Untitled document - 2023-12-24T074158.553
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Date
Nov 24, 2024
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CRCR Multiple Choice (questions with
most accurate answers) 2023\2024
The disadvantages of outsourcing include all of the following EXCEPT:
a) The impact of customer service or patient relations
b) The impact of loss of direct control of accounts receivable services
c) Increased costs due to vendor ineffectiveness
d) Reduced internal staffing costs and a reliance on outsourced staff - ANS D
The Medicare fee-for service appeal process for both beneficiaries and providers
includes all of the following levels EXCEPT:
a) Medical necessity review by an independent physician's panel
b) Judicial review by a federal district court
c) Redetermination by the company that handles claims for
Medicare
d) Review by the Medicare Appeals Council (Appeals Council) - ANS B
Business ethics, or organizational ethics represent:
a) The principles and standards by which organizations operate
b) Regulations that must be followed by law
c) Definitions of appropriate customer service
d) The code of acceptable conduct - ANS A
A portion of the accounts receivable inventory which has NOT qualified for billing
includes:
a) Charitable pledges
b) Accounts created during pre-registration but not activated
c) Accounts coded but held within the suspense period
d) Accounts assigned to a pre-collection agency - ANS A
Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are
Medicare established guideline(s) used to determine:
a) Medicare and Medicaid provider eligibility
b) Medicare outpatient reimbursement rates
c) Which diagnoses, signs, or symptoms are reimbursable
d) What Medicare reimburses and what should be referred to
Medicaid - ANS C
Days in A/R is calculated based on the value of:
a) The total accounts receivable on a specific date
b) Total anticipated revenue minus expenses
c) The time it takes to collect anticipated revenue
d) Total cash received to date - ANS C
Patients are contacting hospitals to proactively inquire about costs and fees prior to
agreeing to service. The problem for hospitals in providing such information is:
a) That hospitals don't want to establish a price without knowing if
the patient has insurance and how much reimbursement can be
expected
b) The fact that charge master lists the total charge, not net charges
that reflect charges after a payer's contractual adjustment
c) That hospitals don't want to be put in the position of
"guaranteeing" price without having room for additional charges
that may arise in the course of treatment
d) Their reluctance to share proprietary information - ANS B
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) Make sure that the attending staff can answer questions and
assist in obtaining required patient financial data
b) Have a patient financial responsibilities kit ready for the patient,
containing all of the required registration forms and instructions
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 - ANS C
A comprehensive "Compliance Program" is defined as
a) Annual legal audit and review for adherence to regulations
b) Educating staff on regulations
c) Systematic procedures to ensure that the provisions of
regulations imposed by a government agency are being met
d) The development of operational policies that correspond to
regulations - ANS C
Case Management requires that a case manager be assigned
a) To patients of any physician requesting case management
b) To a select patient group
c) To every patient
d) To specific cases designated by third party contractual agreement - ANS B
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
a) Identify, compare, and choose providers that offer the desired
level of value
b) Customize health care with a personally chosen mix of providers
c) Negotiate the cost of health plan premiums
d) Verify the cost of individual clinicians - ANS A
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
a) MSO
b) HMO
c) PPO
d) GPO - ANS B
In a Chapter 7 Straight Bankruptcy filing
a) The court liquidates the debtor's nonexempt property, pays
creditors, and discharges the debtor from the debt
b) The court liquidates the debtor's nonexempt property, pays
creditors, and begins to pay off the largest claims first. All claims
are paid some portion of the amount owed
c) The court vacates all claims against a debtor with the
understanding that the debtor may not apply for credit without
court supervision
d) The court establishes a creditor payment schedule with the
longest outstanding claims paid first - ANS A
The core financial activities resolved within patient access include:
a) Scheduling, pre-registration, insurance verification and managed
care processing
b) Scheduling, insurance verification, clinical discharge processing
and payment posting of point of service receipts
c) Scheduling, registration, charge entry and managed care
processing
d) Scheduling, pre-registration, registration, medical necessity
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screening and patient refunds - ANS A
Which of the following is NOT contained in a collection agency agreement?
a) A clear understanding that the provider retains ownership of any
outsourced activities
b) Specific language as to who will pay legal fees, if needed
c) An annual renewal clause
d) A mutual hold-harmless clause - ANS D
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:
a) Patient Accounts
b) Managed Care Contract Staff
c) HIM staff
d) Case Management - ANS D
What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment
from Medicare?
