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CRCR Certification Exam Question and
Answers2023/
Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - ✔️The Medicare Administrative Contractor (MAC) at the end of the hospice cap period Which of the following is required for participation in Medicaid - ✔️Meet Income and Assets Requirements In choosing a setting for patient financial discussions, organizations should first and foremost - ✔️Respect the patients privacy A nightly room charge will be incorrect if the patient's - ✔️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 - ✔️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: - ✔️Charitable pledges What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? - ✔️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 - ✔️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 - ✔️Case management Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? -
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✔️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 - ✔️The Internal Revenue Service Checks received through mail, cash received through mail, and lock box are all examples of - ✔️Control points for cash posting What are some core elements if a board-approved financial assistance policy? - ✔️Eligibility, application process, and nonpayment collection activities A recurring/series registration is characterized by - ✔️The creation of one registration record for multiple days of service 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 - ✔️Assist patients in understanding their insurance coverage and their financial obligation The purpose of a financial report is to: - ✔️Present financial information to decision makers Patient financial communications best practices produce communications that are - ✔️Consistent, clear and transparent Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish - ✔️What services or healthcare items are covered under Medicare 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 - ✔️The Provider Reimbursement Review Board Concurrent review and discharge planning - ✔️Occurs during service Duplicate payments occur: - ✔️When providers re-bill claims based on nonpayment from the initial bill submission
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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 - ✔️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 - ✔️The data collection steps for scheduling and pre-registering a patient Medicare Part B has an annual deductible, and the beneficiary is responsible for - ✔️A co-insurance payment for all Part B covered services The standard claim form used for billing by hospitals, nursing facilities, and other inpatient - ✔️UB- Charges are the basis for - ✔️Separation of fiscal responsibilities between the patient and the health plan All of the following are forms of hospital payment contracting EXCEPT - ✔️Contracted Rebating The most common resolution methods for credit balances include all of the following EXCEPT: - ✔️Designate the overpayment for charity care Ambulance services are billed directly to the health plan for - ✔️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 - ✔️A clean claim The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to - ✔️Medicare and Medicaid payments The Correct Coding Initiative Program consists of - ✔️Edits that are implemented within providers' claim processing systems To provide a patient with information that is meaningful to them, all of the following factors must be included EXCEPT - ✔️The actual physician reimbursement Which department supports/collaborates with the revenue cycle? -
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✔️Information Technology Medicare Part B has an annual deductible and the beneficiary is responsible for - ✔️a co-insurance payment for all Part B covered services The two types of claims denial appeals are - ✔️Beneficiary and Provider Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) - ✔️Registration staff members routinely contact managed care plans for prior authorizations before the patient is seen by the on duty physician Rural Health Clinics (RHC) personnel can provide services in all of the following locations, EXCEPT - ✔️Providing inpatient services in the RHC The patient discharge process begins when - ✔️The physician writes the discharge order Departments that need to be included in charge master maintenance include all of the following EXCEPT - ✔️Quality Assurance The first thing a health plan does when processing a claim is - ✔️Check if the patient is a health plan beneficiary and what is the coverage Vital to accurate calculations of a patient's self-pay amount is - ✔️ The most accurate way to validate patient information is to - ✔️require clinical staff to verify information at each treatment encounter In order for Regulation Z to apply, a hospital must - ✔️ All of the following are minimum requirements for new patients with no MPI number EXCEPT - ✔️Address A typical routine patient financial discussion would include - ✔️Explaining the benefits identified through verifying the patients insurance Components of financial education include informing the patient of the hospital's financial policies, assessing the patient's ability to pay and - ✔️Reviewing payment alternatives with the patient so appropriate resolution of the health care financial obligation is achieved
