CRCR Practice Questions and Answers for Healthcare Management, Exams of Nursing

Download CRCR Practice Questions and Answers for Healthcare Management and more Exams Nursing in PDF only on Docsity!

2024 Graded A+

The 501(r) regulations require not-for-profit providers 501(c) (3) to do which of the following activities? A. Complete a community needs assessment and develop a discount program for patient balances after insurance payment. B. Pursue extraordinary collection activities with all patients eligible for financial assistance. C. Implement a financial assistance program for uninsured and underinsured patients. D. Discount all charges to self-pay patients to an amount generally billed to all other patients. - correct answer ✅A. Complete a community needs assessment and develop a discount program for patient balances after insurance payment The accurate capture of charges remains critically important because: A. Of the potential of fraud and abuse charges from erroneous billing. B. Charges remain one of the few consistent indicators available to monitor resource use. C. Charges are means of measuring physician productivity. D. Charges provide the data used in activity based costing. - correct answer ✅B. Charges remain one of the few consistent indicators available to monitor resource use

2024 Graded A+

The ACO investment model will test the use of pre-paid shared savings to: A. Invest in treatment protocols that reduce costs to Medicare B. Attract physicians to participate in the ACO payment system. C. Raise quality ratings in designated hospitals. D. Encourage new ACOs to form in rural and underserved areas. - correct answer ✅D. Encourage new ACOs to form in rural and underserved areas 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: A. Have a patient financial responsibilities kit ready for the patient, containing all of the required registration forms and instructions. B. Make sure that the attending staff can answer questions and assist in obtaining required patient financial data. C. Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow. D. Decline such request as finance discussions can disrupt patient care and patient flow. - correct answer ✅C. Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow

2024 Graded A+

Activities completed when the scheduled, pre-registered patient arrives for service includes: A. Verifying insurance, activating the record and directing the patient to the service area. B. Scanning the driver's license or other phot identification and directing the patient to the financial counselor. C. Activating the record, obtaining signatures and finalizing financial issues. D. Registering the patient and directing the patient to the service area. - correct answer ✅C. Activating the record, obtaining signatures and 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: A. Utilization review B. Case Management C. Census Management D. Patient through-put - correct answer ✅A. Utilization review or

2024 Graded A+

B. Case Management An advantage of a pre-registration program is: A. The markets value of such a program B. The ability to eliminate no-show appointments. C. The opportunity to reduce processing times at the time of service. D. The opportunity to reduce corporate compliance failures within the registration process. - correct answer ✅C. The opportunity to reduce processing times at the time of service. The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can: A. Obtain price estimates for medical services B. Negotiate the price of medical services with providers C. Purchase qualified health benefit plans regardless of insured's health status D. Meet federal mandates for insurance coverage and obtain the corresponding tax deduction - correct answer ✅C. Purchase qualified health benefit plans regardless of insured's health status.

2024 Graded A+

All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT: A. Offered in an outpatient setting B. Medically unnecessary C. Not delivered in a Medicare licensed care setting. D. Services and procedures that are custodial in nature - correct answer ✅C. Not delivered in a Medicare licensed care setting All of the following are reference resources used to help guide in the application for business ethics EXCEPT: A. Consumer satisfaction reports B. Mission & Value Statements C. Code of Ethics / Code of Conduct D. Compliance Office & Policies - correct answer ✅A. Consumer satisfaction reports All of the following are steps in safeguarding collections EXCEPT: A. Placing collections in a lock-box for posting review the next business day.

2024 Graded A+

B. Posting the payment to the patient's account C. Completing balancing activities D. Issuing receipts - correct answer ✅A. Placing collections in a lock-box for posting review the next business day All of the following are steps in verifying insurance EXCEPT: A. Sequencing plans involved in a coordination of benefits (COB) situation. B. The patient signing the statement of financial responsibility. C. Identifying and documenting the patient's health plan benefits D. Confirming the patient's eligibility for benefits - correct answer ✅B. The patient signing the statement of financial responsibility All of the following information is used to identify a patient EXCEPT: A. Date of Birth B. Gender C. Social Security Number D. Address - correct answer ✅D. Address

