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CRCR FINAL EXAM QUESTIONS & DETAILED ANSWERS (WELL
VERIFIED) ALREADY GRADED A+
Net Accounts Receivable is - CORRECT ANSWER >>> The amount an entity is reasonably confident of collecting from overall accounts receivable The unscheduled "direct" admission represents a patient who - CORRECT ANSWER >>> Is admitted from the physician's office on an urgent basis HIM is responsible for: - CORRECT ANSWER >>> The management of all patient medical records. Scheduler instructions are used to prompt the scheduler to **- CORRECT ANSWER
** Complete the scheduling process correctly based on service requested What types of services are classified as non-acute? - CORRECT ANSWER >>> All of the above: Skilled Nursing Hospice Care Clinic Services The soft cost of a dissatisfied customer is - CORRECT ANSWER >>> The customer passing on information about their negative experience to potential patients or through social media channels
The purpose of the ACA mandated Community Health Needs Assessment is **- CORRECT ANSWER
** To identify significant health needs, prioritize those needs and identify resources to address them Which option is a government-sponsored health care program that is financed through taxes and general revenue funds? - CORRECT ANSWER >>> Medicare Case management requires that a case manager be assigned - CORRECT ANSWER >>> To a select patient group *Suppose an inpatient needs a particular diagnostic or therapeutic service that the hospital cannot provide. In that case, the patient can be transported by ambulance to receive the service and immediately returned to the hospital. The costs of the ambulance services are - CORRECT ANSWER >>> Billed directly to the health plan by the ambulance supplier Medicare allows providers to submit liability claims after a ____-day waiting period, but the provider must cancel its claim against the liability payer as Medicare will pursue payment. - CORRECT ANSWER >>> 120 *The following are types of time of service denials except for: - CORRECT ANSWER >>> Patient admitted as inpatient, but should have been observation. What is an Advanced Directive? - CORRECT ANSWER >>> A document signed by a competent person giving direction to healthcare providers about treatment choices. The Office of Inspector General (OIG) was created to - CORRECT ANSWER >>> Detect and prevent fraud, waste, and abuse
opportunity to request a patient advocate, family member, or other designee to help them in these discussions According to 501r regulations, extraordinary collections actions (ECAs) may not be pursued until
- CORRECT ANSWER >>> After the hospital has taken reasonable efforts to determine the patient's eligibility for financial assistance All of the following are forms of hospital payment contracting EXCEPT **- CORRECT ANSWER
** Contracted Rebating What does the acronym MSP stand for? - CORRECT ANSWER >>> Medicare Secondary Payor The healthcare industry has developed standard claim forms and data sets that must be used for claim processing. The standard hospital claim form is the: - CORRECT ANSWER >>> UB- 04 Internal controls addressing coding and reimbursement changes are put in place to guard against - CORRECT ANSWER >>> Compliance fraud by "upcoding" All of the following are reference resources used to help guide in the application of business
** Patient admitted as inpatient, but should have been observation. What is an Advanced Directive? - CORRECT ANSWER >>> A document signed by a competent person giving direction to healthcare providers about treatment choices. The Office of Inspector General (OIG) was created to - CORRECT ANSWER >>> Detect and prevent fraud, waste, and abuse opportunity to request a patient advocate, family member, or other designee to help them in these discussions According to 501r regulations, extraordinary collections actions (ECAs) may not be pursued until - CORRECT ANSWER >>> After the hospital has taken reasonable efforts to determine the patient's eligibility for financial assistance All of the following are forms of hospital payment contracting EXCEPT - CORRECT ANSWER >>> Contracted Rebating What does the acronym MSP stand for? - CORRECT ANSWER >>> Medicare Secondary Payor The healthcare industry has developed standard claim forms and data sets that must be used for claim processing. The standard hospital claim form is the: - CORRECT ANSWER >>> UB- 04 Internal controls addressing coding and reimbursement changes are put in place to guard against - CORRECT ANSWER >>> Compliance fraud by "upcoding" All of the following are reference resources used to help guide in the application of business ethics EXCEPT - CORRECT ANSWER >>> Consumer satisfaction reports What constitutes an insurance denial? - CORRECT ANSWER >>> All of the above: Missing subscriber information. Lack of medical necessity. Ineligible date of service.