a) Revenue codes
b) Correct Part A and B procedural codes
c) The CMS 1500 Part B attachment
d) Medical necessity documentation - ANS A
Before classifying and subsequently writing off an account to financial assistance or bad
debt, the hospital must establish policy, define appropriate criteria, implement
procedures for identifying and processing accounts:
a) Monitor compliance
b) Have the account triaged for any partial payment possibilities
c) Assist in arranging for a commercial bank loan
d) Obtain the patients income tax statements from the prior 2 years - ANS A
For routine scenarios, such as patients with insurance coverage or a known ability to
pay, financial discussions:
a) Are optional
b) Should take place between the patient or guarantor and properly
trained provider representatives
c) May take place between the patient and discharge planning
d) Are focused on verifying required third-party payer information - ANS B
The purpose of a financial report is to:
a) Provide a public record, if reqluested
b) Present financial information to decision makers
c) Prepare tax documents
d) Monitor expenses - ANS B
Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act)
violation?
a) Registration staff may routinely contact managed are plans for
prior authorizations before the patient is seen by the on-duty
physician
b) Initial registration activities may occur so long as these activities
do not delay treatment or suggest that treatment with not be
provided to uninsured individuals
c) Co-payments may be collected at the time of service once the
medical screening and stabilization activities are completed
d) Signage must be posted where it can be easily seen and read by
patients - ANS A
A claim is denied for the following reasons, EXCEPT:
a) The health plan cannot identify the subscriber
b) The frequency of service was outside the coverage timeline
c) The submitted claim does not have the physicians signature
d) The subscriber was not enrolled at the time of service - ANS C
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) A court appointed federal mediator
b) The Department of Health and Human Services Provider Relations
Division
c) The Office of the Inspector General
d) The Provider Reimbursement Review Board - ANS D
Charges, as the most appropriate measurement of utilization, enables
a) Generation of timely and accurate billing
b) Managing of expense budgets
c) Accuracy of expense and cost capture
d) Effective HIM planning - ANS ???Number 24???
Ambulance services are billed directly to the health plan for
a) All pre-admission emergency transports
b) 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
c) The portion of the bill outside of the patient's self-pay
d) Transports deemed medically necessary by the attending
paramedic-ambulance crew - ANS C
An individual enrolled in Medicare who is dissatisfied with the government's claim
determination is entitled to reconsideration of the decision. This type of appeal is
known as
a) A beneficiary appeal
b) A Medicare supplemental review
c) A payment review
d) A Medicare determination appeal - ANS A
The nuanced data resulting from detailed ICD-10 coding allows senior leadership to
work with physicians to do all of the following EXCEPT:
a) Drive significant improvements in the areas of quality and the
patient experience
b) Embrace new reimbursement models
c) Improve outcomes
d) Obtain higher compensation for physicians - ANS D
Duplicate payments occur:
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 the payer's coordination of benefits is not captured
correctly at the time of patient registration
d) 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 - ANS a
The Affordable Care Act legislated the development of Health Insurance Exchanges,
where individuals and small businesses can
a) Purchase qualified health benefit plans regardless of insured's
health status
b) Obtain price estimates for medical services
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c) Negotiate the price of medical services with providers
d) Meet federal mandates for insurance coverage and obtain the
corresponding tax deduction - ANS A
The most common resolution methods for credit balances include all of the following
EXCEPT:
a) Designate the overpayment for charity care
b) Submit the corrected claim to the payer incorporating credits
c) Either send a refund or complete a takeback form as directed by
the payer
d) Determine the correct primary payer and notify incorrect payer of
overpayment - ANS A
EFT (electronic funds transfer) is
a) An electronic claim submission
b) The record of payments in the hospital's accounting system
c) An electronic confirmation that a payment is due
d) An electronic transfer of funds from payer to payee - ANS D
Revenue cycle activities occurring at the point-of-service include all of the following
EXCEPT:
a) The monitoring of charges
b) The provision of case management and discharge planning
services
c) Providing charges to the third-party payer as they are incurred
d) The generation of charges - ANS C
Medicare beneficiaries remain in the same "benefit period"
a) Up to hospitalization discharge
b) Until the beneficiary is "hospitalization and/or skilled nursing
facility-free" for 60 consecutive days
c) Each calendar year
d) Up to 60 days - ANS B
Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and
a) Provide evidence of financial status
b) Provide a method of measuring the collection and control of A/R
c) Establish productivity targets
d) Make allowance for accurate revenue forecasting - ANS B
Recognizing that health coverage is complicated and not all patients are able to navigate
this terrain, HFMA best practices specify that
a) The patient accounts staff have someone assigned to research
coverage on behalf of patients
b) Patients should be given the opportunity to request a patient
advocate, family member, or other designee to help them in these
discussions
c) Patient coverage education may need to be provided by the
health plan
d) A representative of the health plan be included in the patient
financial responsibilities discussion - ANS B
When there is a request for service, the scheduling staff member must confirm the
patient's unique identification information to
a) Check if there is any patient balance due
b) Verify the patient's insurance coverage if the patient is a returning
customer
c) Confirm that physician orders have been received
d) Ensure that she/he accesses the correct information in the
historical database - ANS D
Once the price is estimated in the pre-service stage, a provider's financial best practice
is to
a) Explain to the patient their financial responsibility and to
determine the plan for payment
b) Allow the patient time to compare prices with other providers
c) Lock-in the prices
d) Have another employee double check the price estimate - ANS A
What type of account adjustment results from the patient's unwillingness to pay a self-
pay balance?
