Revenue Cycle Management in Healthcare, Exams of Advanced Education

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CRCR Certification Exam With 100% Verified Answers 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 Which of the following is required for participation in Medicaid - Correct Answer-Meet Income and Assets Requirements In choosing a setting for patient financial discussions, organizations should first and foremost - Correct Answer-Respect the patients privacy A nightly room charge will be incorrect if the patient's - Correct Answer-Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can - Correct Answer-Purchase qualified health benefit plans regardless of insured's health status A portion of the accounts receivable inventory which has NOT qualified for billing includes: - Correct Answer-Charitable pledges What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? - Correct Answer-Revenue codes This directive 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 - Correct Answer-Patient bill of rights The activity which results in the accurate recording of patient bed and level of care assessment, patient transfer and patient discharge status on a real-time basis is known as - Correct Answer-Case management Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? - Correct Answer-Registration staff may routinely contact managed are plans for prior authorizations before the patient is seen by the on-duty physician HIPAA had adopted Employer Identification Numbers (EIN) to be used in standard transactions to identify the employer of an individual described in a transaction EIN's are assigned by - Correct Answer-The Internal Revenue Service Checks received through mail, cash received through mail, and lock box are all examples of - Correct Answer-Control points for cash posting What are some core elements if a board-approved financial assistance policy? - Correct Answer-Eligibility, application process, and nonpayment collection activities A recurring/series registration is characterized by - Correct Answer-The creation of one registration record for multiple days of service With the advent of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to - Correct Answer-Assist patients in understanding their insurance coverage and their financial obligation The purpose of a financial report is to: - Correct Answer-Present financial information to decision makers Patient financial communications best practices produce communications that are - Correct Answer-Consistent, clear and transparent Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish - Correct Answer-What services or healthcare items are covered under Medicare Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with - Correct Answer-The Provider Reimbursement Review Board Concurrent review and discharge planning - Correct Answer-Occurs during service Duplicate payments occur: - Correct Answer-When providers re-bill claims based on nonpayment from the initial bill submission An individual enrolled in Medicare who is dissatisfied with the government's claim determination is entitled to reconsideration of the decision. This type of appeal is known as - Correct Answer-A beneficiary appeal Insurance verification results in which of the following - Correct Answer-The accurate identification of the patient's eligibility and benefits The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: - Correct Answer-Judicial review by a federal district court The first thing a health plan does when processing a claim is - Correct Answer-Check if the patient is a health plan beneficiary and what is the coverage Vital to accurate calculations of a patient's self-pay amount is - Correct Answer- The most accurate way to validate patient information is to - Correct Answer-require clinical staff to verify information at each treatment encounter In order for Regulation Z to apply, a hospital must - Correct Answer- All of the following are minimum requirements for new patients with no MPI number EXCEPT - Correct Answer-Address A typical routine patient financial discussion would include - Correct Answer-Explaining the benefits identified through verifying the patients insurance Components of financial education include informing the patient of the hospital's financial policies, assessing the patient's ability to pay and - Correct Answer-Reviewing payment alternatives with the patient so appropriate resolution of the health care financial obligation is achieved HFMA best practices indicate that the technology evaluation is conducted to - Correct Answer-Continually align technology with processes rather than technology dictating processes Scheduler instructions are used to prompt the scheduler to - Correct Answer-Complete the scheduling process correctly based on service requested When billing Rural Health Clinic services on a UB-04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521). Although codes are collapsed into a single revenue code, it is still important to list the appropriate CPT codes as part - Correct Answer-These codes will be used to determine medical necessity and useful in determining what happened during the encounter What is likely to occur if credit balances are not identified separately from debit balances in accounts receivable? - Correct Answer-The accounts receivable level would be understated The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as - Correct Answer-insurance verification and reimbursable charges Unless the patient encounter is an emergency, it is more efficient and effective to - Correct Answer-Collect all information after the patient has been discharged Applying the contracted payment amount to the amount of total charges yields - Correct Answer-A pricing agreement "Hard-coded" is the term used to refer to - Correct Answer-Codes for services, procedures, and drugs automatically assigned by the charge master The advantages to using a third-party collection agency include all of the following EXCEPT - Correct Answer-Providers pay pennies on each dollar collected Which of the following is usually covered on a Conditions of Admission form - Correct Answer-Release of information The 501(r) regulations require not-for-profit