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 Process observation is a part of what framework of Revenue Cycle? **- CORRECT ANSWER
** Compliance Which of the following is NOT a factor in self-pay follow-up? - CORRECT ANSWER >>> The type of patient (inpatient, out-patient) Which option is a benefit of pre-registering patients for service? - CORRECT ANSWER >>> The patient arrival processing is expedited, reducing wait times and delays
In order to provide a patient with information that is meaningful to them for obtaining a price, all of the following factors must be considered EXCEPT - CORRECT ANSWER >>> The guarantor on the account Which of the following is true of Level 2 HCPC Codes - CORRECT ANSWER >>> They begin with a single letter (A through V) followed by four numeric digits. The revenue cycle includes - CORRECT ANSWER >>> All of the major processing steps required to process a patient account from the request for service through closing the account with a zero balance What process can the HFMA guide, "Understanding Healthcare Prices: A Consumer Guide" help with? - CORRECT ANSWER >>> Delivering a price estimate to the patient. Which option is a federally-aided, state-operated program established to provide health and long-term care coverage for low-income individuals or families? - CORRECT ANSWER
In what way, can a patient give informed consent? - CORRECT ANSWER >>> Patient signs a written consent form. 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 - CORRECT ANSWER >>> Case Management A recurring/series registration is characterized by - CORRECT ANSWER >>> The creation of one registration record for multiple days of service What is a component of HFMA's "Healthcare Dollars & Sense" initiative? **- CORRECT ANSWER
** Medical Account Resolution Patients are contacting hospitals to proactively inquire about estimated costs and fees prior to agreeing to service. The problem for hospitals in providing such information is - CORRECT ANSWER >>> The fact that charge master lists the total charge, not net charges that reflect charges after a payer's contractual adjustment When Recovery Audit Contractors (RAC) identify improper payments as over payments, the claims processing contractor must - CORRECT ANSWER >>> Send a demand letter to the ** Delivering a price estimate to the patient. Which option is a federally-aided, state-operated program established to provide health and long-term care coverage for low-income individuals or families? - CORRECT ANSWER In what way, can a patient give informed consent? - CORRECT ANSWER >>> Patient signs a written consent form. 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 - CORRECT ANSWER >>> Case Management A recurring/series registration is characterized by - CORRECT ANSWER >>> The creation of one registration record for multiple days of service What is a component of HFMA's "Healthcare Dollars & Sense" initiative? - CORRECT ANSWER >>> Medical Account Resolution Patients are contacting hospitals to proactively inquire about estimated costs and fees prior to agreeing to service. The problem for hospitals in providing such information is - CORRECT ANSWER >>> The fact that charge master lists the total charge, not net charges that reflect charges after a payer's contractual adjustment When Recovery Audit Contractors (RAC) identify improper payments as over payments, the claims processing contractor must - CORRECT ANSWER >>> Send a demand letter to the provider to recover the over payment amount During pre-registration, a search for the patient's MPI number is initiated using which of the following data sets? - CORRECT ANSWER >>> Patient's full legal name and date of birth or the patient's Social Security number In resolving medical accounts, a law firm may be used as - CORRECT ANSWER >>> Legal counsel to patients regarding financing options
To ensure proper internal controls large adjustments are able to be completed by: - CORRECT ANSWER >>> A manager or supervisor In the balance resolution process, providers should - CORRECT ANSWER >>> Ask the patient if he or she would like to receive information about payment options and supportive financial assistance programs A provider that has a contract with a health plan is designated as what? **- CORRECT ANSWER
** PPO All of the following are benefits of electronic claim submission EXCEPT **- CORRECT ANSWER ** Increases payment delays because of frequent file transmission failures Which of the following is NOT contained in a collection agency agreement? **- CORRECT ANSWER ** A mutual hold-harmless clause What tools are used by managed care health plans to determine if care is medically necessary? - CORRECT ANSWER >>> All of the above: Pre-Certification Discharge Planning Referrals Telemedicine/telehealth seeks to improve a patient's health by **- CORRECT ANSWER ** Permitting two-way, real time interactive communication between the patient, and the clinical professional
Appropriate training for patient financial counseling staff must cover all of the following EXCEPT
- CORRECT ANSWER >>> Documenting the conversation in the medical record *Small credit balances below $25 are allowed to be reversed automatically if the following cases, except: - CORRECT ANSWER >>> It is a Medicare Credit Balance When is an appropriate time to see an Emergency Department patient regarding time of service collections? - CORRECT ANSWER >>> After the patient has been triaged and medically stabilized. Medicare will only pay for tests and services that - CORRECT ANSWER >>> Medicare determines are "reasonable and necessary"
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