Revenue Cycle Management in Healthcare, Exams of Nursing

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REPRESENTATIVE REVENUE CYCLE PRACTICE EXAM Questions with 100% Correct Answers Latest Updates 2024 TOP GRADED "cap amount" calculated by (Ans- The Medicare Administrative Contractor (MAC) at the end of the hospice cap period Which of the following is required for participation in Medicaid (Ans- Meet Income and Assets Requirements In choosing a setting for patient financial discussions, organizations should first and foremost (Ans- Respect the patients privacy A nightly room charge will be incorrect if the patient's (Ans- 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 (Ans- 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: Overall aggregate payments made to a hospice are subject to a computed (Ans- Charitable pledges What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? (Ans- 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 (Ans- 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 (Ans- Case management Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? (Ans- 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 (Ans- The Internal Revenue Service The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: (Ans- Judicial review by a federal district court Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the providermay not ask about a patient's insurance information if it would delay what? (Ans- Medical screening and stabilizing treatment Ambulance services are billed directly to the health plan for (Ans- 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 Key performance indicators (KPIs) set standards for accounts receivables (A/R) and (Ans- Provide a method of measuring the collection and control of A/R he patient discharge process begins when (Ans- The physician writes the discharge orders The nightly room charge will be incorrect if the patient's (Ans- Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system. The soft cost of a dissatisfied customer is (Ans- 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 (Ans- The opportunity to reduce the corporate compliance failures within the registration process It is important to have high registration quality standards because (Ans- Inaccurate or incomplete patient data will delay payment or cause denials Telemed seeks to improve a patient's health by (Ans- 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 (Ans- 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 (Ans- The data collection steps for scheduling and pre-registering a patient Medicare Part B has an annual deductible, and the beneficiary is responsible for (Ans- A co-insurance payment for all Part B covered services The standard claim form used for billing by hospitals, nursing facilities, and other inpatient (Ans- UB-04 Charges are the basis for (Ans- Separation of fiscal responsibilities between the patient and the health plan All of the following are forms of hospital payment contracting EXCEPT (Ans- Contracted Rebating The most common resolution methods for credit balances include all of the following EXCEPT: (Ans- Designate the overpayment for charity care Ambulance services are billed directly to the health plan for (Ans- The 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 (Ans- A clean claim Components of financial education include informing the patient of the hospital's financial policies, assessing the patient's ability to pay and (Ans- 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 (Ans- Continually align technology with processes rather than technology dictating processes Scheduler instructions are used to prompt the scheduler to (Ans- 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 (Ans- 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? (Ans- The accounts receivable level would be understated The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as (Ans- insurance verification and reimbursable charges Unless the patient encounter is an emergency, it is more efficient and effective to (Ans- Collect all information after the patient has been discharged Applying the contracted payment amount to the amount of total charges yields (Ans- A pricing agreement "Hard-coded" is the term used to refer to (Ans- 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 (Ans- Providers pay pennies on each dollar collected Which of the following is usually covered on a Conditions of Admission form (Ans- Release of information The 501(r) regulations require not-for-profit providers (501(c)(3) organizations) to do which of the following activities. (Ans- Complete a community needs assessment and develop a discount program for patient balances after insurance payment To be eligible for Medicaid, an individual must (Ans- 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 (Ans- The electronic submission of claims using electronic transfers There are unique billing requirements based on (Ans- The provider type The unscheduled "direct" admission represents a patient who: (Ans- Is admitted from a physician's office on an urgent basis In resolving medical accounts, a law firm may be used as: (Ans- A substitute for a collection agency The legal authority to request and analyze provider claim documentation to ensure that (Ans- The Office of the U.S. Inspector General (OIG) Medicare beneficiaries remain in the same "benefit period" (Ans- Until the beneficiary is "hospitalization and/or skilled nursing facility- free" for 60 consecutive days It is important to calculate reserves to ensure (Ans- Stable financial operations and accurate financial reporting A claim is denied for the following reasons, EXCEPT: (Ans- The submitted claim does not have the physicians signature HFMA best practices call for patient financial discussions to be reinforced (Ans- By changing policies to programs Patients