Revenue Cycle Management in Healthcare, Exams of Nursing

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CRCR Certification 206 Questions and Answers Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - CORRECT ANSWERSThe Medicare Administrative Contractor (MAC) at the end of the hospice cap period Which of the following is required for participation in Medicaid - CORRECT ANSWERSMeet Income and Assets Requirements In choosing a setting for patient financial discussions, organizations should first and foremost - CORRECT ANSWERSRespect the patients privacy A nightly room charge will be incorrect if the patient's - CORRECT ANSWERSTransfer 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 ANSWERSPurchase 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 ANSWERSCharitable pledges What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? - CORRECT ANSWERSRevenue 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 ANSWERSPatient 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 ANSWERSCase management Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? - CORRECT ANSWERSRegistration 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 ANSWERSThe Internal Revenue Service Checks received through mail, cash received through mail, and lock box are all examples of - CORRECT ANSWERSControl points for cash posting What are some core elements if a board-approved financial assistance policy? - CORRECT ANSWERSEligibility, application process, and nonpayment collection activities A recurring/series registration is characterized by - CORRECT ANSWERSThe 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 ANSWERSAssist patients in understanding their insurance coverage and their financial obligation The purpose of a financial report is to: - CORRECT ANSWERSPresent financial information to decision makers Patient financial communications best practices produce communications that are - CORRECT ANSWERSConsistent, clear and transparent Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish - CORRECT ANSWERSWhat 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 Charges are the basis for - CORRECT ANSWERSSeparation of fiscal responsibilities between the patient and the health plan All of the following are forms of hospital payment contracting EXCEPT - CORRECT ANSWERSContracted Rebating The most common resolution methods for credit balances include all of the following EXCEPT: - CORRECT ANSWERSDesignate the overpayment for charity care Ambulance services are billed directly to the health plan for - CORRECT ANSWERSThe portion of the bill outside of the patient's self-pay A claim for reimbursement submitted to a third-party payer that has all the information and documentation required for the payer to make a decision on it is known as - CORRECT ANSWERSA clean claim The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to - CORRECT ANSWERSMedicare and Medicaid payments The Correct Coding Initiative Program consists of - CORRECT ANSWERSEdits that are implemented within providers' claim processing systems To provide a patient with information that is meaningful to them, all of the following factors must be included EXCEPT - CORRECT ANSWERSThe actual physician reimbursement Which department supports/collaborates with the revenue cycle? - CORRECT ANSWERSInformation Technology Medicare Part B has an annual deductible and the beneficiary is responsible for - CORRECT ANSWERSa co-insurance payment for all Part B covered services The two types of claims denial appeals are - CORRECT ANSWERSBeneficiary and Provider Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) - CORRECT ANSWERSRegistration staff members routinely contact managed care plans for prior authorizations before the patient is seen by the on duty physician Rural Health Clinics (RHC) personnel can provide services in all of the following locations, EXCEPT - CORRECT ANSWERSProviding inpatient services in the RHC The patient discharge process begins when - CORRECT ANSWERSThe physician writes the discharge order Departments that need to be included in charge master maintenance include all of the following EXCEPT - CORRECT ANSWERSQuality Assurance The first thing a health plan does when processing a claim is - CORRECT ANSWERSCheck 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 ANSWERS The most accurate way to validate patient information is to - CORRECT ANSWERSrequire clinical staff to verify information at each treatment encounter In order for Regulation Z to apply, a hospital must - CORRECT ANSWERS All of the following are minimum requirements for new patients with no MPI number EXCEPT - CORRECT ANSWERSAddress A typical routine patient financial discussion would include - CORRECT ANSWERSExplaining 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 ANSWERSReviewing 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 ANSWERSContinually align technology with processes rather than technology dictating processes Scheduler instructions are used to prompt the scheduler to - CORRECT ANSWERSComplete 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 ANSWERSThese 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 ANSWERSThe accounts receivable level would be understated The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as - CORRECT ANSWERSinsurance verification and reimbursable charges Unless the patient encounter is an emergency, it is more efficient and effective to - CORRECT ANSWERSCollect all information after the patient has been discharged Applying the contracted payment amount to the amount of total charges yields - CORRECT ANSWERSA pricing agreement "Hard-coded" is the term used to refer to - CORRECT ANSWERSCodes 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 ANSWERSProviders pay pennies on each dollar collected Which of the following is usually covered on a Conditions of Admission form - CORRECT ANSWERSRelease of information Medicare beneficiaries remain in the same "benefit period" - CORRECT ANSWERSUntil the beneficiary is "hospitalization and/or skilled nursing facility- free" for 60 consecutive days It is important to calculate reserves to ensure - CORRECT ANSWERSStable financial operations and accurate financial reporting A claim is denied for the following reasons, EXCEPT: - CORRECT ANSWERSThe submitted claim does not have the physicians signature HFMA best practices call for patient financial discussions to be reinforced - CORRECT ANSWERSBy changing policies to programs Patients should be informed that costs presented in a price estimate may - CORRECT ANSWERSVary from estimates, depending on the actual services performed The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physicians to do all of the following EXCEPT: - CORRECT ANSWERSObtain higher compensation for physicians Charges as the most appropriate measurement of utilization enables - CORRECT ANSWERSAccuracy of expense and cost capture Once the EMTALA requirements are satisfied - CORRECT ANSWERSThe 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 ANSWERSSupport that choice, providing that the discussion does not interfere with patient care or disrupt patient flow In Chapter 7 straight bankruptcy filling - CORRECT ANSWERSThe 