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CRCR Exam Study Guide with 100% Correct Answers
Patient Centric Revenue Cycle - Correct answer-This includes all the major processing steps required to process a pt account from the request for service through closing the account with a zero balance and purging it from the system pre-service - Correct answer-this is the period in which scheduling and pre-access takes place, including different steps that will be completed pre-service - Correct answer-what is it when the requested service is screened for medical necessity, health plan coverage & benefits are verified, and pre-auth is obtained scheduled patient- Time of Service - Correct answer-what is it when a final account review is completed prior to the patient's arrival? (Pre-reg record is activated, consents are signed, and co-payments and other amounts are collected) express arrival - Correct answer-pre-processed patient's can report to this, which is a desk located in a centralized access, upon their arrival. post-service - Correct answer-this includes account activities that occur after the patient is d/c until the account reaches a zero balance post-service - Correct answer-Final coding of all services, perparation and submission of claims, payment processing and balance billing are all included and finalized when? Patient Financial Communications Best Practices - Correct answer-This brings consistency, clarity, and transparency to patient financial communications Patient Financial Communications Best Practices - Correct answer-this outlines steps to help patient's understand the cost of services they receive, their insurance coverage, and their individual responsibility (review Patient Financial Comm. Best Practice document) true - Correct answer-true or false: Conversations should occur in a location and manner that are sensitive to the patient's needs
timely discussions - Correct answer-this type of discussion will help ensure that patient's understand their financial obligation and that providers are aware of the patient's ability to pay guarantor - Correct answer-the person responsible for payment of the bill
unscheduled patients - Correct answer-what are non-emergency pt who come for service w/o prior notification to the provider called? used to evaluate the need for an IP admission - Correct answer-Which of the following statements apply to the Obs patient type? physician, nursing, and pharmacy - Correct answer-which services are hospice programs required to provide on a around-the-clock patient?q
complete the scheduling process correctly based on service requested - Correct answer-Scheduler instructions are used to prompt the scheduler to do what? procedure time - Correct answer-This is the time needed to prepare the patient before services is the difference between the patients arrival time? Documentation of the medical necessity for the test - Correct answer-Medicare guidelines require that when a test is ordered for which an LCD (local cover determination) or NCD (national coverage determination) exists, the info on the order must include what? it reduces processing times at the time of service - Correct answer-what is an advantage of a pre-registration program? the responsible party's full legal name, DOB, and SSN - Correct answer-what data is required to est. a new MPI (Master patient index) entry? parents are received by the provider from the payer responsible for reimbursing the provider for the pt covered services - Correct answer-which of the following statements is true about third-party payments? stop loss - Correct answer-which provision protects the patient from medical expenses that exceed pre-set level? referral - Correct answer-What is it called when a PCP send an HMO (health maintenance organization) pt to authorize a visit to a specialist for additional testing or care? Medical screening and stabilizing - Correct answer-under the EMTALA (emergency medical treatment and labor act) regulations, the provider may not ask the patient about their ins info if it would delay what? to the approved APC rate - Correct answer-the hospital has a APC (ambulatory payment classification) - based contract for the payment of OP services. Total anticipated charges for the visit are $2,380. The approved APC payment rate is $780. Where will the patients benefit package be applied? $100 - Correct answer-a patient has met their $200 deductible and $900 of the $1000 coins responsibility. the coins rate is 20%. The estimated ins plan responsibility is $1975.00. What amount of coins is due from the patient?
sources of readily available funds, such as vehicles, campers, boats and savings accounts - Correct answer-what patient assets are considered in the financial assistance applications? warn the pt that any unpaid accounts are placed with collection agencies for further processing - Correct answer-if the pt cannot agree to payment arrangements, what is the next option? scheduling, pre-reg, ins verification, and managed care processing - Correct answer- what core financial activities are resolved within patient access? a pt who arrives at the hospital via EMS for treatment in the ER - Correct answer- what is an unscheduled direct admission? as a substitute for an IP admission - Correct answer-when is not appropriate to use observation status? home health - Correct answer-parents who require periodic skilled nursing or therapeutic care receive services from what type of program? printed copy of the providers privacy notice - Correct answer-every pt who is new to the healthcare provider must be offered what? the employer provides a traditional HMP health plan - Correct answer-which of the following statements applies to self-insured ins plans? Subrogation - Correct answer-what process does a pt health plan use to retroactively collect payments from liability, automobile, or workers comp plans? DRG rates (diagnosis-related groups) - Correct answer-what type of payment methodology is a lump sum or bundled payment negotiated b/w the payer and some or all providers? site-of-service limitation - Correct answer-what restriction does a managed care plan place on locations that must be used if the plan is to pay for the service provided? if medical necessity for a private room is documented in the chart, pt ins will be billed for the differential, pay per the contract - Correct answer-which of the following statements applies to private rooms? a pt must have both medicare part A & B benefits to be eligible for a
medicare advantage plan - Correct answer-which of the following is NOT true of Medicare advantage plans? failure to complete authorization - Correct answer-what is a valid reason for a payor to deny a claim?
medicaid benefits, the beneficiary must fall into specific need category and meet what other types of requirements?
