Healthcare Revenue Cycle Management, Exams of Public Health

Download Healthcare Revenue Cycle Management and more Exams Public Health in PDF only on Docsity! HFMA CRCR 2023-2024 /172 Questions And Answers (A+) Download to Pass!!! Quiz :Through what document does a hospital establish compliance standards? - √Answer :code of conduct Quiz :What is the purpose OIG work plant? - √Answer :Identify Acceptable compliance programs in various provider setting Quiz :If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? - √Answer :Non- diagnostic service provided on Tuesday through Friday Quiz :What does a modifier allow a provider to do? - √Answer :Report a specific circumstance that affected a procedure or service without changing the code or its definition Quiz :IF outpatient diagnostic services are provided within three days of the admission of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these charges - √Answer :They must be billed separately to the part B Carrier Quiz :what is a recurring or series registration? - √Answer :One registration record is created for multiple days of service Quiz :What are nonemergency patients who come for service without prior notification to the provider called? - √Answer :Unscheduled patients Quiz :Which of the following statement apply to the observation patient type? - √Answer :It is used to evaluate the need for an inpatient admission Quiz :which services are hospice programs required to provide around the clock patient - √Answer :Physician, Nursing, Pharmacy Quiz :Scheduler instructions are used to prompt the scheduler to do what? - √Answer :Complete the scheduling process correctly based on service requeste Quiz :The Time needed to prepare the patient before service is the difference between the patients arrival time and which of the following? - √Answer :Procedure time Quiz :Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include: - √Answer :Documentation of the medical necessity for the test Quiz :What is the advantage of a pre-registration program - √Answer :It reduces processing times at the time of service Quiz :What date are required to establish a new MPI(Master patient Index) entry - √Answer :The responsible party's full legal name, date of birth, and social security number Quiz :Which of the following statements is true about third- party payments? - √Answer :The payments are received by the provider from the payer responsible for reimbursing the provider for the patient's covered services. Quiz :In addition to the member's identification number, what information is recorded in a 270 transaction - √Answer :Name Quiz :What process does a patient's health plan use to retroactively collect payments from liability automobile or worker's compensation plan? - √Answer :Subrogation Quiz :In what type of payment methodology is a lump sum of bundled payment negotiated between the payer and some or all providers? - √Answer :DRG/Case rate Quiz :What Restriction does a managed care plan place on locations that must be used if the plan is to pay for the service provided? - √Answer :Site of service limitation Quiz :Which of the following statements applies to private rooms? - √Answer :If the medical necessity for a private room is documented in the chart. The patients insurance will be billed for the differential Quiz :Which of the following is true about screening a beneficiary of possible MSP(Medicare secondary payer) situations? - √Answer :It is necessary to ask the patient each of the MSP questions Quiz :Which of the following is not true of Medicare Advantage Plans? - √Answer :A patient must have both Medicare Part A and B benefits to be eligible for a Medicare Advantage plan Quiz :Which of the following is a valid reason for a payer to deny a claim? - √Answer :Failure to complete authorization Quiz :Which of the following statements is NOT a possible consequence of selecting the wrong patient in the MPI(master patient index) - √Answer :Claim is paid in full Quiz :Which of the following statements is true of a Medicare Advantage Plan? - √Answer :This plan supplements Part A and Part B benefits Quiz :Which is the following is not a characteristic of Medicaid HMO plan? - √Answer :Medicaid-eligible patients are never required to join a Medicaid HMO plan Quiz :Which of the following is violation of the EMTALA ? - √Answer :Registration staff members routinely contact managed care plans for prior authorizations before the patients is seen by the on duty physician Quiz :Which of the following statements is true of the important message from Medicare notification requirements? - √Answer :Notification can be issued no earlier than 7 days before admission and no more than 2 days before discharge. Quiz :What is the self pay balance after insurance - √Answer :The portion of the adjudicated claim that is due from the patient Quiz :Which of the following options is an alternative to valid long term payment plans - √Answer :Bank loans Quiz :The patient has the following benefit plan $400 per family member deductible, to a maximum of $1200 per year and $2000 per family member co insurance, to a family maximum of $6000 per year excluding the deductible . Five family members are enrolled in this benefit plan. What is the maximum out of pocket expense that that family could incur during the calendar year? - √Answer :$6000 Quiz :What type of plan restricts benefits for non-emergency care to approve providers only? - √Answer :A POS (point of service )plan Quiz :What does scheduling allow provider staff to do? - √Answer :Review the appropriateness of the service requested Quiz :When an adult patient is covered by both his own and his spouse health insurance plan, which of