providers (501(c)(3) organizations) to do which of the following activities. - Correct Answer-Complete a community needs assessment and develop a discount program for patient balances after insurance payment To be eligible for Medicaid, an individual must - Correct Answer-meet income and asset requirements Eliminating mail time and reducing data entry time, electronically monitoring the receipt of claims and online claim adjudication, more prompt payment are all benefits achieved by - Correct Answer-The electronic submission of claims using electronic transfers There are unique billing requirements based on - Correct Answer-The provider type The unscheduled "direct" admission represents a patient who: - Correct Answer-Is admitted from a physician's office on an urgent basis In resolving medical accounts, a law firm may be used as: - Correct Answer-A substitute for a collection agency The legal authority to request and analyze provider claim documentation to ensure that - Correct Answer-The Office of the U.S. Inspector General (OIG) The office of inspector general (OIG) publishes a compliance work plan - Correct Answer-Annually Room and bed charges are typically posted - Correct Answer-From the midnight census All of the following information should be reviewed as part of schedule finalization EXCEPT: - Correct Answer-The results of any and all test Revenue cycle activities occurring at the point-of-service include all of the following EXCEPT: - Correct Answer-Providing charges to the third-party payer as they are incurred HFMA's patient financial communications best practices specify that pts should be told about the - Correct Answer-The service providers that typically participate in the service, e.g. radiologists ,pathologists, etc. The core financial activities resolved within patient access include: - Correct Answer- Scheduling, pre-registration, insurance verification and managed care processing A decision on whether a patient should be admitted as an inpatient or become about patient observation patient requires medical judgments based on all of the following EXCEPT - Correct Answer-The patient's home care coverage Which option is a benefit of pre-registering a patient for services - Correct Answer-The patient arrival process is expedited, reducing wait times and delays Days in A/R is calculated based on the value of - Correct Answer-The total accounts receivable on a specific date Case Management requires that a case manager be assigned - Correct Answer-To a select patient group Which of the following is required for participation in Medicaid? - Correct Answer-Meet income and assets requirements All of the following are steps in safeguarding collections EXCEPT - Correct Answer- Issuing receipts The Electronic Remittance Advice (ERA) data set is : - Correct Answer-A standardized form that provides third party payment details to providers All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT - Correct Answer-Services and procedures that are custodial in nature Medicare beneficiaries remain in the same "benefit period" - Correct Answer-Until the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days It is important to calculate reserves to ensure - Correct Answer-Stable financial operations and accurate financial reporting A claim is denied for the following reasons, EXCEPT: - Correct Answer-The submitted claim does not have the physicians signature HFMA best practices call for patient financial discussions to be reinforced - Correct Answer-By changing policies to programs Health Plan Contracting Departments do all of the following EXCEPT - Correct Answer- Establish a global reimbursement rate to use with all third-party payer For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: - Correct Answer-Should take place between the patient or guarantor and properly trained provider representatives What type of account adjustment results from the patient's unwillingness to pay a self- pay balance? - Correct Answer-Bad debt adjustment Most major health plans including Medicare and Medicaid, offer - Correct Answer- Electronic and/or web portal verification The important Message from Medicare provides beneficiaries information concerning their - Correct Answer-Right to appeal a discharge decision if the patient disagrees with the plan Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the provider may not ask about a patient's insurance information if it would delay what? - Correct Answer-Medical screening and stabilizing treatment Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implement - Correct Answer-Monitor compliance Medicare will only pay for tests and services that - Correct Answer-Medicare determines are "reasonable and necessary" The physician who wrote the order for an inpatient service and is in charge of the patients - Correct Answer-The attending physician When primary payment is received, the actual reimbursement - Correct Answer-Is compared to the expected reimbursement, the remaining contractual adjustments are posted, and secondary claims are submitted The ICD-10 codes set and CPT/HCPCS code sets combines provide - Correct Answer- The specificity and coding needed to support reimbursement claims In a self-insured (or self-funded) plan, the costs of medical care are - Correct Answer- Borne by the employer on a pay-as-you-go basis Indemnity plans usually reimburse: - Correct Answer-A certain percentage of the charges after the patient meets the policy's annual deductible The first and most critical step in registering a patient, whether scheduled or unscheduled, is - Correct Answer-Verifying the patient's identification When Recovery Audit Contractors (RAC) identify improper payments as over payments, the - Correct Answer-Send a demand letter to the provider to recover the over payment amount Across all care settings, if a patient consents to a financial discussion during a medical encounter - Correct Answer-Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by: - Correct Answer-Each state's Medicaid plan Medicare patients are NOT required to produce a physician order to receive which of these services - Correct Answer-Screening Mammography, flu vaccine or pneumonia vaccine EFT (electronic