.gMedicaregpatientgandgstaffgsafetygstandards C.gJointgCommissiongforgAccreditationgofgHealthcaregOrganizationsg(JCAHO)gsafetygstan dards D.gPayergqualitygmonitoring

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B.gFailuregtogincludegthegCPTgcodesgwillgtriggergagdenial C.gThesegcodesgwillgbegusedgtogdeterminegmedicalgnecessitygandgusefulgingdetermininggwh atghappenedgduringgthegencounter D.gThisgisgagrequiredgcompliancegprotocol Whichgdepartmentgsupports/collaboratesgwithgthegrevenuegcycle?g- gCORRECTgANSWERg-**A.gInformationgTechnology B.gContinuumgofgCare C.gSoftwaregApplications D.gHospice WhichgofgthegfollowinggisgagviolationgofgthegEMTALAg(EmergencygMedicalgTreatmentgan dgLaborgAct)?g-gCORRECTgANSWERg- A.gInitialgregistrationgactivitiesgonlygtakegplacegwhengtheygdognotgdelaygtreatmentgandgthe regisgnogsuggestiongthatgtreatmentgwillgnotgbegprovidedgtoguninsuredgpeople **B.gRegistrationgstaffgmembersgroutinelygcontactgmanagedgcaregplansgforgpriorgauthoriz ationsgbeforegthegpatientgisgseengbygthegon-dutygphysician C.gSignagegisgpostedgwheregitgcangbegeasilygseengandgreadgbygpatients D.gCopaymentsgaregcollectedgatgthegtimegofgservicegoncegthegmedicalgscreeninggandgstabili zationgactivitiesgaregcompleted WhichgofgthegfollowinggisgrequiredgforgparticipationgingMedicaidg-gCORRECTgANSWERg- A.gBegfreegofgchronicgconditions B.gMeetgagminimumgyearlygpremium C.gObtaingagsupplementalghealthginsurancegpolicy **D.gMeetgincomegandgassetsgrequirements