Revenue Cycle Management in Healthcare, Exams of Nursing

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Certified Revenue Cycle Representative

- CRCP (2021) HFMA.org

Patients considered scheduled - correct answer recurring/series patients Which option is NOT a type of denial. - correct answer Contractual adjustment Which option is NOT a lien type? - correct answer Subrogation Which Items are required components of a financial assistance policy? - correct answer Concise statement of the hospital's mission Guidelines for bad debt or previous unpaid accounts Installment arrangement guidelines Payment Methods A clearly defined financial assistance statement Which activity is not considered when initiating self-pay follow up and account resolution activities? - correct answer Patient Open Balance Billing Which option is NOT a required component of a FAP? - correct answer Out of Network Providers Match the title to the appropriate consumer credit protection act component. - correct answer Truth in lending act - Title 1 Restrictions on garnishment - Title III Fair debt collections practices act - Title VIII Fair credit reporting Act - Title VI Which is not a bankruptcy type governed by thee 1979 bankruptcy act? - correct answer Creditor priority

Which evaluation criteria demonstrates reputation expectations? - correct answer The employment of staff who have documented experience working in financial areas of health care. Agency fees are: - correct answer The cost to the provider for collecting agency monies offset by the return on baddest accounts. The correct way to handle the retention and payment of agency fees is? - correct answer Follow the contractual agreement between the agency and the provider as to how monies sent to the agency will be handled. Patient Relations Include? - correct answer The ability to sensitively deal with patients or individuals while managing collection efficiency. Collection agency reports should be provided: - correct answer In at least two formats regarding accounts assigned on a routine basis. Collection results are: - correct answer Accurately calculated to demonstrate the actual recovery percentage rate. Which option is NOT a HFMA best practice. - correct answer Coordinate the resolution of bad debt accounts with a law firm. T or F: The following statement represents an advantage of outsourcing: Access to qualified staff. - correct answer True or T T or F: The following statement represents an advantage of outsourcing: Vendors absorbs some financial risk based on "efficiency" factor - correct answer True of T T or F: The following statement represents an advantage of outsourcing: Impact on direct control of accounts receivable. - correct answer False

T or F: The following statement represents an advantage of outsourcing: Capitalizes on the economies of scale. - correct answer True T or F: The following statement represents an advantage of outsourcing: Limits internal staffing requirements. - correct answer False T or F: The following statement represents an advantage of outsourcing: Impact on customer service. - correct answer False T or F: The following statement represents an advantage of outsourcing: Legal impact if vendor represents themselves as provider employees. - correct answer False T or F: The following statement represents an advantage of outsourcing: Ineffective vendor results in increased costs. - correct answer False Which function within the revenue cycle is NOT a good candidate for outsourcing? - correct answer Health Care Patient Services 1 Consents are signed as part of the post-service process. 2 Patient service costs are calculated in the pre-service process for scheduled patients. 3 The patient is scheduled and registered for service is a time of service activity. 4 The patient account is monitored for payment is a time-of-service activity. 5 Case management and discharge planning services are a post service activity. 6 Sending the bill electronically to the health plan is a time-of-service activity. - correct answer 1 False 2 True 3 False 4 False 5 False 6 False

What happens during the post-service stage? - correct answer Final coding of all services, preparation and submission of claims, payment and balance billing a resolution. The following statement describes the best practices established by the Medical Debt Task Force. - correct answer -Follow best practices for communication. -Be consistent in key aspects of account resolution. -Coordinate to avoid duplicate patient contracts. -Educate patients. Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle initiative? - correct answer Process Compliance What is the objective of the HCAHPS initiative? - correct answer To provide a standardized method for evaluating patients' perspective on hospital care. Which option is NOT a department that supports and collaborates with the revenue cycle? - correct answer Assisted Living Services Which option is NOT a continuum of care provider? - correct answer Health Plan Contracting Annually, the OIG publishes a work plan of compliance issues and objectives that will be focused on throughout the following year. Identify which option is NOT a work plan task mentioned in this course. - correct answer Standard Unique Employer Identifier In order to promote the use of correct coding methods on a national basis and prevent payment errors due to improper coding, CMS developed what? - correct answer The Correct Coding Initiative (CCI) Ethics violations vary. Typical violations include: - correct answer Financial misconduct Overcharging Theft of property Falsifying records to boost reimbursement

Miscoding claims What do business/organizational ethics represent? - correct answer Principles and standards by which organizations operate. What is the intended outcome of collaborations made through an ACO delivery system? - correct answer To ensure appropriateness of care, elimination of duplicate services, and prevention of medical errors for a population of patients. Which of these statements describes the new methodology for the determination of net patient service revenue: - correct answer Net patient service revenue is defined as the total incurred charges, less the explicit price concession, less any applicable implicit price concession(s) as applied to the specific portfolio of accounts. What are KPIs? - correct answer Key performance indicators, which set standards for accounts receivable (A/R) and provide a method of measuring the collection and control of A/R. Name the guideline that Medicare established to determine which diagnoses, signs, or symptoms are payable. - correct answer Local Coverage Determinations What is the purpose of insurance verification? - correct answer To ensure accuracy of the health plan information. Attempt to reduce costs through contractual agreements with providers. - correct answer Managed Care Plans Which option is a federally-aided, state-operated program to provide health and long-term care coverage? - correct answer Medicaid 1 Subscriber agrees to a high initial deductible, in return for lower premiums. 2 A group of medical providers is identified to furnish services at lower than usual fees. 3 A health plan that provides comprehensive healthcare services, within a designated population, on a pre-payment basis.

