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CRCR Certification Exam With 100% Correct Answers
Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - Correct answer-The Medicare Administrative Contractor (MAC) at the end of the hospice cap period Which of the following is required for participation in Medicaid - Correct answer-Meet Income and Assets Requirements In choosing a setting for patient financial discussions, organizations should first and foremost - Correct answer-Respect the patients privacy A nightly room charge will be incorrect if the patient's - Correct answer- 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 - Correct answer-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: - Correct answer-Charitable pledges What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? - Correct answer-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
- Correct answer-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 - Correct answer-Case management Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? - Correct answer-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 - Correct answer-The Internal Revenue Service
The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: - Correct answer- Judicial review by a federal district court
Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the providermay not ask about a patient's insurance information if it would delay what? - Correct answer-Medical screening and stabilizing treatment Ambulance services are billed directly to the health plan for - Correct answer- Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility Key performance indicators (KPIs) set standards for accounts receivables (A/R) and - Correct answer-Provide a method of measuring the collection and control of A/R he patient discharge process begins when - Correct answer-The physician writes the discharge orders The nightly room charge will be incorrect if the patient's - Correct answer- Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system. The soft cost of a dissatisfied customer is - Correct answer-The customer passing on info about their negative experience to potential pts or through social media channels An advantage of a pre-registration program is - Correct answer-The opportunity to reduce the corporate compliance failures within the registration process It is important to have high registration quality standards because - Correct answer- Inaccurate or incomplete patient data will delay payment or cause denials Telemed seeks to improve a patient's health by - Correct answer-Permitting 2- way real time interactive communication between the patient and the clinical professional Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a monthly fee is known as a - Correct answer-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
All of the following are forms of hospital payment contracting EXCEPT - Correct answer- Contracted Rebating The most common resolution methods for credit balances include all of the following EXCEPT: - Correct answer-Designate the overpayment for charity care Ambulance services are billed directly to the health plan for - Correct answer-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 - Correct answer-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 - Correct answer- Medicare and Medicaid payments The Correct Coding Initiative Program consists of - Correct answer-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 - Correct answer-The actual physician reimbursement Which department supports/collaborates with the revenue cycle? - Correct answer- Information Technology Medicare Part B has an annual deductible and the beneficiary is responsible for - Correct answer-a co-insurance payment for all Part B covered services The two types of claims denial appeals are - Correct answer-Beneficiary and Provider Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) - Correct answer-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 - Correct answer-Providing inpatient services in the RHC The patient discharge process begins when - Correct answer-The physician
writes the discharge order Departments that need to be included in charge master maintenance include all of the following EXCEPT - Correct answer-Quality Assurance
effective to - Correct answer-Collect all information after the patient has been discharged
Applying the contracted payment amount to the amount of total charges yields - Correct answer-A pricing agreement "Hard-coded" is the term used to refer to - Correct answer-Codes for services, procedures, and drugs automatically assigned by the charge master The advantages to using a third-party collection agency include all of the following EXCEPT - Correct answer-Providers pay pennies on each dollar collected Which of the following is usually covered on a Conditions of Admission form - Correct answer-Release of information The 501(r) regulations require not-for-profit providers (501(c)(3) organizations) to do which of the following activities. - Correct answer-Complete a community needs assessment and develop a discount program for patient balances after insurance payment To be eligible for Medicaid, an individual must - Correct answer-meet income and asset requirements Eliminating mail time and reducing data entry time, electronically monitoring the receipt of claims and online claim adjudication, more prompt payment are all benefits achieved by - Correct answer-The electronic submission of claims using electronic transfers There are unique billing requirements based on - Correct answer-The provider type The unscheduled "direct" admission represents a patient who: - Correct answer-Is admitted from a physician's office on an urgent basis In resolving medical accounts, a law firm may be used as: - Correct answer-A substitute for a collection agency The legal authority to request and analyze provider claim documentation to ensure that - Correct answer-The Office of the U.S. Inspector General (OIG) The office of inspector general (OIG) publishes a compliance work plan - Correct answer-Annually Room and bed charges are typically posted - Correct answer-From the midnight census
HFMA's patient financial communications best practices specify that pts should be told about the - Correct answer-The service providers that typically participate in the service, e.g. radiologists ,pathologists, etc. The core financial activities resolved within patient access include: - Correct answer- 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 - Correct answer-The patient's home care coverage Which option is a benefit of pre-registering a patient for services - Correct answer-The patient arrival process is expedited, reducing wait times and delays Days in A/R is calculated based on the value of - Correct answer-The total accounts receivable on a specific date Case Management requires that a case manager be assigned - Correct answer- To a select patient group Which of the following is required for participation in Medicaid? - Correct answer-Meet income and assets requirements All of the following are steps in safeguarding collections EXCEPT - Correct answer- Issuing receipts The Electronic Remittance Advice (ERA) data set is : - Correct answer-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 - Correct answer-Services and procedures that are custodial in nature Medicare beneficiaries remain in the same "benefit period" - Correct answer-Until the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days It is important to calculate reserves to ensure - Correct answer-Stable financial operations and accurate financial reporting A claim is denied for the following reasons, EXCEPT: - Correct answer-The
submitted claim does not have the physicians signature HFMA best practices call for patient financial discussions to be reinforced - Correct answer-By changing policies to programs
responsibility of: - Correct answer-Case Management Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and - Correct answer-Provide a method of measuring the collection and control of A/R With any remaining open balances, after insurance payments have been posted, the account financial liability is - Correct answer-Potentially transferred to the patient
Pricing transparency is defined as readily available information on the price of healthcare services, that together with other information, help define the value of those services and enable consumers to - Correct answer-Identify, compare, and choose providers that offer the desired level of value All of the following are potential causes of credit balances EXCEPT - Correct answer-A patient's choice to build up a credit against future medical bills A comprehensive "Compliance Program" is defined as - Correct answer- Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met An originating site is - Correct answer-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: - Correct answer- 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 - Correct answer-Will be admitted as an inpatient The benefit of Medicare Advantage Plan is - Correct answer-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 - Correct answer- Accurate billing Claims with dates of service received later than one calendar year beyond the date of service, will be - Correct answer-Denied by Medicare A portion of the accounts receivable inventory which has NOT qualified for billing includes - Correct answer-Charitable pledges The standard claim form used for billing by hospitals, nursing facilities, and other in- patient - Correct answer-UB- Once the price is estimated in the pre-service stage, a provider's financial best practice is to - Correct answer-Explain to the patient their financial responsibility and to determine the plan for payment
Health Plan Contracting Departments do all of the following EXCEPT - Correct answer- Establish a global reimbursement rate to use with all third-party payer For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: - Correct answer-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? - Correct answer-Bad debt adjustment Most major health plans including Medicare and Medicaid, offer - Correct answer- Electronic and/or web portal verification The important Message from Medicare provides beneficiaries information concerning their - Correct answer-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? - Correct answer-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 - Correct answer-Monitor compliance Medicare will only pay for tests and services that - Correct answer-Medicare determines are "reasonable and necessary" The physician who wrote the order for an inpatient service and is in charge of the patients - Correct answer-The attending physician When primary payment is received, the actual reimbursement - Correct answer-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 - Correct answer- The specificity and coding needed to support reimbursement claims In a self-insured (or self-funded) plan, the costs of medical care are - Correct answer- Borne by the employer on a pay-as-you-go basis Indemnity plans usually reimburse: - Correct answer-A certain percentage
of the charges after the patient meets the policy's annual deductible