a) Charity adjustment
b) Bad debt adjustment
c) Contractual adjustment
d) Administrative adjustment - ANS B
All of the following are conditions that disqualify a procedure or service from being paid
for by Medicare EXCEPT
a) Medically unnecessary
b) Not delivered in a Medicare licensed care setting
c) Offered in an outpatient setting
d) Services and procedures that are custodial in nature - ANS D
All of the following are forms of hospital payment contracting EXCEPT
a) Contracted Rebating
b) Per Diem Payment
c) Fixed Contracting
d) Bundled Payment - ANS A
Overall aggregate payments made to a hospice are subject to a computed "cap amount"
calculated by:
a) The Center for Medicare and Medicaid Services (CMS)
b) Each state's Medicaid plan
c) Medicare
d) The Medicare Administrative Contractor (MAC) at the end of the
hospice cap period - ANS D
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
a) Reschedule the visit for non-payment of a prior balance
b) Strictly limit charity care and bad-debt
c) Collect patient's self-pay and deductibles in the first encounter
d) Assist patients in understanding their insurance coverage and
their financial obligation - ANS D
A nightly room charge will be incorrect if the patient's
a) Discharge for the next day has not been charted
b) Condition has not been discussed during the shift change report
meeting
c) Pharmacy orders to the ICU have not been entered in the
pharmacy system
d) Transfer from ICU (intensive care unit) to the Medical/Surgical
floor is not reflected in the registration system - ANS D
Which of the following is required for participation in Medicaid?
a) Meet income and assets requirements
b) Meet a minimum yearly premium
c) Be free of chronic conditions
d) Obtain a health insurance policy - ANS A
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HFMA best practices call for patient financial discussions to be reinforced
a) By issuing a new invoice to the patient
b) By copying the provider's attorney on a written statement of
conversation
c) By obtaining some type of collateral
d) By changing policies to programs - ANS B
A Medicare Part A benefit period begins:
a) With admission as an inpatient
b) The first day in which an individual has not been a hospital
inpatient not in a skilled nursing facility for the previous 60 days
c) Upon the day the coverage premium is paid
d) Immediately once authorization for treatment is provided by the
health plan - ANS A
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
a) Will remain in observation for up to 72 hours after which the
patient is admitted as an inpatient
b) Will be admitted as an inpatient
c) Will be discharged and if needed, designated to a priority one
outpatient status
d) Will have his/her case reviewed by the attending physician, a
consulting physician and the primary care physician and a future
course of care will then be determined - ANS B
It is important to have high registration quality standards because
a) Incomplete registrations will trigger exclusion from Medicare
participation
b) Incomplete registrations will raise satisfaction scores for the
hospital
c) Inaccurate registration may cause discharge before full treatment
is obtained
d) Inaccurate or incomplete patient data will delay payment or
cause denials - ANS D
Medicare will only pay for tests and services that
a) Constitute appropriate treatment and are fairly priced
b) Have solid documentation
c) Can be demonstrated as necessary
d) Medicare determines are "reasonable and necessary" - ANS D
Room and bed charges are typically posted
a) From case management reports generated for contracted payers
b) Through the case management daily resource report
c) At the end of each business day
d) From the midnight census - ANS D
The process of creating the pre=registration record ensures
a) Ability to pursue extraordinary collection activities
b) Early and productive communication with a third-party payer
c) Accurate billing
d) That access staff will have the compete and valid information
needed to finalize any remaining pre-access activities - ANS C
Once the EMTALA requirements are satisfied
a) Third-party payer information should be collected from the
patient and the payer should be notified of the ED visit
b) The patient then assumes full liability for services unless a third-
party is notified or the patient applies for financial assistance with
the first 48 hours
c) The remaining registration processing is initiated at the bedside or
in a registration area
d) An initial registration records is completed so that the proper
coding can be initiated - ANS C
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
a) Payer quality monitoring
b) Medicare patient and staff safety standards
c) Joint Commission for Accreditation of Healthcare Organizations
(JCAHO) safety
d) Patient bill of rights - ANS D
A scheduled inpatient represents an opportunity for the provider to do which of the
following?