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 ANSWERSThat 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 ANSWERSClaims processing The importance of Medical records being maintained by HIM is that the patient records: - CORRECT ANSWERSAre 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 ANSWERSEnsure 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 ANSWERSCase Management Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and - CORRECT ANSWERSProvide 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 ANSWERSPotentially 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 ANSWERSIdentify, compare, and choose providers that offer the desired level of value All of the following are potential causes of credit balances EXCEPT - CORRECT ANSWERSA patient's choice to build up a credit against future medical bills A comprehensive "Compliance Program" is defined as - CORRECT ANSWERSSystematic procedures to ensure that the provisions of regulations imposed by a government agency are being met An originating site is - CORRECT ANSWERSThe 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 ANSWERSWhich 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 ANSWERSWill be admitted as an inpatient The benefit of Medicare Advantage Plan is - CORRECT ANSWERSPatients 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 ANSWERSAccurate billing Claims with dates of service received later than one calendar year beyond the date of service, will be - CORRECT ANSWERSDenied by Medicare A portion of the accounts receivable inventory which has NOT qualified for billing includes - CORRECT ANSWERSCharitable pledges The standard claim form used for billing by hospitals, nursing facilities, and other in-patient - CORRECT ANSWERSUB-04 Once the price is estimated in the pre-service stage, a provider's financial best practice is to - CORRECT ANSWERSExplain to the patient their financial responsibility and to determine the plan for payment To maximize the value derived from customer complaints, all consumer complaints should be - CORRECT ANSWERSResponded to within two business days A scheduled inpatient represents an opportunity for the provider to do which of the following? - CORRECT ANSWERSComplete registration and insurance approval before service In the pre-service stage, the requested service is screened for medical necessity, health - CORRECT ANSWERSPre-authorization are obtained Hospitals need which of the following information sets to assess a patient's financial status: - CORRECT ANSWERSPatient and guarantor's income, expenses and assets Patients are contacting hospitals to proactively inquire about costs and fees prior to - CORRECT ANSWERSThe 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 ANSWERSThe Internal Revenue Service The HCAHPS (hospital consumer assessment of healthcare providers and systems) initiative - CORRECT ANSWERSProvide 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 ANSWERSPosting errors in the patient accounting system A Medicare Part A benefit period begins: - CORRECT ANSWERSWith admission as an inpatient Chapter 13 Bankruptcy, debtor rehabilitation, is a court proceeding - CORRECT ANSWERSThat 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 ANSWERSCost of services The disadvantages of outsourcing include all of the following EXCEPT: - CORRECT ANSWERSReduced internal staffing costs and a reliance on outsourced staff Improving the overall patient experience requires revenue cycle leadership and staff to simultaneously be: - CORRECT ANSWERSClear on policies and consistent in applying the policies Because 501(r) regulations focus on identifying potential eligible financial assistants patients hospitals must: - CORRECT ANSWERSHold financial conversations with patients as soon as possible Which of the following is NOT contained in a collection agency agreement? - CORRECT ANSWERSA mutual hold-harmless clause HFMA best practices stipulate that a reasonable attempt should be made to have the financial - CORRECT ANSWERSAs 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 ANSWERSPatients 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 ANSWERSFinal bill is presented for payment HFMA's patient financial communication best practices specify that patients should be told about the types of services provided and - CORRECT ANSWERSThe service providers that typically participate in the service, e.g., radiologists, pathologists, etc. Successful account resolution begins with - CORRECT ANSWERSCollecting all deductibles and copayments during the pre-service stage Recognizing that health coverage is complicated and not all patients are able to navigate this terrain, HFMA best practices specify that - CORRECT ANSWERSPatients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions In the balance resolution process, providers should: - CORRECT ANSWERSAsk the patient if he or she would like to receive information about payment options and supportive financial assistance programs Business ethics, or organizational ethics represent: - CORRECT ANSWERSThe 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 ANSWERSMedicare 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 ANSWERSHMO In a Chapter 7 Straight Bankruptcy filing - CORRECT ANSWERSThe 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 ANSWERSEnsure 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 ANSWERSRevenue codes Appropriate training for patient financial counseling staff must cover all of the following EXCEPT: - CORRECT ANSWERSDocumenting the conversation in the medical records HIPAA contains all of the following goals EXCEPT - CORRECT ANSWERSTo ensure proper coding across the continuum of care Which of the following is NOT included in the Standardized Quality Measures? - CORRECT ANSWERS Account Receivable (A/R) Aging reports - CORRECT ANSWERSDivide accounts receivable into 30, 60, 90 ,120 days past due categories Patients expect value for their healthcare dollar, including greater transparency of - CORRECT ANSWERSQuality and price information The impact of denials on the revenue cycle includes all of the following EXCEPT - CORRECT ANSWERSPatient outcomes Examples of ethics violations that impact the revenue cycle include all of the following EXCEPT - CORRECT ANSWERSSeeking payment options for patient self- pay Scheduled procedures routinely include - CORRECT ANSWERSPatient preparation instructions ICD-10-CM and ICD-10-PCS codes sets are modifications of - CORRECT ANSWERSThe International ICD-10 codes as developed by the WHO (World Health Organization) The result of accurate census balancing on a daily basis is - CORRECT ANSWERSThe correct recording of room charges All of the following are steps in verifying insurance EXCEPT - CORRECT ANSWERSThe patient signing the statement of financial responsibility Health Information Management (HIM) is responsible for - CORRECT ANSWERSAll 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 ANSWERSThe 1500 Which of the following is NOT a factor in self-pay follow-up? - CORRECT ANSWERSThe type of patient (inpatient, out-patient) The Office of Inspector General (OIG) was created - CORRECT ANSWERSDetect and prevent fraud, waste, and abuse - CORRECT ANSWERS