Revenue Cycle Management in Healthcare, Exams of Nursing

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HFMA CRCR EXAM 150 QUESTIONS WITH VERIFIED CORRECT AND COMPLETE SOLUTIONS/A+GRADE/2024 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 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 Scheduler instructions are used to prompt the scheduler to do what? - Correct answer- Complete the scheduling process correctly based on service requeste which services are hospice programs required to provide around the clock patient - Correct answer-Physician, Nursing, Pharmacy Which of the following statement apply to the observation patient type? - Correct answer-It is used to evaluate the need for an inpatient admission What are nonemergency patients who come for service without prior notification to the provider called? - Correct answer-Unscheduled patients what is a recurring or series registration? - Correct answer-One registration record is created for multiple days of service 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 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 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 is the purpose OIG work plant? - Correct answer-Identify Acceptable compliance programs in various provider setting Through what document does a hospital establish compliance standards? - Correct answer-code of conduct HFMA CRCR EXAM 150 QUESTIONS WITH VERIFIED CORRECT AND COMPLETE SOLUTIONS/A+GRADE/2024 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. The hospital has a APC based contract for the payment of outpatient services. Total anticipated charges for the visit are $2,380. The approved APC payment rate is $780. Where will the patients benefit package be applied? - Correct answer-To the approved APC payment rate If the patient cannot agree to payment arrangements, What is the next option? - Correct answer-Warn the patient that unpaid accounts are placed with collection agencies for further processing What patient assets are considered in the financial assistance application? - Correct answer-Sources of readily available funds , vehicles, campers, boats and saving accounts When is a patient considered to be medically indigent? - Correct answer-The patient's outstanding medical bills exceed a defined dollar amount or percentage of assets. A patient has met the $200 individual deductible and $900 of the $1000 co-insurance responsibility. The co-insurance rate is 20%. The estimated insurance plan responsibility is $1975.00. What amount of coinsurance is due from the patient? - Correct answer-$100.00 Which of the following is a step in the discharge process? - Correct answer-Have a case management service complete the discharge 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 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 provision protects the patient from medical expenses that exceed the pre-set level - Correct answer-stop loss 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 What is the advantage of a pre-registration program - Correct answer-It reduces processing times at the time of service HFMA CRCR EXAM 150 QUESTIONS WITH VERIFIED CORRECT AND COMPLETE SOLUTIONS/A+GRADE/2023 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. HIPAA privacy rules require covered entities to take all, of the following actions EXCEPT: - Correct answer-Use only designated software platforms to secure patient date. Hospital need which of the following information sets to assess a patient's financial status? - Correct answer-Demographic, Income, Assets and Expenses. Hospital can only convert an inpatient case to observation if: - Correct answer-The hospital utilization review committee determines before the patient is discharged and prior to billing that an observation setting would be more appropriate. For scheduled payments, important revenue cycle activities in the time-of-service stage DO Not include: - Correct answer-Obtaining or updating patient and guarantor information 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 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. Which of the following is NOT included in the standardized quality measures? - Correct answer-Cost of services 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. Departments that need to be included in Charge master maintenance include all EXCEPT - Correct answer-Quality Assurance Indemnity plans usually reimburse what? - Correct answer-A certain percentage of charges after patient meets policy's annual deductible. 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 HFMA CRCR EXAM 150 QUESTIONS WITH VERIFIED CORRECT AND COMPLETE SOLUTIONS/A+GRADE/2023 When Recovery Audit Contractors (RAC) identify improper payments as overpayment. the claims processing contractor must: - 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 to expedite discharge, the HFMA best practice is to: - Correct answer- Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow. A scheduled inpatient represents an opportunity for the provider to do which of the following? - Correct answer-Complete registration and insurance approval before service The disadvantage of outsourcing includes all, of the following Except - Correct answer- Reduces internal staffing costs and a reliance on outsourced staff. 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: - Correct answer-The amount the patient may be expected to pay after insurance. Important Revenue Cycle Activities in the pre-service stage include: - Correct answer- Obtaining or updating patient and guarantor information The importance of medical records 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 Applying the contracted payment methodology to the total charges yields: - Correct answer-An estimate price The soft cost of a dissatisfied customer is: - Correct answer-The customer passing on information about their negative experience to potential patients or through social media channels. To maximize the value derived from customer complaints, all consumer complaints should be: - Correct answer-Tracked and shared to improve customer experience The Medicare Bundled Payments for Care Initiative (BCP) is designed to: - Correct answer-Align incentives between hospitals, physicians, and non-physician providers in- order to better coordinate patient care. Which HIPPA transaction set provides electronic processing of 8insurance verification requests and responses? - Correct answer-The 270-271 set HFMA CRCR EXAM 150 QUESTIONS WITH VERIFIED CORRECT AND COMPLETE SOLUTIONS/A+GRADE/2023 The Electronic Remittance Advice (ERA) data sets are: - Correct answer-A standardized for that provides 3rd party payment details to providers 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 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 The correct coding initiative program consist of: - Correct answer-Edits that are implemented within provider's claim processing system 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 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 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 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? 