a) Refer the patient to another location with the health system
b) Comply with EMTALA (Emergency Medical Treatment and Labor Act)
requirements before service
c) Complete registration and insurance approval before service
d) Register the patient after he or she is placed in a bed on that service
unit. - ANS C
The first and most critical step in registering a patient, whether scheduled or
unscheduled, is
a) Having the patient initial the HIPAA privacy statement
b) Verifying insurance to activate the patient medical record
c) Verifying the patient's identification
d) Check the schedule for treatment availability - ANS C
The legal authority to request and analyze provider clam documentation to ensure that
IPPS services were reasonable and necessary is given to
a) Recovery Audit Contractors (RAC)
b) The Office of the U.S. Inspector General (OIG)
c) All health plans
d) State insurance commissioners - ANS B
An advantage of a pre-registration program is
a) The opportunity to reduce processing times at the time of service
b) The ability to eliminate no-show appointments
c) The opportunity to reduce the corporate compliance failures
within the registration process
d) The marketing value of such a program - ANS C
Claims with dates of service received later than one calendar year beyond the date of
service, will be
a) Denied by Medicare
b) The provider's responsibility but can be deemed charity care
c) Fully paid with interest
d) The full responsibility of the patient. - ANS A
This concept encompasses all activities required to send a request for payment to a
third-party health plan for payment of benefits
a) Third-party invoicing
b) Account resolution
c) Claims processing
d) Billing - ANS C
The ACO investment model will test the use of pre-paid shared savings to
a) Raise quality ratings in designated hospitals.
b) Encourage new ACOs to form in rural and underserved areas
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c) Attract physicians to participate in the ACO payment system
d) Invest in treatment protocols that reduce costs to Medicare - ANS B
Chapter 13 Bankruptcy, debtor rehabilitation, is a court proceeding
a) That establishes a payment priority order to creditors' claims
b) That classifies the debtor as eligible for government financial assistance
for housing, medical treatment and food as debts are paid
c) That creates a clear court-supervised payment accountability plan going
forward
d) That reorganizes a debtor's holdings and instructs creditors to look to the
debtor's future earnings for payment - ANS D
HFMA's patient financial communication best practices specify that patients should be
told about the types of services provided and
a) A satisfaction survey regarding clinical service providers
b) The price of service to their covering health plan
c) The service providers that typically participate in the service, e.g.,
radiologists, pathologists, etc.
d) An expiration of why a specific service is not provided - ANS C
The important Message from Medicare provides beneficiaries information concerning
their
a) Understanding of billing issues and the deductibles and/or co-insurance
due for the current visit
b) Right to refuse to use lifetime reserve days for the current stay
c) Right to appeal a discharge decision if the patient disagrees with the plan
d) Obligation to reimburse the hospital for any services not covered by the
Medicare program - ANS C
All of the following are potential causes of credit balances EXCEPT
a) Duplicate payments
b) Primary and secondary payers both paying as primary
c) Inaccurate upfront collections based on incorrect liability estimates
d) A patient's choice to build up a credit against future medical bills - ANS D
Medicare Part B has an annual deductible, and the beneficiary is responsible for
a) A co-insurance payment for all Part B covered services
b) Physicians office fees
c) Tests outside of an inpatient setting
d) Prescriptions - ANS A
The importance of medical records being maintained by HIM is that the patient records
a) Are the primary source for clinical data required for reimbursement by
health plans and liability payers
b) Are the strongest evidence and defense in the event of a Medicare audit
c) Are evidence used in assessing the quality of care
d) Are the evidence cited in quality review - ANS A
A decision on 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 home care coverage
b) Current medical needs
c) The likelihood of an adverse event occurring to the patient
d) The patient's medical history - ANS A
Medicare has established guidelines called the Local Coverage Determinations (LCD) and
National Coverage Determinations (NCD) that establish
a) Provider and physician reimbursement for specific diagnoses and tests
b) Prospective Medicare patient financial responsibilities for a given
diagnosis
c) Reasonable and customary prices for services in a given area
d) What services or healthcare items are covered under Medicare - ANS D
What are some core elements if a board-approved financial assistance policy?