the statements is true? - √Answer :The patients insurance plan is primary Quiz :Mrs. Jones , a Medicare beneficiary was admitted to the hospital on June 20,2010. As of the admission date, she had only used 8 inpatient days in the current benefit period. If she is not discharge on what date will Mr jones exhaust her full coverage days. - √Answer :August 9, 2010 Quiz :In order to meet eligibility guidelines for healthcare benefits, Medicaid beneficiaries must fall into a specified need category and meet what other types of requirements - √Answer :Income and assets Quiz :Fee for service plans pay claims based on a percentage of charges. How are patients out of pocket cost calculated? - √Answer :They are calculated quarterly Quiz :Indemnity plans usually reimburse what? - √Answer :A certain percentage of charges after patient meets policy's annual deductible. Quiz :A scheduled inpatient represents an opportunity for the provider to do which of the following? - √Answer :Complete registration and insurance approval before service Quiz :The Medicare Bundled Payments for Care Initiative (BCP) is designed to: - √Answer :Align incentives between hospitals, physicians, and non-physician providers in-order to better coordinate patient care. Quiz :To maximize the value derived from customer complaints, all consumer complaints should be: - √Answer :Tracked and shared to improve customer experience Quiz :The soft cost of a dissatisfied customer is: - √Answer :The customer passing on information about their negative experience to potential patients or through social media channels. Quiz :Applying the contracted payment methodology to the total charges yields: - √Answer :An estimate price Quiz :The importance of medical records maintained by HIM is that the patient records: - √Answer :Are the primary source for clinical data required for reimbursement by health plans and liability payers Quiz :Important Revenue Cycle Activities in the pre-service stage include: - √Answer :Obtaining or updating patient and guarantor information Quiz :In the pre-service stage, the cost of the schedule services is identified and the patient's health plan and benefits are used to calculate: - √Answer :The amount the patient may be expected to pay after insurance. Quiz :The disadvantage of outsourcing includes all, of the following Except - √Answer :Reduces internal staffing costs and a reliance on outsourced staff. Quiz :Marinating routine contact with health plan or liability payer, making sure all required information is provided and all needed approvals are obtained is the responsibility of who: - √Answer :Case Management Quiz :A claim is denied for the following reasons EXCEPT: - √Answer :The submitted claim does not have the physician signature Quiz :All Hospitals are required to establish a written financial assistance policy that applies to: - √Answer :All emergency and medically necessary care Quiz :Examples of ethics violation that impact the revenue cycle include all of the following EXCEPT: - √Answer :Seeking payment options for self-pay Quiz :Verbal orders from a physician for a service(s) are: - √Answer :Acceptable if given to "qualified" staff as defined in a hospitals policies and procedures Quiz :Medicare has established guidelines called Local Coverage Determination (LCD) and National Coverage Determination (NCD) that establish: - √Answer :What serviced or healthcare items are covered under Medicare? Quiz :A decision on whether a patient should be admitted as an inpatient or become an outpatient observation patient requires medical judgement based on all of the following EXCEPT: - √Answer :The patient's home care coverage Quiz :What is the first step of the daily cash reconciliation process? - √Answer :Obtaining cash, check, credit card and debit card payment from that day Quiz :The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to: - √Answer :Medicare and Medicaid payments Quiz :The correct coding initiative program consist of: - √Answer :Edits that are implemented within provider's claim processing system Quiz :The Affordable Health Care Act legislated the development of Health Insurance Exchange, where individuals and small businesses can: - √Answer :Purchase health benefits plans regardless of insured's health status Quiz :Before classifying and subsequently writing off an account to financial assistance or bad debit, the hospital must establish policy define appropriate criteria, implement procedures for identifying accounts and: - √Answer :Monitor compliance Quiz :For scheduled patients, important revenue cycle activities in the time-of -service stage DO NOT include: - √Answer :Final bill is presented for payment Quiz :If a medical service authorization, who is typically responsible for obtaining the authorization: - √Answer :The provider scheduling Quiz :Concurrent review and discharge planning - √Answer :Occurs during service Quiz :The fundamental approach in managing denials is: - √Answer :To analyze the type and sources of denials and consider process changes to eliminate further denials Quiz :The first thing a health plan does when processing a claim is: - √Answer :Check if the patient is a health plan beneficiary and what is the coverage Quiz :Outsourcing options should be evaluated as - √Answer :Any other business service purchase Quiz :Insurance verification results in which of the following: - √Answer :The accurate identification of the patient's eligibility and benefits Quiz :EMTLA and HFMA best practices specify that in an Emergency Department setting: - √Answer :No patient financial discussions should occur before a patient is screened and stabilized Quiz :he HCCAHPS (Hospital Consumer Assessment