Revenue Cycle Management in Healthcare, Exams of Nursing

Download Revenue Cycle Management in Healthcare and more Exams Nursing in PDF only on Docsity! CRCR EXAM 74 Questions with Answers 2023 HFMA patient financial communications best practices call for annual training for all staff EXCEPT - CORRECT ANSWERSA. Patient access B. Customer service representatives **C. Nursing D. Staff who engage in patient financial communications discussions What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? - CORRECT ANSWERSMedical necessity documentation B. The CMS 1500 Part B attachment C. Correct Part A and B procedural codes **D. Revenue codes The most common resolution methods for credit balances include all of the following EXCEPT - CORRECT ANSWERSA. Designate the overpayment for charity care B. Determine the correct primary payer and notify incorrect payer of overpayment C. Submit the corrected claim to the payer incorporating credits D. Either send a refund or complete a takeback form as directed by the payer. Net Accounts Receivable is - CORRECT ANSWERSA. The total bad debt B. Total debt owed by an entity **C. The amount an entity is reasonably confident of collecting from overall accounts receivable D. The total claims amount billed to health plans For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions - CORRECT ANSWERSA. May take place between the patient and discharge planning **B. Should take place between the patient or guarantor and properly trained provider representatives C. Are optional D. Are focused on verifying required third-party payer information Scheduled procedures routinely include - CORRECT ANSWERSA. Physician's office contact information B. Physician notification that scheduling is complete C. The scheduler's name and contact information **D. Patient preparation instructions ICD-10-CM and ICD-10-PCS code sets are modifications of - CORRECT ANSWERSA. DRGs B. CPT codes C. ICD 9 codes **D. The international ICD-10 codes as developed by the WHO (World Health Organization) The Medicare Bundled Payments for Care Initiative (BCPI) is designed to - CORRECT ANSWERSA. Prevent duplicate billing B. "Stretch" the impact of patient self-pay by squeezing costs down through a lump-sum payment to providers **C. Align incentives between hospitals, physicians, and non-physician providers in order to better coordinate patient care D. Drive down physician fees by forcing physicians to share equitably in one payment Which of the following is required for participation in Medicaid - CORRECT ANSWERSA. Be free of chronic conditions B. Meet a minimum yearly premium C. Obtain a supplemental health insurance policy **D. Meet income and assets requirements 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 ANSWERSA. CPT codes B. ICD-10 Procedural codes C. HCPCs codes **D. Revenue codes Medicare beneficiaries may appeal - CORRECT ANSWERSA. For a waiver from pre- authorization of treatment for specified chronic conditions B. Only payment issues seriously affecting the patient's access to care C. Virtually any issue related to the provision and payment of services **D. For reclassification of ongoing services not covered by Medicare as a Medicare Chronic Care Exemption What is the Continuum of Care? - CORRECT ANSWERSA. The clinical treatment course selected by the attending physician **B. The coordination and linkage of resources needed to avoid the duplication of services and the facilitation of a seamless movement among care settings C. All clinical services provided in a hospital D. Post- inpatient treatment 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 ANSWERS**A. Patient bill of rights B. Medicare patient and staff safety standards C. Joint Commission for Accreditation of Healthcare Organizations (JCAHO) safety standards D. Payer quality monitoring Claims with dates of service received later than one calendar year beyond the date of service, will be - CORRECT ANSWERSA. The full responsibility of the patient **B. Denied by Medicare C. The provider's responsibility but can be deemed charity care D. Fully paid with interest Applying the contracted payment amount to the amount of total charges yields - CORRECT ANSWERSA. A pricing agreement **B. An estimated price for the patients responsibility C. A service cost guarantee D. A price justified revenue accrual 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 ANSWERS**A. The data collection steps for scheduling and pre-registering a patient B. The steps mandated for billing Medicare Part A C. Registration steps that must be completed before any medical services are provided D. The process of closing an account 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 ANSWERS**A. The electronic submission of claims using electronic transactions B. Regular chargemaster description maintenance C. Accurate and complete documentation of medical record by coders D. Well-trained Patient Access and Contract Management staff Which department supports/collaborates with the revenue cycle? - CORRECT ANSWERS**A. Information Technology B. Continuum of Care C. Software Applications D. Hospice The Truth in Lending Act establishes - CORRECT ANSWERSA. Consumer disclosure requirements to obtain credit B. Repayment and interest rate schedules C. Conditions under which a non-profit entity may extend credit **D. Disclosure rules for consumer credit sales and consumer loans The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physicians to do all of the following EXCEPT - CORRECT ANSWERS**A. Obtain higher compensation for physicians B. Embrace new reimbursement models C. Drive significant improvements in the areas of quality and the patient experience D. Improve outcomes Insurance verification results in which of the following? - CORRECT ANSWERSA. The resolution of managed care and billing requirements **B. The accurate identification of the patient's eligibility C. The consistent formatting of the patient's name and identification number D. The identification of physician fee schedule amounts and the NPI (National Provider Identifier) numbers Medicare Part A benefits provide coverage for - CORRECT ANSWERSA. Physician office visits B. All medical services for eligible beneficiaries over the age of 70 **C. Inpatient hospital services, skilled nursing care, and home health care D. Medical services for indigents and those living below the poverty level What type of account adjustment results from the patient's unwillingness to pay a self-pay balance? - CORRECT ANSWERS**A. Bad debt adjustment B. Charity adjustment C. Administrative adjustment D. Contractual adjustment Medicare Part B has an annual deductible, and the beneficiary is responsible for - CORRECT ANSWERSA. Physicians office fees B. Prescriptions C. Tests outside of an inpatient setting **D. A co-insurance payment for all Part B covered services The Two Midnight Rule allows hospitals to account for total hospital time including - CORRECT ANSWERSA. Costs outside of what is regular and customary occurring within the first 48 hours of inpatient care B. Attending physician "on-call" time C. Off site ancillary services **D. Outpatient time directly preceding the inpatient admission 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 ANSWERS**A. The Provider Reimbursement Review Board B. The Department of Health and Human Services Provider Relations Division Duplicate payments occur - CORRECT ANSWERS**A. When providers re-bill claims based on nonpayment from the initial bill submission B. When service departments do not process charges with the organization's suspense days C. When there are other healthcare claims in process and the anticipated deductibles and co-insurance amounts still show open but will be met by the in- process claims D. When the payer's coordination of benefits is not captured correctly at the time of patient registration In a self-insured (or self-funded) plan, the costs of medical care are - CORRECT ANSWERSA. Created by a combination of employer and employee contributions B. Mandated by the Affordable Care Act for small businesses unable to obtain commercial coverage C. Backed-up by stop-loss insurance against a catastrophic claim **D. Borne by the employer on a pay-as-you-go basis The result of accurate census balancing on a daily basis is - CORRECT ANSWERS**A. The overall accuracy of resource planning B. Improved ability to plan nursing staff support services C. The increased efficiency in treatment D. The correct recording of room charges Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - CORRECT ANSWERS**A. The Medicare Administrative Contractor (MAC) at the end of the hospice cap period B. Each state's Medicaid plan C. Medicare D. The Center for Medicare and Medicaid Services (CMS) Internal controls addressing coding and reimbursement changes are put in place to guard against - CORRECT ANSWERSA. Denials **B. Compliance fraud by "upcoding" C. Underpayments D. Charge master error 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 ANSWERSA. Admission to observation status **B. Medical screening and stabilizing treatment C. Transfer to another facility D. Complete course of treatment Medicare patients are NOT required to produce a physician's order to receive which of these services? - CORRECT ANSWERS**A. Screening mammography, flu vaccine or pneumonia vaccine B. Diagnostic mammography, flu vaccine or pneumonia vaccine C. Screening mammography, flu vaccine or B-12 shots D. Diagnostic mammography, flu vaccine or B-12 shots In order for Regulation Z to apply, a hospital must - CORRECT ANSWERSA. Meet all five of the conditions specified by Regulation Z **B. Make available to all creditors, patient financial information obtained in the credit application process C. Have a credit granting mechanism in place D. Obtain credit insurance in the event of a debtor credit default In a Chapter 7 Straight Bankruptcy filing - CORRECT ANSWERSA. The court establishes a creditor payment schedule with the longest outstanding claims paid first B. The court liquidates the debtor's nonexempt property, pays creditors, and begins to pays off the largest claims first. All claims are paid some portion of the amount owed. **C. The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt D. The court vacates all claims against a debtor with the understanding that the debtor may not apply for credit without court supervision The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to - CORRECT ANSWERSA. Patient financial obligations for the entire cost of treatment **B. Medicare and Medicaid payments C. Commercial third-party payers D. Unregulated market activity for third-party payers Revenue cycle activities occurring at the point-of-service include all of the following EXCEPT - CORRECT ANSWERSA. The provision of case management and discharge planning services B. The monitoring of charges **C. Providing charges to the third-party payer as they are incurred D. The generation of charges In resolving medical accounts, a law firm may be used as - CORRECT ANSWERSA. An independent broker of patient financial assistance from banks B. An independent auditor of a Financial Assistance Policy C. Legal counsel to patients regarding financing options **D. A substitute for a collection agency Health Information Management (HIM) is responsible for - CORRECT ANSWERSA. The maintenance of all software applications B. Clean claims being filed C. The maintenance of the entire technology infrastructure **D. All patient medical records The soft cost of a dissatisfied customer is - CORRECT ANSWERSA. Potentially negative treatment outcomes leading to expanding length-of-stay **B. The customer passing on information about their negative experience to potential patients or through social media channels C. Lowered quality outcomes for the dissatisfied patient D. The "cost" of staff providing extra attention in trying to perform service recovery A routine patient financial discussion would include - CORRECT ANSWERSA. Gathering the patient's banking information B. Determining and notifying the patient of their ineligibility for financial assistance due to existing insurance coverage **C. Explaining the benefits identified through verifying the patient's insurance D. Refunding an overpayment