a) Payment requirements, staffing hours, and admission policies
b) Case management, payment methods, and discharge policies
c) Deposit requirements, pre-registration calling hours, and charity care
policy
d) Eligibility, application process, and nonpayment collection
activities - ANS D
The ICD-10 codes set and CPT/HCPCS code sets combines provide
a) Pricing floors for services
b) The financial data required for activity-based costing
c) Patients an overview of services covered by their health insurance plan
d) The specificity and coding needed to support reimbursement claims - ANS D
A recurring/series registration is characterized by
a) A creation of multiple registrations for multiple services
b) The creation of one registration record for multiple days of service
c) The creation of multiple patient types for one date of service
d) The creation of one registration record per diagnosis per visit - ANS B
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?
a) Complete course of treatment
b) Medical screening and stabilizing treatment
c) Admission to observation status
d) Transfer to another facility - ANS B
In resolving medical accounts, a law firm may be used as:
a) An independent auditor of a financial assistance policy
b) Legal counsel to patients regarding financing options
c) An independent broker of patient financial assistance from banks
d) A substitute for a collection agency - ANS D
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 - ANS A
In the balance resolution process, providers should:
a) Stress to the patient that serious consequences may result from refusal to pay
b) Remind the patient of their legal responsibility to pay the balance due
c) Ask the patient if he or she would like to receive information about
payment options and supportive financial assistance programs
d) Tag the patients record for possible financial assistance for bad debt - ANS C
Which of the following in NOT included in the Standardized Quality Measures
a) Clinical outcomes
b) Patient perceptions
c) Health care processes
d) Cost of services - ANS D
In the pre-service stage, the requested service is screened for medical necessity, health
plan coverage and benefits are verified and:
a) Billing authorization is signed by the patient
b) The patient signs the consents for treatment
c) The patient signs a statement attesting an understanding and acceptance of payment
policies
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d) Pre-authorization are obtained - ANS D
Improving the overall patient experience requires revenue cycle leadership and staff to
simultaneously be:
a) Clear on policies and consistent in applying the policies
b) Careful in screening patient demands
c) Monitoring the costs and charges the patient incurs
d) Inquisitive, responsive and flexible - ANS A
Hospitals need which of the following information sets to assess a patient's financial
status:
a) Income, expenses, debt
b) Patient and guarantor's income, expenses and assets
c) Income, expenses and capacity to take on more debt
d) Assets liquidity, Income, expenses, credit worthiness - ANS B
For scheduled patients, important revenue cycle activities I the Time of Service stage DO
NOT INCLUDE:
a) Pre-registration record is activated, consents are signed, and co-payment is collected
b) Positive patient identification is completed, and patient is given an armband
c) Final bill is presented for payment
d) Preprocessed patients may report to a designated "express arrival" desk - ANS C
The Electronic Remittance Advice (ERA) data set is :
a) Used for Electronic Funds Transfers between hospitals and a bank
b) A standardized form that provides 3rd party payment details to
providers
c) Required for annual Medicare quality reporting forms
d) Safeguards the Electronic claims process - ANS B
Appropriate training for patient financial counseling 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 records
d) Available patient financing options - ANS C
All of the following information should be reviewed as part of schedule finalization
EXCEPT:
a) The results of any and all test
b) The service to be provided
c) The arrival time and procedure time
d) The patient's preparation instructions - ANS A
Indemnity plans usually reimburse:
a) Only for contracted Services
b) A claim up to 80% of the charges
c) A certain percentage of the charges after the patient meets the
policy's annual deductible
d) A patient for out-of-pocket charges - ANS C
Because 501(r) regulations focus on identifying potential eligible financial assistants
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 schedule
d) Expedite payment processing of normal accounts receivable to protect cash flow - ANS B
Which option is a benefit of pre-registering a patient for services
a) The patient arrival process is expedited, reducing wait times and
delays
b) The verification of insurance after completion of the services
c) Service departments have the ability to override schedules and block time to reduce
testing volume
d) The patient receiving multiple calls from the provider - ANS A
HIPPA 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
a) The Social Security Administration
b) The US department of the Treasury
c) The United States department of labor
d) The Internal Revenue Service - ANS D
The nightly room charge will be incorrect if the patient's
a) Transfer from ICU to the Medical/Surgical floor is not reflected in the
registration system.