of Healthcare Provider's and Systems) initiative was launched to: - √Answer :Provide a standardized method for evaluation patients' perspective on hospital care Quiz :All of the following are potential causes of credit balances EXCEPT: - √Answer :A patient's choice to build up a credit against future medical bills Quiz :Medicare will only pay for tests and services that: - √Answer :Can be demonstrated as necessary Quiz :This 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: - √Answer :Joint Commission for Acceleration of Healthcare Organizations (JCAHO) safety standards Quiz :It is important to calculate reserves to ensure: - √Answer :A stable financial operations and accurate financial reporting Quiz :An advantage of a pre-registration program in - √Answer :The opportunity to reduce processing times at the time of service Quiz :To be eligible for Medicaid, an individual must: - √Answer :Meet income and asset requirements Quiz :The patient discharge process begins when: - √Answer :The physician writes the order Quiz :Appropriate training for patient financial counseling staff must cover all of the following EXCEPT: - √Answer :Documenting the conversation in the medical records Quiz :Patients should be informed that costs presented in a price estimation may: - √Answer :Only determine the percentage of the total that the patients is responsible for and not the actual cost. Quiz :Any healthcare insurance plan that providers or insures comprehensive health maintenance and services for an enrolled group of persons based on a monthly fee is known as a - √Answer :HMO Quiz :Chapter 11 Bankruptcy permits a debtor to: - √Answer :Work out a court-supervised plan with creditors Quiz :A portion of the accounts receivable inventory which has NOT qualified for billing includes: - √Answer :Accounts created during pre-registration but not activated Quiz :Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by: - √Answer :The Medicare Administrative Contractor (MAC) at the end of the hospice cap period Quiz :The ICD-10 code set and CPT/HCPCS code sets combined provide: - √Answer :The specificity and coding accuracy needed to support reimbursement claims Quiz :What are collection agency fees based on ? - √Answer :A percentage of dollars collected Quiz :Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - √Answer :Birthday Quiz :What customer service improvements might improve the patient accounts department? - √Answer :Holding Staff accountable for customer service during performance reviews Quiz :What is an ABN(Advance Beneficiary Notice of Non- coverage) required to do? - √Answer :Inform Medicare beneficiary that Medicare may not pay for the order or service Quiz :What is the initial hospice benefit? - √Answer :Two 90- day periods and an unlimited number of subsequent periods Quiz :How should a provider resolve a late-charge credit posted after an account is billed? - √Answer :Post a late-charge adjustment to the account Quiz :an increase in the dollars aged greater than 90 days from date of service indicate what about accounts - √Answer :They are not being processed in a timely manner Quiz :What are the two statutory exclusions from hospice coverage? - √Answer :Medically Unnecessary services and custodial care Quiz :What statement applies to the scheduled outpatient? - √Answer :The services do not include an overnight stay Quiz :How is a mis-posted contractual allowance resolved? - √Answer :Comparing the contract reimbursement rates with the contract on the admittance advice to identify the correct amount Quiz :What type of patient status is used to evaluate the patients need for inpatient care? - √Answer :Observation Quiz :Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has received what? - √Answer :Medically necessary inpatient hospital services for at least 3 consecutive days before the skilled nursing care admission. Quiz :When is the word "SAME" entered on the CMS 1500 billing form in feild 0 - √Answer :When the patient is insured Quiz :If the insurance verification response reports that a subscriber has a single policy, what is the status of the subscriber's spouse? - √Answer :Neither enrolled not entitled to benefits Quiz :Regulation Z of the consumer Credit Protection Act, also known as the Truth in lending Act establishes what? - √Answer :Disclosure rules for consumer credit sales and consumer loans Quiz :What is a principle diagnosis? - √Answer :Primary reason for the patients admission Quiz :Collecting patient liability dollars after service leads to what? - √Answer :Lower accounts receivable levels Quiz :What is the daily out-of-pocket amount for each lifetime reserve day used? - √Answer :50% of the current deductible amount Quiz :What service provided to a Medicare beneficiary in a rural health clinic(RHC) is not billable as an RHC service? - √Answer :Inpatient care Quiz :What code indicates the disposition of the patient at the conclusion of service? - √Answer :Patient discharge status code Quiz :What are hospitals required to do for Medicare credit balance accounts? - √Answer :They result in lost reimbursement and additional cost to collect. Quiz :When an undue delay of payment results from a dispute between the patient and the third party payer, who is responsible for payment? - √Answer :Patient Quiz :With advances in internet security and encryption, revenue-cycle processes are expanding to allow patients to do what? - √Answer :Access their information and perform functions on-line Quiz :What date is required on all CMS 1500 claim forms? - √Answer :onset date of current illness Quiz :What code is used to report the provider's most common semiprivate room rate? - √Answer :Condition code