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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 - ✔️The electronic submission of claims using electronic transfers There are unique billing requirements based on - ✔️The provider type The unscheduled "direct" admission represents a patient who: - ✔️Is admitted from a physician's office on an urgent basis In resolving medical accounts, a law firm may be used as: - ✔️A substitute for a collection agency The legal authority to request and analyze provider claim documentation to ensure that - ✔️The Office of the U.S. Inspector General (OIG) The office of inspector general (OIG) publishes a compliance work plan - ✔️Annually Room and bed charges are typically posted - ✔️From the midnight census All of the following information should be reviewed as part of schedule finalization EXCEPT: - ✔️The results of any and all test Revenue cycle activities occurring at the point-of-service include all of the following EXCEPT: - ✔️Providing charges to the third-party payer as they are incurred HFMA's patient financial communications best practices specify that pts should be told about the - ✔️The service providers that typically participate in the service, e.g. radiologists ,pathologists, etc. The core financial activities resolved within patient access include: - ✔️Scheduling, pre-registration, insurance verification and managed care processing A decision on whether a patient should be admitted as an inpatient or become about patient observation patient requires medical judgments based on all of the following EXCEPT - ✔️The patient's home care coverage Which option is a benefit of pre-registering a patient for services - ✔️The patient arrival process is expedited, reducing wait times and delays
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Days in A/R is calculated based on the value of - ✔️The total accounts receivable on a specific date Case Management requires that a case manager be assigned - ✔️To a select patient group Which of the following is required for participation in Medicaid? - ✔️Meet income and assets requirements All of the following are steps in safeguarding collections EXCEPT - ✔️Issuing receipts The Electronic Remittance Advice (ERA) data set is : - ✔️A standardized form that provides third party payment details to providers All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT - ✔️Services and procedures that are custodial in nature Medicare beneficiaries remain in the same "benefit period" - ✔️Until the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days It is important to calculate reserves to ensure - ✔️Stable financial operations and accurate financial reporting A claim is denied for the following reasons, EXCEPT: - ✔️The submitted claim does not have the physicians signature HFMA best practices call for patient financial discussions to be reinforced - ✔️By changing policies to programs Patients should be informed that costs presented in a price estimate may - ✔️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: - ✔️Obtain higher compensation for physicians Charges as the most appropriate measurement of utilization enables - ✔️Accuracy of expense and cost capture Once the EMTALA requirements are satisfied - ✔️The remaining registration processing is initiated at the bedside or in a registration area
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✔️Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met An originating site is - ✔️The location of the patient at the time the service is provided Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare established guideline(s) used to determine: - ✔️Which diagnoses, signs, or symptoms are reimbursable 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 - ✔️Will be admitted as an inpatient The benefit of Medicare Advantage Plan is - ✔️Patients generally have their Medicare-coverage healthcare through the plan and do not need to worry about "part a" or "part b" benefits The process of creating the pre-registration record ensures - ✔️Accurate billing Claims with dates of service received later than one calendar year beyond the date of service, will be - ✔️Denied by Medicare A portion of the accounts receivable inventory which has NOT qualified for billing includes - ✔️Charitable pledges The standard claim form used for billing by hospitals, nursing facilities, and other in- patient - ✔️UB- Once the price is estimated in the pre-service stage, a provider's financial best practice is to - ✔️Explain to the patient their financial responsibility and to determine the plan for payment Internal controls addressing coding and reimbursement changes are put in place to guard against - ✔️Compliance fraud by upcoding Health Plan Contracting Departments do all of the following EXCEPT - ✔️Establish a global reimbursement rate to use with all third-party payer
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For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: - ✔️Should take place between the patient or guarantor and properly trained provider representatives What type of account adjustment results from the patient's unwillingness to pay a self-pay balance? - ✔️Bad debt adjustment Most major health plans including Medicare and Medicaid, offer - ✔️Electronic and/or web portal verification The important Message from Medicare provides beneficiaries information concerning their - ✔️Right to appeal a discharge decision if the patient disagrees with the plan 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? - ✔️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 - ✔️Monitor compliance Medicare will only pay for tests and services that - ✔️Medicare determines are "reasonable and necessary" The physician who wrote the order for an inpatient service and is in charge of the patients - ✔️The attending physician When primary payment is received, the actual reimbursement - ✔️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 - ✔️The specificity and coding needed to support reimbursement claims In a self-insured (or self-funded) plan, the costs of medical care are - ✔️Borne by the employer on a pay-as-you-go basis Indemnity plans usually reimburse: - ✔️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 -
