HFMA CRCR exam with 100% correct verified answers latest update, Exams of Nursing

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HFMA CRCR exam with 100% correct verified answers latest update Through what document does a hospital establish compliance standards? --- correct answer ---code of conduct What is the purpose OIG work plant? --- correct answer ---Identify Acceptable compliance programs in various provider setting If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? --- correct answer ---Non-diagnostic service provided on Tuesday through Friday What does a modifier allow a provider to do? --- correct answer ---Report a specific circumstance that affected a procedure or service without changing the code or its definition 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 --- correct answer ---They must be billed separately to the part B Carrier what is a recurring or series registration? --- correct answer ---One registration record is created for multiple days of service What are nonemergency patients who come for service without prior notification to the provider called? --- correct answer ---Unscheduled patients Which of the following statement apply to the observation patient type? --- correct answer ---It is used to evaluate the need for an inpatient admission which services are hospice programs required to provide around the clock patient --- correct answer ---Physician, Nursing, Pharmacy Scheduler instructions are used to prompt the scheduler to do what? --- correct answer ---Complete the scheduling process correctly based on service requeste The Time needed to prepare the patient before service is the difference between the patients arrival time and which of the following? --- correct answer ---Procedure time Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include: --- correct answer ---Documentation of the medical necessity for the test What is the advantage of a pre-registration program --- correct answer ---It reduces processing times at the time of service What date are required to establish a new MPI(Master patient Index) entry - -- correct answer ---The responsible party's full legal name, date of birth, and social security number Which of the following statements is true about third-party payments? --- correct answer ---The payments are received by the provider from the payer responsible for reimbursing the provider for the patient's covered services. Which provision protects the patient from medical expenses that exceed the pre-set level --- correct answer ---stop loss what documentation must a primary care physician send to HMO patient to authorize a visit to a specialist for additional testing or care? --- correct answer ---Referral Which of the following statements applies to private rooms? --- correct answer ---If the medical necessity for a private room is documented in the chart. The patients insurance will be billed for the differential Which of the following is true about screening a beneficiary of possible MSP(Medicare secondary payer) situations? --- correct answer ---It is necessary to ask the patient each of the MSP questions Which of the following is not true of Medicare Advantage Plans? --- correct answer ---A patient must have both Medicare Part A and B benefits to be eligible for a Medicare Advantage plan Which of the following is a valid reason for a payer to deny a claim? --- correct answer ---Failure to complete authorization Which of the following statements is NOT a possible consequence of selecting the wrong patient in the MPI(master patient index) --- correct answer ---Claim is paid in full Which of the following statements is true of a Medicare Advantage Plan? --- correct answer ---This plan supplements Part A and Part B benefits Which is the following is not a characteristic of Medicaid HMO plan? --- correct answer ---Medicaid-eligible patients are never required to join a Medicaid HMO plan Which of the following is violation of the EMTALA ? --- correct answer --- Registration staff members routinely contact managed care plans for prior authorizations before the patients is seen by the on duty physician Which of the following statements is true of the important message from Medicare notification requirements? --- correct answer ---Notification can be issued no earlier than 7 days before admission and no more than 2 days before discharge. What is the self pay balance after insurance --- correct answer ---The portion of the adjudicated claim that is due from the patient Which of the following options is an alternative to valid long term payment plans --- correct answer ---Bank loans 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? --- correct answer ---$6000 What type of plan restricts benefits for non-emergency care to approve providers only? --- correct answer ---A POS (point of service )plan What does scheduling allow provider staff to do? --- correct answer --- Review the appropriateness of the service requested When an adult patient is covered by both his own and his spouse health insurance plan, which of the statements is true? --- correct answer ---The patients insurance plan is primary 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. --- correct answer ---August 9, 2010 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 --- correct answer ---Income and assets Fee for service plans pay claims based on a percentage of charges. How are patients out of pocket cost calculated? --- correct answer ---They are calculated quarterly Indemnity plans usually reimburse what? --- correct answer ---A certain percentage of charges after patient meets policy's annual deductible. Departments that need to be included in Charge master maintenance include all EXCEPT --- correct answer ---Quality Assurance Using HIPPA standardized transaction sets allow providers to: --- correct answer ---Submit a standardized transaction to any of the health plans with which it conducts business. Which of the following is NOT included in the standardized quality measures? --- correct answer ---Cost of services The ACO investment model will test the use of pre-paid shared savings to: -- - correct answer ---Encourage new ACOs to form in rural and underserved areas. Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons on a monthly fee is known as: --- correct answer ---HMO Ambulance services are billed directly to the health plan for: --- correct answer ---Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility. Any provider that has filed a timely cost report may appeal in an adverse final decision received from the Medicare Administrative Contractor (MAC), the appeal may be filed with: --- correct answer ---The Provider Reimbursement Review Board. A claim is denied for the following reasons EXCEPT: --- correct answer --- The submitted claim does not have the physician signature All Hospitals are required to establish a written financial assistance policy that applies to: --- correct answer ---All emergency and medically necessary care Examples of ethics violation that impact the revenue cycle include all of the following EXCEPT: --- correct answer ---Seeking payment options for self- pay Verbal orders from a physician for a service(s) are: --- correct answer --- Acceptable if given to "qualified" staff as defined in a hospitals policies and procedures Medicare has established guidelines called Local Coverage Determination (LCD) and National Coverage Determination (NCD) that establish: --- correct answer ---What serviced or healthcare items are covered under Medicare? 