should be informed that costs presented in a price estimate may (Ans- Vary 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: (Ans- Obtain higher compensation for physicians Charges as the most appropriate measurement of utilization enables (Ans- Accuracy of expense and cost capture Once the EMTALA requirements are satisfied (Ans- 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: (Ans- Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow In Chapter 7 straight bankruptcy filling (Ans- 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 (Ans- 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 (Ans- Claims processing The importance of Medical records being maintained by HIM is that the patient records: (Ans- 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 (Ans- 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: (Ans- Case Management Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and (Ans- 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 (Ans- 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 (Ans- Identify, compare, and choose providers that offer the desired level of value All of the following are potential causes of credit balances EXCEPT (Ans- A patient's choice to build up a credit against future medical bills A comprehensive "Compliance Program" is defined as (Ans- Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met An originating site is (Ans- The location of the patient at the time the service is provided information if it would delay what? (Ans- Medical screening and stabilizing treatment Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implement (Ans- Monitor compliance Medicare will only pay for tests and services that (Ans- Medicare determines are "reasonable and necessary" The physician who wrote the order for an inpatient service and is in charge of the patients (Ans- The attending physician When primary payment is received, the actual reimbursement (Ans- Is compared to the expected reimbursement, the remaining contractual adjustments are posted, and secondary claims are submitted The ICD-10 codes set and CPT/HCPCS code sets combines provide (Ans- The specificity and coding needed to support reimbursement claims In a self-insured (or self-funded) plan, the costs of medical care are (Ans- Borne by the employer on a pay-as-you-go basis Indemnity plans usually reimburse: (Ans- 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 (Ans- Verifying the patient's identification When Recovery Audit Contractors (RAC) identify improper payments as over payments, the (Ans- 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 (Ans- 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: (Ans- Each state's Medicaid plan Medicare patients are NOT required to produce a physician order to receive which of these services (Ans- Screening Mammography, flu vaccine or pneumonia vaccine EFT (electronic funds transfer) is (Ans- An electronic transfer of funds from payer to payee The importance of medical records being maintained by HIM is that the patient records (Ans- 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: (Ans- The time it takes to collect anticipated revenue To maximize the value derived from customer complaints, all consumer complaints should be (Ans- Responded to within two business days A scheduled inpatient represents an opportunity for the provider to do which of the following? (Ans- Complete registration and insurance approval before service In the pre-service stage, the requested service is screened for medical necessity, health (Ans- Pre-authorization are obtained Hospitals need which of the following information sets to assess a patient's financial status: (Ans- Patient and guarantor's income, expenses and assets Patients are contacting hospitals to proactively inquire about costs and fees prior to (Ans- 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 (Ans- The Internal Revenue Service The HCAHPS (hospital consumer assessment of healthcare providers and systems) initiative (Ans- Provide a standardized method for evaluating patient's perspective on hospital care. In the balance resolution process, providers should: (Ans- Ask 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: (Ans- 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 (Ans- 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 (Ans- HMO In a Chapter 7 Straight Bankruptcy filing (Ans- 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 (Ans- 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 (Ans- Revenue codes Appropriate training for patient financial counseling staff must cover all of the following EXCEPT: (Ans- Documenting the conversation in the medical records The ACO investment model will test the use of pre-paid shared savings to (Ans- 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 (Ans- Send a demand letter to the provider to recover the over payment amount The purpose of the ACA mandated Community Health Needs Assessment is (Ans- To identify significant health needs, prioritize those needs and identify resources to address them A balance sheet is (Ans- 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 (Ans- 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? (Ans- 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 (Ans- A good resource when developing written appeals of denials The Truth in Lending Act establishes (Ans- Disclosure rules for consumer credit sales and consumer loans What is Continuum of Care? (Ans- 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 (Ans- 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 (Ans- 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 (Ans- Assist patients in understanding their insurance coverage and their financial obligation HFMA patient financial communications best practices call for annual training for all staff EXCEPT (Ans- Nursing