Revenue Cycle Management in Healthcare, Exams of Nursing

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CRCR CERTIFICATION EXAM NEWEST ACTUAL EXAM QUESTIONS AND DETAILED CORRECT ANSWERS 2025 | CRCR A+ GRADE COMPREHENSIVE STUDYGUIDE The soft cost of a dissatisfied customer is Correct Answer The customer passing on info about their negative experience to potential pts or through social media channels An advantage of a pre-registration program is Correct Answer The opportunity to reduce the corporate compliance failures within the registration process It is important to have high registration quality standards because Correct Answer Inaccurate or incomplete patient data will delay payment or cause denials Telemed seeks to improve a patient's health by Correct Answer Permitting 2-way real time interactive communication between the patient and the clinical professional Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a monthly fee is known as a Correct Answer HMO Identifying the patient, in the MPI, creating the registration record, completing medical necessity screening, determining insurance eligibility and benefits resolving managed care, requirements and completing financial education/resolution are all Correct Answer The data collection steps for scheduling and pre-registering a patient Medicare Part B has an annual deductible, and the beneficiary is responsible for Correct Answer A co- insurance payment for all Part B covered services The standard claim form used for billing by hospitals, nursing facilities, and other inpatient Correct Answer UB- 04 Charges are the basis for Correct Answer Separation of fiscal responsibilities between the patient and the health plan All of the following are forms of hospital payment contracting EXCEPT Correct Answer Contracted Rebating The most common resolution methods for credit balances include all of the following EXCEPT: Correct Answer Designate the overpayment for charity care Ambulance services are billed directly to the health plan for Correct Answer The portion of the bill outside of the patient's self-pay 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 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 Once the EMTALA requirements are satisfied Correct Answer The remaining registration processing is initiated at the bedside or in a registration area 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 In Chapter 7 straight bankruptcy filling Correct Answer The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt Chapter 13 Bankruptcy, debtor rehabilitation is a court proceeding Correct Answer That reorganizes a debtor's holdings and instructs creditors to look to the debtors' future earnings for payment This concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits Correct Answer Claims processing 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 When there is a request for service, the scheduling staff member must confirm the patient's unique identification information to Correct Answer Ensure that she/he accesses the correct information in the historical database Maintaining routine contact with the health plan or liability payer, making sure all required information is provided and all needed approvals are obtained is the responsibility of: Correct Answer Case Management Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and Correct Answer Provide a method of measuring the collection and control of A/R With any remaining open balances, after insurance payments have been posted, the account financial liability is Correct Answer Potentially transferred to the patient Pricing transparency is defined as readily available information on the price of healthcare services, that together with other information, help define the value of those services and enable consumers to Correct Answer Identify, compare, and choose providers that offer the desired level of value All of the following are potential causes of credit balances EXCEPT Correct Answer A patient's choice to build up a credit against future medical bills A comprehensive "Compliance Program" is defined as Correct Answer Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met An originating site is Correct Answer The location of the patient at the time the service is provided Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare established guideline(s) used to determine: Correct Answer Which diagnoses, signs, or symptoms are reimbursable If further treatment can only be provided in a hospital setting, the patient's condition cannot be evaluated and/or treated within 24 hours, or if there is not an anticipation of improvement in the patient's condition with 24 hours, the patient Correct Answer Will be admitted as an inpatient The benefit of Medicare Advantage Plan is Correct Answer Patients generally have their Medicare-coverage healthcare through the plan and do not need to worry about "part a" or "part b" benefits The process of creating the pre-registration record ensures Correct Answer Accurate billing Claims with dates of service received later than one calendar year beyond the date of service, will be Correct Answer Denied by Medicare A portion of the accounts receivable inventory which has NOT qualified for billing includes Correct Answer Charitable pledges 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 Business ethics, or organizational ethics represent: Correct Answer The principles and standards by which organizations operate Which option is a government-sponsored health care program that is financed through taxes and general revenue funds Correct Answer Medicare Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on; a monthly fee is known as a Correct Answer HMO In a Chapter 7 Straight Bankruptcy filing Correct Answer The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt When there is a request for service the scheduling staff member must confirm the patient's Correct Answer Ensure that she/he accesses the correct information in the historical database A four digit number code established by the National Uniform Billing Committee (NUBC)that categorizes/classifies a line item in the charge master is known as Correct Answer Revenue codes Appropriate training for patient financial counseling staff must cover all of the following EXCEPT: Correct Answer Documenting the conversation in the medical records 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 When recovery audit contractors (RAC) identify improper payments as over payments the claims processing contractor must Correct Answer Send a demand letter to the provider to recover the over payment amount The purpose of the ACA mandated Community Health Needs Assessment is Correct Answer To identify significant health needs, prioritize those needs and identify resources to address them A balance sheet is Correct Answer A statement of assets, liabilities, and capital for an organization at a specified point in time Hospitals can only convert an inpatient case to observation if the hospital utilization review committee determines this status before the patient is discharged and Correct Answer Prior to billing, that an observation setting will be more appropriate During pre-registration, a search for the patients MPI 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 Because case managers document the clinical reasons for treatment, they are Correct Answer A good resource when developing written appeals of denials The Truth in Lending Act establishes Correct Answer Disclosure rules for consumer credit sales and consumer loans What is Continuum of Care? Correct Answer The coordination and linkage of resources needed to avoid the duplication of services and the facilitation of a seamless movement among care settings HIPAA privacy rules require covered entities to take all of the following actions EXCEPT Correct Answer Use only designated software platforms to secure patient data The Two Midnight Rule allows hospitals to account for total hospital time when determining if an inpatient admission order should be written based on Correct Answer A beneficiary needing a minimum of 48 hours of care Since passage 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