2024 Graded A+

All of the following information should be reviewed as part of schedule finalization EXCEPT: A. The estimated patient financial obligations B. The service to be provided C. The arrival time and procedure time D. The patient's preparation instructions - correct answer ✅A. The estimated patient financial obligations Ambulance services are billed directly to the health plan for : A. All pre-admission emergency transports B. Transport deemed medically necessary by the attending paramedic- ambulance crew C. 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 D. The portion of the bill outside of the patient's self-pay - correct answer ✅C. 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 the another facility

2024 Graded A+

Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons on a monthly fee is known as a: A. HMO B. PPO C. MSO D. GPO - correct answer ✅A. HMO 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: A. The Provider Reimbursement Review Board B. The Department of Health and Human Services Provider Relations Division C. A court appointed federal mediator D. The Office of the Inspector General - correct answer ✅A. The Provider Reimbursement Review Board Applying the contracted payment methodology to the total charges yields: A. An estimated price

2024 Graded A+

B. An anticipated health plan payment C. A price justified revenue accrual D. A pricing agreement - correct answer ✅A. An estimated price Appropriate training for the patient financial counselling staff must cover all of the following EXCEPT: A. Patient financial communications best practices specific to staff role B. Financial assistance policies C. Documenting the conversation in the medical record D. Available patient financing options - correct answer ✅C. Documenting the conversation in the medical record The basis for qualification in Medicaid is typically: A. The Federal Poverty Guidelines B. Financial need as demonstrated by the prior two-years federal income tax fillings C. The patient's score on the Internal Revenue Service's Personal Wealth and Spending indicator

2024 Graded A+

D. Bank statements for the previous 18 months - correct answer ✅A. The Federal Poverty Guidelines Because 501(r) regulations focus on identifying potentially eligible financial assistance patients, hospitals must: A. Capture their experience with such patients to properly budget B. Hold financial conversations with patients as soon as possible C. Build the necessary processes to handle the potentially lengthy payment schedules D. Expedite payment processing of normal accounts receivables to protect cash flow - correct answer ✅B. Hold financial conversations with patients as soon as possible Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implementation, identifying and processing accounts and: A. Obtain the patients income tax statements from the prior 2 years B. Having the account triaged for any partial payment possibilities C. Monitor compliance

2024 Graded A+

D. Assist in arranging for a commercial bank loan - correct answer ✅C. Monitor compliance The benefit of a Medicare Advantage Plan is: A. It is a less costly plan compared to traditional Medicare B. Patients may retain a primary care physician and see another physician for a second opinion at no charge C. Patients generally have their entire Medicare-covered healthcare through the plan and do not need to worry about "Part A" or "Part B' benefits D. Patients receive significant discounting on services contracted by the federal government - correct answer ✅C. Patients generally have their entire Medicare-covered healthcare through the plan and do not need to worry about "Part A" or "Part B" benefits A benefit period begins: A. With admission as an inpatient B. Upon the day the coverage premium is paid C. The first day in which a patient is furnished extended care services in the period the patient is entitled to hospital insurance

2024 Graded A+

D. Immediately once authorization for treatment is provided by the health plan - correct answer ✅C. The first day in which a patient is furnished extended care services in the period the patient is entitled to hospital insurance The best practice in billing is to generate bills and financial information that is: A. Timely and specifies the patient's next steps B. Clear, concise, correct and patient-friendly C. Comprehensive and all-inclusive D. Direct in summarizing charges and in requesting prompt payment - correct answer ✅B. Clear, concise, correct and patient-friendly Case management requires that a case manager be assigned: A. To a select group of resource intensive patient cases B. To every patient C. To specific cases designated by third-party contractual agreement D. To patients of any physician requesting case management - correct answer ✅B. To every patient

2024 Graded A+

Claims edits are: A. Rules developed to verify the accuracy of claims based on each health plan's policies B. The specific reimbursement areas of a claim that are denied by the health plan C. Special addendums to the claim allowing the provider to submit additional documentation D. Triggers in the health plan claim adjudication system that disallows reimbursement - correct answer ✅A. Rules developed to verify the accuracy of claims based on each health plan's policies Claims with dates of service received later than one year beyond the date of service, will be: A. Denied by Medicare B. The full responsibility of the patient C. The provider's responsibility but can be deemed charity care D. Fully paid with interest - correct answer ✅A. Denied by Medicare