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 Examples of ethics violation that impact the revenue cycle include all of the following EXCEPT: - Correct answer-Seeking payment options for self-pay All Hospitals are required to establish a written financial assistance policy that applies to: - Correct answer-All emergency and medically necessary care A claim is denied for the following reasons EXCEPT: - Correct answer-The submitted claim does not have the physician signature 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: - Correct answer-Case Management HFMA CRCR EXAM 150 QUESTIONS WITH VERIFIED CORRECT AND COMPLETE SOLUTIONS/A+GRADE/2023 All of following are steps in safeguarding collections EXCEPT: - Correct answer-Placing collections in a lock-box for posting review the next business day HFMA best practices call for patient financial discussions to be reinforced: - Correct answer-By issuing a new invoice to the patient Medicare benefits provide coverage for: - Correct answer-Inpatient hospital services, skilled nursing care. And home health care Days in A/R calculated based on the value of: - Correct answer-The total account receivable on a specific date Charges, as the most appropriate measurement of utilization, enables: - Correct answer-Generation of timely and accurate billing The ICD-10 code set and CPT/HCPCS code sets combined provide: - Correct answer- The specificity and coding accuracy needed to support reimbursement claims 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 A portion of the accounts receivable inventory which has NOT qualified for billing includes: - Correct answer-Accounts created during pre-registration but not activated Chapter 11 Bankruptcy permits a debtor to: - Correct answer-Work out a court- supervised plan with creditors 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 - Correct answer-HMO Patients should be informed that costs presented in a price estimation may: - Correct answer-Only determine the percentage of the total that the patients is responsible for and not the actual cost. Appropriate training for patient financial counseling staff must cover all of the following EXCEPT: - Correct answer-Documenting the conversation in the medical records The patient discharge process begins when: - Correct answer-The physician writes the order To be eligible for Medicaid, an individual must: - Correct answer-Meet income and asset requirements HFMA CRCR EXAM 150 QUESTIONS WITH VERIFIED CORRECT AND COMPLETE SOLUTIONS/A+GRADE/2023 The code indication of the disposition of the patient at the conclusion of service is called the: - Correct answer-Patient discharge status code 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. What customer service improvements might improve the patient accounts department? - Correct answer-Holding Staff accountable for customer service during performance reviews Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - Correct answer-Birthday What are collection agency fees based on ? - Correct answer-A percentage of dollars collected 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 Net Accounts Receivable is - Correct answer-The amount an entity is reasonably confident of collection form overall accounts Which of the following is usually covered on a Conditions of Admissions form: - Correct answer-Patient's bill of rights. What are some elements of a board-approved financial assistance policy: - Correct answer-Eligibility application process and nonpayment collection activities Most major health plans including Medicare and Medicaid offer: - Correct answer- Electronic and/or web portal verification Applying the contracted payment amount to the amount of total charges yields: - Correct answer-An estimated price for the patient's responsibility Account Receivable (A/R) aging reports - Correct answer-Identify past due accounts likely to become bad debit 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 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 HFMA CRCR EXAM 150 QUESTIONS WITH VERIFIED CORRECT AND COMPLETE SOLUTIONS/A+GRADE/2023 If the insurance verification response reports that a subscriber has a single policy, what is the status of the subscriber's spouse? - Correct answer-Neither enrolled not entitled to benefits Collecting patient liability dollars after service leads to what? - Correct answer-Lower accounts receivable levels What is a principle diagnosis? - Correct answer-Primary reason for the patients admission Regulation Z of the consumer Credit Protection Act, also known as the Truth in lending Act establishes what? - Correct answer-Disclosure rules for consumer credit sales and consumer loans When is the word "SAME" entered on the CMS 1500 billing form in feild 0 - Correct answer-When the patient is insured Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has received what? - Correct answer-Medically necessary inpatient hospital services for at least 3 consecutive days before the skilled nursing care admission. What type of patient status is used to evaluate the patients need for inpatient care? - Correct answer-Observation 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 statement applies to the scheduled outpatient? - Correct answer-The services do not include an overnight stay What are the two statutory exclusions from hospice coverage? - Correct answer- Medically Unnecessary services and custodial care 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 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 What is the initial hospice benefit? - Correct answer-Two 90-day periods and an unlimited number of subsequent periods 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