b) Pharmacy orders to the ICU have not been entered into the pharmacy system
c) Condition has not been discussed during the shift change report meeting
d) Discharge for the next day has not been charted - ANS A
With any remaining open balances, after insurance payments have been posted, the
account financial liability is
a) Written off as bad debt
b) Potentially transferred to the patient
c) Sold to a collection agency
d) Treated as the cost of doing business - ANS B
When there is a request for service the scheduling staff member must confirm the
patient's
unique identification information to:
a) Verify the patient's insurance coverage if the patient is a returning customer
b) Ensure that she/he accesses the correct information in the historical
database
c) Confirm that physician orders have been received
d) Check if any patient balance due - ANS B
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
a) The data collection steps for scheduling and pre-registering a patient
b) Registration steps that must be completed before any medical services are provided
c) The steps mandated for billing Medicare Part A
d) The process of closing an account - ANS A
Insurance verification results in which of the following
a) The accurate identification of the patient's eligibility and benefits
b) The consistent formatting of the patient's name and identification number
The resolution of managed care and billing requirements
The identification of physician fee schedule amounts and the NPI (national provider
identifier) numbers - ANS A
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
a) HCPCs codes
b) ICD-10 Procedural codes
c) CPT codes
d) Revenue codes - ANS D
The importance of Medical records being maintained by HIM is that the patient records:
a) Are evidence used in assessing the quality of care
b) Are the primary source for clinical data required for reimbursement
by health plans and liability payers
C) Are the strongest evidence and defense in the event of a Medicare Audit
d) Are the evidence cited in quality review - ANS B
Medicare patients are NOT required to produce a physician order to receive which of
these services
a) Diagnostic Mammography, flu vaccine, or B-12 shots
b) Diagnostic Mammography, flu vaccine, or pneumonia vaccine
c) Screening Mammography, flu vaccine or pneumonia vaccine
d) Screening Mammography, flu vaccine or B-12 shots - ANS C
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Patients should be informed that costs presented in a price estimate may
a) Vary from estimates, depending on the actual services performed
b) Be guaranteed if the patient satisfies all patient financial responsibilities at the time
of registration
c) Be lower as price estimates use the highest market price
d) Only determine the percentage of the total that the patient is responsible for and not
the actual cost - ANS A
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 - ANS C
In Chapter 7 straight bankruptcy filling
a) 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 discharges the debtor from the debt
c) The court vacates all claims against a debtor with the understanding that the debtor
may not apply for credit without court supervision
d) The court liquidates the debtor's nonexempt property, pays creditors, and begins to
pay off the largest claims first. All claims are paid some portions of the amount owed. - ANS B
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 - ANS B
Which of the following is required for participation in Medicaid
a) Obtain a supplemental health insurance policy
b) Meet income and assets requirements
c) Meet a minimum yearly premium
d) Be free of chronic conditions - ANS B
When primary payment is received, the actual reimbursement
a) Is compared to the expected reimbursement
b) Is recorded by Patient Accounting and the patient's account is the closed
c) Is compared to the expected reimbursement, the remaining
contractual adjustments are posted, and secondary claims are
submitted
d) Trigger that the secondary claims can then be prepared. - ANS C
Days in A/R is calculated based on the value of
a) Total cash received to date
b) The time it takes to collect anticipated revenue
c) The total accounts receivable on a specific date
d) Total anticipated revenue minus expenses - ANS C
All of the following are forms of hospital payment contracting EXCEPT
a) Per diem payment
b) Bundled Payment
c) Fixed Contracting
d) Contracted Rebating - ANS D
The standard claim form used for billing by hospitals, nursing facilities, and other in-
patient
services is called the
a) UB-04
b) 1500
c) COST REPORT
d) REMITTANCE NOTICE - ANS A
To maximize the value derived from customer complaints, all consumer complaints should
be
a) Responded to within two business days
b) Tracked and shared to improve the customer experience
c) Handled by a specially trained "service recovery" team
d) Brought immediately to management's attention - ANS A
The HCAHPS (hospital consumer assessment of healthcare providers and systems)
initiative
was launched to
a) Gather national date on overall trust in the nation's health care system
b) Create a national database on physician quality
c) Provide a standardized method for evaluating patient's perspective on
hospital care. ?