2024 Graded A+

A "Compliance Program" is defined as: A. Educating staff on regulations B. The development of operational policies that correspond to regulations C. Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met D. Annual legal audit and review for adherence to regulations - correct answer ✅C. Systematic procedures to ensure that provisions of regulations imposed by government agency are being met The concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits: A. Billing B. Account resolution C. Claims Processing D. Third-party invoicing - correct answer ✅C. Claims processing Concurrent review and discharge planning: A. Occurs during service B. Is performed by the health plan during the time of service

2024 Graded A+

C. Is a significant part of quality and is performed by the clinical treatment team D. Is performed at discharge with the patient - correct answer ✅C. Is a significant part of quality and is preformed by the clinical treatment team A decision of whether a patient should be admitted as an inpatient or become an outpatient observation patient requires medical judgments based on all of the following EXCEPT: A. The patient's medical history B. The safe-guarding against medical error C. Current medical needs D. The Medical predictability of something adverse happening - correct answer ✅B. The safe-guarding against medical error The disadvantages of outsourcing include all the following EXCEPT: A. Increased costs due to vendor ineffectiveness B. Possible staff job cuts due to vendor efficiencies C. The impact of customer service or patient relations

2024 Graded A+

D. The impact of direct control of accounts receivable - correct answer ✅B. Possible staff job cuts due to vendor efficiencies During the pre-registration, a search for the patient's MPI is initiated using which of the following data sets? A. Patient's full legal name and address B. Patient's full legal name and health plan group numbers C. Patient's full legal name and date of birth or the patient's Social security number D. Patient's Social Security number and home address - correct answer ✅C. Patient's full legal name and date of birth or the patient's Social Security number Each time a patient is transferred: A. Any additional charges must be explained to the patient B. The attending physician must sign-off on the transfer request C. The patient must give consent

2024 Graded A+

D. A transfer request must be made to staff responsible for bed assignments

• correct answer ✅D. A transfer request must be made to staff responsible for bed assignments The enhanced data-mining opportunities that results from the more detailed coding under ICD-10 allow senior leadership to work with physicians to do all of the following EXCEPT: A. Improve outcomes B. Obtain higher compensation for physicians C. Embrace new reimbursement models D. Drive significant improvements in areas of quality and the patient experience - correct answer ✅B. Obtain higher compensation for physicians Failure to take the appropriate precautions with a bankruptcy account, to identify and isolate the debtor's accounts from further collection activity: A. Provides evidence of unauthorized extraordinary collections activity B. Could be in violation of a court's order C. May violate the provisions of the patient protection regulations

2024 Graded A+

D. Could potentially create under "write-offs" - correct answer ✅B. Could be in violation of a court's order The first thing a health plan does when processing a claim is: A. Review to make sure the claim is complete B. Verify if the provider(s) is(are) in network or not C. Check if the patient is covered D. Confirm if deductibles and con-insurance requirements have been met - correct answer ✅C. Check if the patient is covered For Medicare patients, an important component of the pre-registration process is: A. Obtaining clear physician's orders B. Verifying Medicare eligibility C. Clear authorization for all services covered in Part A D. The effective completion of the Medicare Secondary Payer (MSP) screening process - correct answer ✅D. The effective completion of the Medicare Secondary Payer (MSP) screening process

2024 Graded A+

For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: A. 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 information - correct answer ✅B. Should take place between the patient or guarantor and properly trained provider representatives For scheduled patients, important revenue cycle activities in the time-of- service stage DO NOT include: A. Pre-registration record is activated, consents are signed, and co-payments are collected B. Positive patient identification is completed, and the patient is given an armband C. Obtaining or updating patient and guarantor information D. Pre-processed patients report to a designated "express arrival" desk - correct answer ✅C. Obtaining or updating patient and guarantor information