4 Members can refer themselves outside the plan and still get some coverage. - correct answer 1 CDHP 2 PPO 3 HMO 4 POS Which option is NOT a specific managed care requirement? - correct answer Preferred Provider Organization Below are 5 major steps involved in determining a surgical case price estimate for an uninsured patient. Match the step to the appropriate number. - correct answer 1 Verify patient is not eligible for Medicaid. 2 Obtain total charges for hospital portion of case and identify network status of additional providers. 3 Apply organization's self pay discount, if applicable. 4 Share results with patient and explain discount applied. 5 Come to a financial resolution with patient and document resolution in patient's record. What is the first component of a pricing determination? - correct answer Verification of the patient's insurance eligibility and benefits What is the purpose of financial counseling? - correct answer To educate the patient on his/her health plan coverage and financial responsibility for healthcare services What does EMTALA require hospitals to do? - correct answer To provide a medical screening examination and stabilizing treatment to every person presenting at an ED and requesting medical evaluation or treatment. In what manner do case managers assist revenue cycle staff? - correct answer Providing assistance with written appeals to health plans related to utilization and other care issues. Why is it critical that a chargemaster is reviewed and updated regularly? - correct answer To ensure it supports and represents the services provided within the organization.

What is the responsibility of HIM? - correct answer To maintain all patient medical records UB-04 Claim Form - correct answer This form contains 81 form locators and is used by institutional providers (hospitals, hospice, rural health clinics, skilled nursing facilities, etc.) for submitting claims. CMS-1500 Claim Form - correct answer This form contains 33 major items, subdivided into a total of 55 detailed items, and is used by professional service providers (physicians, allied health professionals, certified registered nurse anesthetists [CRNAs], home health agencies, medical equipment suppliers, etc.) not hospitals, for submitting claims for services to health plans. What are claim edits? - correct answer Rules developed to verify the accuracy and completeness of claims based on each health plan's policies 1 Section 6404 of the Patient Protection and ACA states that claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service, will be denied by Medicare. 2 Applies to Rural Health Clinic; Hospice; Skilled Nursing Facility; Ambulance; and Hospital-Based Physicians. 3 Providers typically submit a single claim for an inpatient or outpatient episode of care, or a series or recurring claim or repeat outpatient services for the same condition. 4 A day begins at midnight and ends 24 hours later, this is called the midnight-to-midnight method. - correct answer 1 Time Limits for Billing 2 Provider Type Billing Rules 3 Outpatient Series 4 Counting Inpatient Days Originating Site - correct answer An originating site is the location of the patient at the time the service is furnished. This could be an office of a physician or APP, hospital (including CAH), Rural Health Clinic, Federally Qualified Health Center, hospital-based or CAH-based Renal Dialysis Centers, Skilled Nursing Facilities and Community Mental Health Centers. Distant Site Practitioner - correct answer Practitioners at the distant site who may furnish and receive payment for covered telehealth services. This may include physicians, nurse practitioners, physician

assistants, nurse-midwives, clinical nurse specialists, certified registered nurse anesthetists, clinical psychologist, clinic social workers and registered dietitians. Which statement is NOT a unique billing rule specific to providers? - correct answer A patient may be balance billed for whatever amount the non-contracting physician charges above the health plan's reimbursement amount. Which of the following statements does not apply to billing during the COVID-19 public health emergency: - correct answer Telemedicine claims are not payable if the patient conducts the telemedicine visit from home. Which concept is NOT a contracted payment model? - correct answer Stop-Loss Provision Sue Smith came into the hospital. Her insurance provider sent an EFT directly into the hospital's account at the bank. John, the hospital representative, receives an electronic Level 2 ERA. What should he do next? - correct answer Manually match the ERA to the patient account. What is EFT? - correct answer The electronic transfer of funds from payer to payee through the banking system. 1 Determine overpayment amount; issue refund check to patient. 2 Submit corrected claim to payer or remove credit charges from patient's account. 3 Notify payer, send refund or complete take back form as directed by payer. 4 Determine correct primary, notify incorrect payer of overpayment. - correct answer 1 Inaccurate upfront collections 2 Late charge credits processing 3 Duplicate payments 4 Primary and secondary payers both paying as primary Which statement is false regarding credit balances? - correct answer There are no CMS hospital compliance requirements regarding credit balances.

Which list of practices that help to reduce or eliminate rejections and denials is correct? - correct answer Provide only ordered services. Closely monitor patient services and verify that all services ordered and provided are clearly documented. Code accurately based on documentation. Communicate to the involved staff.