they are calculated quarterly - Correct answer-fee-for-service plans pay claims based on a % of charges. How are patients out of pocket costs calculated? certain % of charges ate4r patient meets policy annual deductible - Correct answer- indemnity plans usually reimburse what? quality assurance - Correct answer-dept that need to be included in Charge master3 Maintenance include all EXCEPT what? submit a standardized transaction to any of the health plans with which it conducts business - Correct answer-using HIPPA standardized transaction sets allow providers to what? cost of services - Correct answer-which of the following is NOT included in the standardized quality measures? encourage new ACOs to form in rural and underserved areas - Correct answer-the ACO investment model will test the use of per-paid shared savings to do what? HMO - Correct answer-this type of ins plan provides comprehensive health maintenance and treatment services for an enrolled group of persons on a monthly fee services provided before admission and for the rides to take them home after discharge or to transfer to another facility. - Correct answer-EMS services are billed directly to the health plan for what? the provider reimbursement review board - Correct answer-any provider that files a timely cost report may appeal in an adverse final decision recited from the Medicare Admin Contractor (MAC), the appeal may be filed with what? obtaining or updating pt and guarantor info - Correct answer-for SCHEDULED payments, important rev cycle activities in the time-of=service state DO NOT include what? the hospital UR committee determines before the pt is d/c and prior to billing that an obsveration setting would be more appropriate - Correct answer-hospital can only convert an inpatient case to observation if what? used only designated software platforms to secure pt date - Correct answer- HIPAA privacy rules require covered entities to take all, of the following EXCEPT what?
270-271 set - Correct answer-Which HIPAA transaction set provides electronic processing of ins verification requests and responses? support that choice, inform that the discussion does not interfere with patient care or disrupt patient flow - Correct answer-across all care settings if a pt consents to a financial discussion during a medial encounter to expedite discharge, the HFMA best practice is to make sure what is informed? complete registration and ins approval before service - Correct answer-a SCHEDULED inpatient represents an opportunity for the provider to do what? align incentives b/w hospitals, physicians, and non-physician providers in-order to better coordinate pt care - Correct answer-the Medicare Bundled Payments for Care Initiative (BCP) is designed to for what? tracked and shared to improve customer experience - Correct answer-to maximize the value derived from customer complaints, all consumer complaints should be..? an estimated price - Correct answer-applying the contracted payment methodology to the total charges yields what? primary source for clinical data required for reimbursement by health plans and liability payers - Correct answer-the importance of MR maintained by HIM is that the pt records: obtaining or updating pt and guarantor info - Correct answer-important rev cycle activities in the pre-service state include what? amount the pt may be expected to pay after ins - Correct answer-in the pre-service stage, all cost of the schedule services is identified and the patient plan and benefits are used to calculate what? reduces internal staffing costs and a reliance on outsourced staff - Correct answer-the disadvantage of outsourcing includes all of the following EXCEPT what? case management - Correct answer-maintaining routine contract with health plan or liability payer, making sure all required info is provided and all needed approvals are obtained is the responsibility of who? the submitted claim does not have the physician signature - Correct answer-a claim can be denied for the following reasons EXCEPT for?
all emergency and medically necessary care - Correct answer-all hospitals are required to est. a written financial assistance policy that applies to what? seeking payment options for self-pay - Correct answer-examples of ethics violation that impact the rev cycle include all of the following except what?
activities? pt full legal name and DOB or the pt SSN - Correct answer-During pre-reg, a search for the pt MRI number is initiated using which of the following data sets:
tracked and shared to improve the customer experience - Correct answer-to maximize the value derived from customer complaints, all consumer complaints should be what? the principles and standards by which organizations operate - Correct answer-the Business ethics, or organizational ethics represent what? third-party payers - Correct answer-provides are advised that it is best to est pt financial responsibility and assistance policies and make sure they are followed internally and by whom? providers pay pennies on each dollar collected (false) - Correct answer-the advantage to using 3rd party collection agencies includes all of the following EXCEPT what? which dx, signs, or symptoms are reimbursable - Correct answer-LCD and NCD are Medicare guidelines used to determine what? denied by Medicare - Correct answer-claims with the DOS received later than one calendar year beyond the DOS will be what? pre-auth is obtained - Correct answer-in the pre-service stage, the requested service is screened for medically necessity, health plan cvg, and benefits are verified and what is obtained? claim edits - Correct answer-these are rules developed to verify the accuracy of claims based on each health plans polices provider scheduling - Correct answer-who is typically responsible for obtaining the auth? during service - Correct answer-when does concurrent review and discharge planning occur? check if pt is a health plan beneficiary and what is their cvg - Correct answer-what is the first thing a health plan does when processing a claim? no pt financial discussion should occur before a pt is screened and stabilized - Correct answer-EMTLA and HFMA best practices specify that in an ER setting provide a standardized method for evaluation pt perspective on hospital care - Correct answer-the HCCAHPS (hospital consumer assessment of healthcare providers and sys) initiative was launched to provide what?
quality and value and also to protect consumers and workers in the healthcare sys. This directive is called what? Explicit price concessions and implicit price consessions - Correct answer-What is the new terminology now employed in the calculation of net patient service revenues.