d) Provide data for building shared savings reimbursement for quality procedures. - ANS C
Health Plan Contracting Departments do all of the following EXCEPT
a) Establish a global reimbursement rate to use with all third-party payer
b) Review all managed care contracts for accuracy for loading contract terms into the
patient accounting system
c) Review payment schemes to ensure that the health plan and provider understand how
reimbursements must be calculated
d) Review contracts to ensure the appeals process for denied claims is clearly specified - ANS
A
The benefit of 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 Medicare-coverage 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 - ANS C
Once the EMTALA requirements are satisfied
a) Third-party payer info should be collected from the pt and the payer
should be notified of the ED visit
b) An initial registration record is completed so that the proper coding can be initiated
c) The pt then assumes full liability for services unless a third-party payer is notified or
the pt applies for financial assistance within the first 48 hours
d) The remaining registration processing is initiated either at the bedside or In a
registration area - ANS A
The soft cost of a dissatisfied customer is
a) The "cost" of staff providing extra attention in trying to perform service recovery
b) The customer passing on info about their negative experience to
potential pts or through social media channels
c) Potentially negative treatment outcomes leading to expanding length-of-stay
d) Lowered quality outcomes for the dissatisfied pt - ANS B
Concurrent review and discharge planning
a) Occurs during service
b) Is performed by the health plan during the time of service
c) Is a significant part of quality and is performed by the clinical treatment team
d) Is performed at discharge with the pt - ANS A
In a self-insured (or self-funded) plan, the costs of medical care are
a) Borne by the employer on a pay-as-you-go basis
b) Backed-up by stop-loss insurance against a catastrophic claim
c) Mandated by the Affordable Care Act for small businesses unable to obtain commercial
coverage
d) Created by a combination of employer and employee contributions - ANS A
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In choosing a setting for pt financial discussions, organizations should first and foremost
a) Have processes in place to document the discussions
b) Assess locations for convenience, professionalism, and comfort
c) Respect the pts privacy
d) Ensure all staff involved are properly trained and the pt financial education is included
in all discussions - ANS C
All of the following are steps in safeguarding collections EXCEPT
a) Placing collections in a lock-box for posting review the next business day
b) Posting the payment to the pts account
c) Completing balance activities
d) Issuing receipts - ANS D
Which option is a government-sponsored health care program that is financed through
taxesand general revenue funds
a) Medicaid
b) Medicare
c) Insurance exchange
d) Social security - ANS B
It is important to calculate reserves to ensure
a) Stable financial operations and accurate financial reporting
b) Collateral for credit
c) Expense coverage in the event of a revenue short fall
d) Coverage of B/D write offs and charity care costs - ANS A
Successful account resolution begins with
a) Educating pts on their estimated financial responsibility
b) Collecting all deductibles and copayments during the pre-service stage
c) Accurate documentation of services
d) Pt compliance with the course of treatment - ANS B
An individual enrolled in Medicare who is dissatisfied with the government's claim
determination is entitled to reconsideration of the decision. This type of appeal is known
as
a) A medicare determination appeal
b) A payment review
c) A medicare supplemental review
d) A beneficiary appeal - ANS D
A portion of the accounts receivable inventory which has NOT qualified for billing
includes
a) Charitable pledges
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b) Accounts assigned to a pre-collection agency
c) Accounts coded but held within the suspense period
d) Accounts created during pre-registration but not activated - ANS A
Checks received through mail, cash received through mail, and lock box are all examples
of
a) Highly fraud prone processes
b) Payment methods in which the majority of fraud occurs
c) Payment methods being phased out for more secure payment method options
d) Control points for cash posting - ANS D
Recognizing that health coverage is complicated and not all pts are able to navigate this
terrain, HFMA best practices specify that
a) A representative of the health plan be included in the pt financial responsibilities
discussion
b) The patient accounts staff have someone assigned to research coverage on behalf of
pts
c) Pts should be given the opportunity to request a pt advocate, family
member or other designee to help them In these discussions
d) Pt coverage education may need to be provided by the health plan - ANS C
Once the price is estimated in the pre-service stage, a provider's financial best practice is to
a) Allow the pt time to compare prices with other providers
b) Have another employee double check the price estimate
c) Lock-in the prices
d) Explain to the pt their financial responsibility and to determine the plan for payment - ANS D
Charges as the most appropriate measurement of utilization enables
a) Accuracy of expense and cost capture
b) Managing of expense budgets
c) Effective HIM planning
d) Generation of timely and accurate billing - ANS A
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
a) HMO
b) PPO
c) MSO
d) GPO - ANS A
Charges are the basis for
a) Third party and regulatory review of resources used
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b) Evaluating quality
c) Separation of fiscal responsibilities between the pt and the health plan
d) Demonstrating medical necessity - ANS C
Chapter 13 Bankruptcy, debtor rehabilitation is a court proceeding