funds transfer) is - Correct Answer-An electronic transfer of funds from payer to payee The importance of medical records being maintained by HIM is that the patient records - Correct Answer-Are the primary source for clinical data required for reimbursement by health plans and liability payers Days in A/R is calculated based on the value of: - Correct Answer-The time it takes to collect anticipated revenue To maximize the value derived from customer complaints, all consumer complaints should be - Correct Answer-Responded to within two business days A scheduled inpatient represents an opportunity for the provider to do which of the following? - Correct Answer-Complete registration and insurance approval before service In the pre-service stage, the requested service is screened for medical necessity, health - Correct Answer-Pre-authorization are obtained Hospitals need which of the following information sets to assess a patient's financial status: - Correct Answer-Patient and guarantor's income, expenses and assets Patients are contacting hospitals to proactively inquire about costs and fees prior to - Correct Answer-The fact that charge master lists the total charge, not net charges that reflect charges after a payer's contractual adjustment HIPAA had adopted Employer Identification Numbers (EIN) to be used in standard transactions to identify the employer of an individual described in a transaction EIN's are assigned by - Correct Answer-The Internal Revenue Service The HCAHPS (hospital consumer assessment of healthcare providers and systems) initiative - Correct Answer-Provide a standardized method for evaluating patient's perspective on hospital care. A large number of credit balances are not the result of overpayments but of - Correct Answer-Posting errors in the patient accounting system A Medicare Part A benefit period begins: - Correct Answer-With admission as an inpatient Chapter 13 Bankruptcy, debtor rehabilitation, is a court proceeding - Correct Answer- That reorganizes a debtor's holdings and instructs creditors to look to the debtor's future earnings for payment Which of the following in NOT included in the Standardized Quality Measures - Correct Answer-Cost of services The disadvantages of outsourcing include all of the following EXCEPT: - Correct Answer-Reduced internal staffing costs and a reliance on outsourced staff Improving the overall patient experience requires revenue cycle leadership and staff to simultaneously be: - Correct Answer-Clear on policies and consistent in applying the policies Because 501(r) regulations focus on identifying potential eligible financial assistants patients hospitals must: - Correct Answer-Hold financial conversations with patients as soon as possible Which of the following is NOT contained in a collection agency agreement? - Correct Answer-A mutual hold-harmless clause HFMA best practices stipulate that a reasonable attempt should be made to have the financial - Correct Answer-As early as possible, before a financial obligation is incurred Recognizing that health coverage is complicated and not all pts are able to navigate this terrain, HFMA best practices specify that - Correct Answer-Patients should be given the opportunity to request a patient advocate, family member or other designee to help them In these discussions For scheduled patients, important revenue cycle activities In the Time of Service stage DO NOT INCLUDE: - Correct Answer-Final bill is presented for payment Net Accounts Receivable is - Correct Answer-The amount an entity is reasonably confident of collecting from overall accounts receivable. ED patients should be informed that their ability to pay - Correct Answer-Will not interfere with treatment of any emergency medical conditions 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- Business affiliates Incorrect data gathering can cause all of the following EXCEPT - Correct Answer-The inability to discuss quality with physicians All Hospitals are required to establish a written financial assistance policy that applies to - Correct Answer-All emergency and medically necessary care All of the following are reference resources used to help guide in the application of business ethics EXCEPT - Correct Answer-Consumer satisfaction reports Each patient is assigned a unique number, commonly called the - Correct Answer- Master Patient Index (MPI) number HIPAA contains all of the following goals EXCEPT - Correct Answer-To ensure proper coding across the continuum of care Which of the following is NOT included in the Standardized Quality Measures? - Correct Answer- Account Receivable (A/R) Aging reports - Correct Answer-Divide accounts receivable into 30, 60, 90 ,120 days past due categories Patients expect value for their healthcare dollar, including greater transparency of - Correct Answer-Quality and price information The impact of denials on the revenue cycle includes all of the following EXCEPT - Correct Answer-Patient outcomes Examples of ethics violations that impact the revenue cycle include all of the following EXCEPT - Correct Answer-Seeking payment options for patient self-pay Scheduled procedures routinely include - Correct Answer-Patient preparation instructions ICD-10-CM and ICD-10-PCS codes sets are modifications of - Correct Answer-The International ICD-10 codes as developed by the WHO (World Health Organization) The result of accurate census balancing on a daily basis is - Correct Answer-The correct recording of room charges All of the following are steps in verifying insurance EXCEPT - Correct Answer-The patient signing the statement of financial responsibility Health Information Management (HIM) is responsible for - Correct Answer-All patient medical records This form contains major items, subdivided into a total of 55 detailed items, and is used by professional service providers and not hospitals for submitting claims for services to health plans this form is called - Correct Answer-The 1500 Which of the following is NOT a factor in self-pay follow-up? - Correct Answer-The type of patient (inpatient, out-patient) The Office of Inspector General (OIG) was created - Correct Answer-Detect and prevent fraud, waste, and abuse - Correct Answer-