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✔️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 - ✔️The Internal Revenue Service The HCAHPS (hospital consumer assessment of healthcare providers and systems) initiative - ✔️Provide a standardized method for evaluating patient's perspective on hospital care. A large number of credit balances are not the result of overpayments but of - ✔️Posting errors in the patient accounting system A Medicare Part A benefit period begins: - ✔️With admission as an inpatient Chapter 13 Bankruptcy, debtor rehabilitation, is a court proceeding - ✔️That reorganizes a debtor's holdings and instructs creditors to look to the debtor's future earnings for payment Which of the following in NOT included in the Standardized Quality Measures - ✔️Cost of services The disadvantages of outsourcing include all of the following EXCEPT: - ✔️Reduced internal staffing costs and a reliance on outsourced staff Improving the overall patient experience requires revenue cycle leadership and staff to simultaneously be: - ✔️Clear on policies and consistent in applying the policies Because 501(r) regulations focus on identifying potential eligible financial assistants patients hospitals must: - ✔️Hold financial conversations with patients as soon as possible Which of the following is NOT contained in a collection agency agreement? - ✔️A mutual hold-harmless clause HFMA best practices stipulate that a reasonable attempt should be made to have the financial - ✔️As early as possible, before a financial obligation is incurred Recognizing that health coverage is complicated and not all pts are able to navigate this terrain, HFMA best practices specify that -
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✔️Patients should be given the opportunity to request a patient advocate, family member or other designee to help them In these discussions For scheduled patients, important revenue cycle activities In the Time of Service stage DO NOT INCLUDE: - ✔️Final bill is presented for payment HFMA's patient financial communication best practices specify that patients should be told about the types of services provided and - ✔️The service providers that typically participate in the service, e.g., radiologists, pathologists, etc. Successful account resolution begins with - ✔️Collecting all deductibles and copayments during the pre-service stage Recognizing that health coverage is complicated and not all patients are able to navigate this terrain, HFMA best practices specify that - ✔️Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions In the balance resolution process, providers should: - ✔️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: - ✔️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 - ✔️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 - ✔️HMO In a Chapter 7 Straight Bankruptcy filing - ✔️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 - ✔️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 - ✔️Revenue codes
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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 - ✔️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 - ✔️Nursing The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as - ✔️Insurance verification of reimbursable charges Net Accounts Receivable is - ✔️The amount an entity is reasonably confident of collecting from overall accounts receivable. ED patients should be informed that their ability to pay - ✔️Will not interfere with treatment of any emergency medical conditions Providers are advised that it is best to establish patient financial responsibility and assistance policies and make sure they are followed internally and by - ✔️Business affiliates Incorrect data gathering can cause all of the following EXCEPT - ✔️The inability to discuss quality with physicians All Hospitals are required to establish a written financial assistance policy that applies to - ✔️All emergency and medically necessary care All of the following are reference resources used to help guide in the application of business ethics EXCEPT - ✔️Consumer satisfaction reports Each patient is assigned a unique number, commonly called the - ✔️Master Patient Index (MPI) number HIPAA contains all of the following goals EXCEPT - ✔️To ensure proper coding across the continuum of care Which of the following is NOT included in the Standardized Quality Measures? - ✔️ Account Receivable (A/R) Aging reports - ✔️Divide accounts receivable into 30, 60, 90 ,120 days past due categories
Answers2023/2024|Already Graded A+
Patients expect value for their healthcare dollar, including greater transparency of - ✔️Quality and price information The impact of denials on the revenue cycle includes all of the following EXCEPT - ✔️Patient outcomes Examples of ethics violations that impact the revenue cycle include all of the following EXCEPT - ✔️Seeking payment options for patient self-pay Scheduled procedures routinely include - ✔️Patient preparation instructions ICD-10-CM and ICD-10-PCS codes sets are modifications of - ✔️The International ICD-10 codes as developed by the WHO (World Health Organization) The result of accurate census balancing on a daily basis is - ✔️The correct recording of room charges All of the following are steps in verifying insurance EXCEPT - ✔️The patient signing the statement of financial responsibility Health Information Management (HIM) is responsible for - ✔️All patient medical records This form contains major items, subdivided into a total of 55 detailed items, and is used by professional service providers and not hospitals for submitting claims for services to health plans this form is called - ✔️The 1500 Which of the following is NOT a factor in self-pay follow-up? - ✔️The type of patient (inpatient, out-patient) The Office of Inspector General (OIG) was created - ✔️Detect and prevent fraud, waste, and abuse
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