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: --- correct answer ---The patient's home care coverage What is the first step of the daily cash reconciliation process? --- correct answer ---Obtaining cash, check, credit card and debit card payment from that day The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to: --- correct answer ---Medicare and Medicaid payments The correct coding initiative program consist of: --- correct answer ---Edits that are implemented within provider's claim processing system The Affordable Health Care Act legislated the development of Health Insurance Exchange, where individuals and small businesses can: --- correct answer ---Purchase health benefits plans regardless of insured's health status 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: --- correct answer ---Monitor compliance The Electronic Remittance Advice (ERA) data sets are: --- correct answer ---A standardized for that provides 3rd party payment details to providers The first and most critical step in registering a patient, whether scheduled or unscheduled is: --- correct answer ---Verifying the patient's identification The standard claim form used for the billing by hospitals, nursing facilities, and other inpatient services is called the: --- correct answer ---UB-04 A four-digit number code established by the National Uniform Billing Committee (NUBC) that categorizes/classifies a line in the charge master is known as: --- correct answer ---Revenue codes Internal controls addressing coding and reimbursement charges are put in place to guard against: --- correct answer ---Compliance fraud by "upcoding" The 501(R) regulations require non-for-profit providers (501) ©(3) organizations to do which of the following activities: --- correct answer --- Complete a community needs assessment and develop a discount program for patient's balances after insurance payment During pre-registration, a search for the patient's MRI number is initiated using which of the following data sets: --- correct answer ---Patient's full legal name and date of birth or the patient's Social Security number To maximize the value derived from customer complaints, all consumer complaints should be: --- correct answer ---Tracked and shared to improve the customer experience The Business ethics, or organizational ethics represent: --- correct answer --- The principles and standards by which organizations operate Providers are advised that it is best to establish patient financial responsibility and assistance policies and make sure they are followed internally and by: --- correct answer ---Third-party payers The advantage to using a third-part, collection agency includes all of the following EXCEPT: --- correct answer ---Providers pay pennies on each dollar collected. Local Coverage Determination (LCD) and National Coverage Determinations (NCD) are Medicare established guidelines used to determine: --- correct answer ---Which diagnosis, signs, or symptoms are reimbursable Claims with the dates of service received later than one calendar year beyond the date of service will be: --- correct answer ---Denied by Medicare in the pre-service stage, the requested service is screened for medical necessity, health plan coverage and benefits are verified and: --- correct answer ---Pre-authorization are obtained For scheduled patients, important revenue cycle activities in the time-of - service stage DO NOT include: --- correct answer ---Final bill is presented for payment If a medical service authorization, who is typically responsible for obtaining the authorization: --- correct answer ---The provider scheduling Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by: --- correct answer ---The Medicare Administrative Contractor (MAC) at the end of the hospice cap period The ICD-10 code set and CPT/HCPCS code sets combined provide: --- correct answer ---The specificity and coding accuracy needed to support reimbursement claims Charges, as the most appropriate measurement of utilization, enables: --- correct answer ---Generation of timely and accurate billing Days in A/R calculated based on the value of: --- correct answer ---The total account receivable on a specific date Medicare benefits provide coverage for: --- correct answer ---Inpatient hospital services, skilled nursing care. And home health care HFMA best practices call for patient financial discussions to be reinforced: - -- correct answer ---By issuing a new invoice to the patient All of following are steps in safeguarding collections EXCEPT: --- correct answer ---Placing collections in a lock-box for posting review the next business day The code indication of the disposition of the patient at the conclusion of service is called the: --- correct answer ---Patient discharge status code HIPPA has adopted Employer Identification Numbers (EINs) to be used in standard transactions to identify the employer of an individual described in a transaction. EINs are created and assigned by: --- correct answer ---The Internal Revenue Service The purpose of the ACA mandated Community Health Needs Assessment is: - -- correct answer ---To provide community benefit outreach to those without insurance and who have not had a physical within the past 2 years What is Continuum of Care: --- correct answer ---The coordination and linkage of resource needed to avoid the duplication of services and the facilitation of seamless movement among care settings. Account Receivable (A/R) aging reports --- correct answer ---Identify past due accounts likely to become bad debit Applying the contracted payment amount to the amount of total charges yields: --- correct answer ---An estimated price for the patient's responsibility Most major health plans including Medicare and Medicaid offer: --- correct answer ---Electronic and/or web portal verification What are some elements of a board-approved financial assistance policy: --- correct answer ---Eligibility application process and nonpayment collection activities Which of the following is usually covered on a Conditions of Admissions form: --- correct answer ---Patient's bill of rights. Net Accounts Receivable is --- correct answer ---The amount an entity is reasonably confident of collection form overall accounts A common billing issue with hospital-based physician's is --- correct answer ---They are not contracted with the patient's health plan to provide services What are collection agency fees based on ? --- correct answer ---A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? --- correct answer ---Birthday What customer service improvements might improve the patient accounts department? --- correct answer ---Holding Staff accountable for customer service during performance reviews What is an ABN(Advance Beneficiary Notice of Non-coverage) required to do? --- correct answer ---Inform Medicare beneficiary that Medicare may not pay for the order or service What is the initial hospice benefit? --- correct answer ---Two 90-day periods and an unlimited number of subsequent periods How should a provider resolve a late-charge credit posted after an account is billed? --- correct answer ---Post a late-charge adjustment to the account an increase in the dollars aged greater than 90 days from date of service indicate what about accounts --- correct answer ---They are not being processed in a timely manner What are the two statutory exclusions from hospice coverage? --- correct answer ---Medically Unnecessary services and custodial care What statement applies to the scheduled outpatient? --- correct answer --- The services do not include an overnight stay How is a mis-posted contractual allowance resolved? --- correct answer --- Comparing the contract reimbursement rates with the contract on the admittance advice to identify the correct amount What type of patient status is used to evaluate the patients need for inpatient care? --- correct answer ---Observation