a) That reorganizes a debtor's holdings and instructs creditors to look to the debtors'
future earnings for payment
b) That establishes a payment priority order to creditos'
c) That creates a clear court-supervised payment accountability plan going forward
d) That classifies the debtor as eligible for government financial assistance for housing
medical treatment and food as debts are paid - ANS A
Pt financial communications best practices produce communications that are
a) Timely and remind pts of their financial responsibilities
b) Consistent, clear and transparent
c) Current and report the status of a pts claim
d) Timely, comprehensive and specifying next steps - ANS B
Key performance indicators (KPIs) set standards for accounts receivables (A/R) and
a) Establish productivity targets
b) Provide a method of measuring the collection and control of A/R
c) Provide evidence of financial status
d) Make allowance for accurate revenue forecasting - ANS B
When Recovery Audit Contractors (RAC) identify improper payments as over payments,
the
claims processing contractor must
a) Assume legal responsibility for repaying the overage amount
b) Make recovery of the overpayment the top processing priority
c) Send a demand letter to the provider to recover the over payment amount
d) Conduct an audit of all the effected providers claims within the past twelve months - ANS C
A recurring/series registration is characterized by
a) The creation of one registration record for multiple days of service
b) The creation of multiple registrations for multiple services
c) The creation of one registration record per diagnosis per visits
d) The creation of multiple pt types for one date of service - ANS A
It is important to have high registration quality standards because
a) Inaccurate or incomplete pt data will delay payment or cause denials
b) Incomplete registrations will trigger exclusion from Medicare participation
c) Inaccurate registration may cause discharge before full treatment is obtained
d) Incomplete registrations will raise satisfaction scores for the hospital - ANS A
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When recovery audit contractors (RAC) identify improper payments as over payments the
claims processing contractor must
a) Assume legal responsibility for repaying the overage amount
b) Make recovery of the overpayment the top processing priority
c) Send a demand letter to the provider to recover the over payment
amount
d) Conduct an audit of all the effected providers claims within the past 12 months - ANS C
Internal controls addressing coding and reimbursement changes are put I place to guard
against
a) Underpayments
b) Denials
c) Compliance fraud by upcoding
d) Charge master error - ANS C
The pt discharge process begins when
a) The physician writes the discharge orders
b) Clinical services are completed and pt accounts have all the info necessary to bill
c) The physician writes the discharge orders and the third-party payer sign-off on the
necessity of the services provided
d) Clinical services are completed, pt accounts can generated and accurate bill and there
is agreement o the handling of pt financial responsibilities - ANS A
Most major health plans including medicare and Medicaid, offer
a) Toll free verification hot lines, staffed around the clock
b) Electronic and/or web portal verification
c) Pt "verification of benefits" cards
d) A grace period for obtaining verification within 72 hours of treatment - ANS B
The physician who wrote the order for an inpatient service and is in charge of the pts
treatment during admission is
a) The pts personal physician
b) The primary care physician
c) The attending physician
d) The physician pt care director - ANS C
An originating site is
a) The location where the pts bill is generated
b) The location of the pt at the time the service is provided
c) The site that generates reimbursement of a claim
d) The location of the medical treatment provider - ANS B
HFMA best practices stipulate that a reasonable attempt should be made to have the
financial
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responsibilities discussion
a) As early as possible, before a financial obligation is incurred
b) During the registration process
c) Before scheduling of services
d) No later than the evening of the day of admission - ANS A
HFMA's pt financial communications best practices specify that pts should be told about
the
types of services provided and
a) An explanation of why a specific service is not provided
b) The service providers that typically participate in the service, e.g.radiologists,
pathologists, etc.
c) A satisfaction survey regarding clinical service providers
d) The price of service to their covering health plan - ANS B
Telemed seeks to improve a pt's health by
a) Permitting 2-way real time interactive communication between the pt
and the clinical professional
b) Using high-compression fiber optics to transmit medical data
c) Providing relevant, on-demand consumer medical education
d) Providing physician access to the most current medical research - ANS A
A large number of credit balances are not the result of overpayments but of
a) Posting errors in the pt accounting system
b) Incorrect claim submissions
c) Inadequate staff training
d) Banking transaction errors - ANS A
Across all care settings, if a pt consents to a financial discussion during a medical
encounter
to expedite discharge, the HFMA best practice is to
a) Have a pt financial responsibilities kit ready for the pt containing all of the required
registration forms and instructions
b) Make sure that the attending staff can answer questions and assist in obtaining
required pt financial data
c) Support that choice, providing that the discussion does not interfere with pt care or
disrupt pt flow
d) Decline such request as finance discussions can disrupt pt care and pt flow - ANS C
The office of inspector general (OIG) publishes a compliance work plan
a) Monthly
b) Quarterly
c) Semi-annually
d) Annually - ANS D
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