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HFMA CRCR FINAL EXAM AND PRACTICE EXAM TEST BANK WITH 300 MULTIPLE CHOICE 2024 | ACTUAL REAL EXAM QUESTIONS WITH DETAILED ANSWERS | EXPERT VERIFIED | GUARANTEED PASS | GRADED A | LATEST UPDATE
Typology: Exams
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The Medicare fee-for service appeal process for both beneficiaries and providers
a. Medical necessity review by an independent physician's panel b. Judicial review by a federal district court c. Redetermination by the company that handles claims for Medicare d) Review by the Medicare Appeals Council (Appeals Council) - B
a. The principles and standards by which organizations operate b. Regulations that must be followed by law c. Definitions of appropriate customer service d. The code of acceptable conduct - A
a. Charitable pledges b. Accounts created during pre-registration but not activated
c. Accounts coded but held within the suspense period d. Accounts assigned to a pre-collection agency - A
Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are
a. Medicare and Medicaid provider eligibility b. Medicare outpatient reimbursement rates c. Which diagnoses, signs, or symptoms are reimbursable d. What Medicare reimburses and what should be referred to Medicaid - C
a. The total accounts receivable on a specific date b. Total anticipated revenue minus expenses c. The time it takes to collect anticipated revenue d. Total cash received to date - C
a. Make sure that the attending staff can answer questions and assist in obtaining required patient financial data
b) Have a patient financial responsibilities kit ready for the patient, containing all of the required registration forms and instructions c) Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow d) Decline such request as finance discussions can disrupt patient care and patient flow - C
a. Annual legal audit and review for adherence to regulations b. Educating staff on regulations c. Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met d) The development of operational policies that correspond to regulations - C
a. To patients of any physician requesting case management b. To a select patient group c. To every patient d. To specific cases designated by third party contractual agreement - B
a. Identify, compare, and choose providers that offer the desired level of value b) Customize health care with a personally chosen mix of providers c) Negotiate the cost of health plan premiums
d) Verify the cost of individual clinicians - A
Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a
b. HMO c. PPO d. GPO - B
a. The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt b) The court liquidates the debtor's nonexempt property, pays creditors, and begins to pay off the largest claims first. All claims are paid some portion of the amount owed c) The court vacates all claims against a debtor with the understanding that the debtor may not apply for credit without court supervision d) The court establishes a creditor payment schedule with the longest outstanding claims paid first - A
a. Scheduling, pre-registration, insurance verification and managed care processing b) Scheduling, insurance verification, clinical discharge processing and payment posting of point of service receipts c) Scheduling, registration, charge entry and managed care processing d) Scheduling, pre-registration, registration, medical necessity screening and patient refunds - A
a. A clear understanding that the provider retains ownership of any outsourced activities b) Specific language as to who will pay legal fees, if needed c) An annual renewal clause d) A mutual hold-harmless clause - D
a. Patient Accounts b. Managed Care Contract Staff c. HIM staff d. Case Management - D
a. Revenue codes b. Correct Part A and B procedural codes c. The CMS 1500 Part B attachment d. Medical necessity documentation - A
a. Provide a public record, if reqluested
b. Present financial information to decision makers c. Prepare tax documents d. Monitor expenses - B
a. Registration staff may routinely contact managed are plans for prior authorizations before the patient is seen by the on-duty physician b) Initial registration activities may occur so long as these activities do not delay treatment or suggest that treatment with not be provided to uninsured individuals c) Co-payments may be collected at the time of service once the medical screening and stabilization activities are completed d) Signage must be posted where it can be easily seen and read by patients - A
a. The health plan cannot identify the subscriber b. The frequency of service was outside the coverage timeline c. The submitted claim does not have the physicians signature d. The subscriber was not enrolled at the time of service - C
a. A court appointed federal mediator b. The Department of Health and Human Services Provider Relations Division c) The Office of the Inspector General d) The Provider Reimbursement Review Board - D
a. Generation of timely and accurate billing b. Managing of expense budgets c. Accuracy of expense and cost capture d. Effective HIM planning - ???Number 24???