2024 Graded A+

A four digit number code established by the National Uniform Billing (NUBC) that categorizes/classifies a line item in the chargemaster is known as: A. HCPCs codes B. ICD-10 Procedural codes C. CPT codes D. Revenue codes - correct answer ✅D. Revenue codes The fundamental approach in managing denials is: A. To create billing "double-check" processes B. To analyze the type and sources of denials and consider process changes to eliminate further denials C. To standardize and centralize all billing activity to focus on compliance with contractual agreements D. to review all claims processing for compliance with contractual agreements - correct answer ✅B. To analyze the type and sources of denials and consider process changes to eliminate further denials The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statues and regulations pertaining to:

2024 Graded A+

A. Patient financial obligations for the entire cost of treatment B. Unregulated market activity for third-party payers C. Medicare and Medicaid payments D. Commercial third-party payers - correct answer ✅C. Medicare and Medicaid payments Health Information Management (HIM) is responsible for: A. All patient medical records B. The maintenance of all software applications C. The maintenance of the entire technology infrastructure D. Clean claims being filed - correct answer ✅A. All patient medical records To provide a patient with information that is meaningful to them, all the following factors must be included EXCEPT: A. The actual physician reimbursement B. The patient's benefit plan C. The type of hospital service based on CPT or MD-DRG code D. The patient's insurance carrier - correct answer ✅A. The actual physician reimbursement

2024 Graded A+

The Two Midnight Rule allows hospitals to account for total hospital time including: A. Off site ancillary services B. Costs outside of what is regular and customary occurring within the first 48 hours of inpatient care C. Outpatient time directly preceding the inpatient admission D. Attending physician "on-call" time - correct answer ✅C. Outpatient time directly preceding the inpatient admission Under EMTALA (Emergency Medial Treatment Labor Act) regulations, the provider may not ask about a patient's insurance information if it would delay what? A. Transfer to another facility B. Complete course of treatment C. Admission to observation status D. Medical screening and stabilizing treatment - correct answer ✅D. Medical screening and stabilizing treatment

2024 Graded A+

Unless the patient encounter is an emergency, it is more efficient and effective to: A. Collect all information after the patient has been discharged B. Use historical information and contact the patient only if the claim is rejected C. Obtain the required demographic and insurance information before services are rendered D. Contact the patient's physician to obtain the necessary registration information after services are rendered - correct answer ✅C. Obtain the required demographic and insurance information before services are rendered Unless the patient encounter is an emergency, it is more efficient and effective to: A. Collect all information after the patient has been discharged B. Use historical information and contact the patient only if the claim rejects C. Obtain the required demographic and insurance information before services are rendered D. Contact the patient's physician to obtain the necessary registration information after services are rendered - correct answer ✅C. Obtain the

2024 Graded A+

required demographic and insurance information before services are rendered The unscheduled "direct" admission represents a patient who: a) Is admitted from a physician's office on an urgent basis b) Arrives at the hospital via ambulance for treatment in the emergency room c) Is an ambulatory patient who collapses in the hospital lobby d) Arrives on the medical helicopter for trauma services - correct answer ✅A. Is admitted from the physician's office on an urgent basis Vital to accurate calculations of a patient's self-pay amount is: A. Understanding exactly how each contracted payer adjudicates the benefit package provided to the patient B. Knowing exactly what each contracted payer will accept as an "approved" charge C. The total out-of-pocket that a patient must meet before a third-party payer is liable

2024 Graded A+

D. Understanding the payer's claims adjudication requirements - correct answer ✅C. The total out-of-pocket that a patient must meet before a third- party payer is liable What activities are completed when a scheduled, pre-registered patient arrives for service?: A. Verifying insurance, activating the record, and directing the patient to the service area B. Scanning the driver's license or other photo identification and directing the patient to the financial counselor C. Activating the record, obtaining signatures, and finalizing financial issues D. Registering the patient and directing the patient to the serve area - correct answer ✅C. Activating the record, obtaining signatures, and finalizing financial issues What are some core elements of a board-approved financial policy: A. Charity care, payment methods, and installment payment guidelines B. Case management, payment methods, and discharge policies C. Payment requirements, staffing hours, and admission policies