a. A beneficiary appeal b. A Medicare supplemental review c. A payment review d. A Medicare determination appeal - A
work with physicians to do all of the following EXCEPT:
a. Drive significant improvements in the areas of quality and the patient experience b) Embrace new reimbursement models c) Improve outcomes d) Obtain higher compensation for physicians - D
a. When providers re-bill claims based on nonpayment from the initial bill submission b) When service departments do not process charges with the organization's suspense days c) When the payer's coordination of benefits is not captured correctly at the time of patient registration d) When there are other healthcare claims in process and the anticipated deductibles and co- insurance amounts still show open but will be met by the in-process claims - a
a. Purchase qualified health benefit plans regardless of insured's health status b) Obtain price estimates for medical services c) Negotiate the price of medical services with providers d) Meet federal mandates for insurance coverage and obtain the corresponding tax deduction - A
a. Designate the overpayment for charity care b. Submit the corrected claim to the payer incorporating credits c. Either send a refund or complete a takeback form as directed by the payer d) Determine the correct primary payer and notify incorrect payer of overpayment - A
a. An electronic claim submission b. The record of payments in the hospital's accounting system c. An electronic confirmation that a payment is due d. An electronic transfer of funds from payer to payee - D
a. The monitoring of charges b. The provision of case management and discharge planning services c) Providing charges to the third-party payer as they are incurred d) The generation of charges - C
a. Provide evidence of financial status
b. Provide a method of measuring the collection and control of A/R c. Establish productivity targets d. Make allowance for accurate revenue forecasting - B
a. The patient accounts staff have someone assigned to research coverage on behalf of patients b) Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions c) Patient coverage education may need to be provided by the health plan d) A representative of the health plan be included in the patient financial responsibilities discussion - B
a. Check if there is any patient balance due b. Verify the patient's insurance coverage if the patient is a returning customer c) Confirm that physician orders have been received d) Ensure that she/he accesses the correct information in the historical database - D
is to
a. Explain to the patient their financial responsibility and to determine the plan for payment b) Allow the patient time to compare prices with other providers c) Lock-in the prices d) Have another employee double check the price estimate - A
a. Charity adjustment b. Bad debt adjustment c. Contractual adjustment d. Administrative adjustment - B
a. Medically unnecessary b. Not delivered in a Medicare licensed care setting c. Offered in an outpatient setting d. Services and procedures that are custodial in nature - D
a. Contracted Rebating b. Per Diem Payment c. Fixed Contracting d. Bundled Payment - A
a. The Center for Medicare and Medicaid Services (CMS) b. Each state's Medicaid plan c. Medicare d. The Medicare Administrative Contractor (MAC) at the end of the hospice cap period - D
a. Discharge for the next day has not been charted b. Condition has not been discussed during the shift change report meeting c) Pharmacy orders to the ICU have not been entered in the pharmacy system d) Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system - D
a. By issuing a new invoice to the patient b. By copying the provider's attorney on a written statement of conversation c) By obtaining some type of collateral d) By changing policies to programs - B
d) Will have his/her case reviewed by the attending physician, a consulting physician and the primary care physician and a future course of care will then be determined - B
b) Incomplete registrations will raise satisfaction scores for the hospital c) Inaccurate registration may cause discharge before full treatment is obtained d) Inaccurate or incomplete patient data will delay payment or cause denials - D
a. Third-party payer information should be collected from the patient and the payer should be notified of the ED visit b) The patient then assumes full liability for services unless a third- party is notified or the patient applies for financial assistance with the first 48 hours c) The remaining registration processing is initiated at the bedside or in a registration area d) An initial registration records is completed so that the proper coding can be initiated - C
a. Payer quality monitoring b. Medicare patient and staff safety standards c. Joint Commission for Accreditation of Healthcare Organizations (JCAHO) safety d) Patient bill of rights - D
a. Refer the patient to another location with the health system b. Comply with EMTALA (Emergency Medical Treatment and Labor Act) requirements before service Complete registration and insurance approval before service d) Register the patient after he or she is placed in a bed on that service unit. - C
a. Having the patient initial the HIPAA privacy statement b. Verifying insurance to activate the patient medical record c. Verifying the patient's identification d. Check the schedule for treatment availability - C
a. The opportunity to reduce processing times at the time of service b. The ability to eliminate no-show appointments c. The opportunity to reduce the corporate compliance failures within the registration process d) The marketing value of such a program - C
a. Denied by Medicare b. The provider's responsibility but can be deemed charity care c. Fully paid with interest d. The full responsibility of the patient. - A
a. Third-party invoicing b. Account resolution c. Claims processing d. Billing - C
a. Raise quality ratings in designated hospitals. b. Encourage new ACOs to form in rural and underserved areas c. Attract physicians to participate in the ACO payment system d. Invest in treatment protocols that reduce costs to Medicare - B
a. A satisfaction survey regarding clinical service providers b. The price of service to their covering health plan c. The service providers that typically participate in the service, e.g.,
a. Understanding of billing issues and the deductibles and/or co-insurance
a. Duplicate payments b. Primary and secondary payers both paying as primary c. Inaccurate upfront collections based on incorrect liability estimates d. A patient's choice to build up a credit against future medical bills - D
a. A co-insurance payment for all Part B covered services b. Physicians office fees c. Tests outside of an inpatient setting d. Prescriptions - A
a. The patient's home care coverage b. Current medical needs c. The likelihood of an adverse event occurring to the patient d. The patient's medical history - A
a. Provider and physician reimbursement for specific diagnoses and tests b. Prospective Medicare patient financial responsibilities for a given
a. Pricing floors for services b. The financial data required for activity-based costing c. Patients an overview of services covered by their health insurance plan d. The specificity and coding needed to support reimbursement claims - D
a. A creation of multiple registrations for multiple services b. The creation of one registration record for multiple days of service
c. The creation of multiple patient types for one date of service d. The creation of one registration record per diagnosis per visit - B
a. Complete course of treatment b. Medical screening and stabilizing treatment c. Admission to observation status d. Transfer to another facility - B
a. Clinical outcomes b. Patient perceptions c. Health care processes d. Cost of services - D
In the pre-service stage, the requested service is screened for medical necessity, health