CRCR Review 36 Questions With Answers 2022/2023,100% CORRECT

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CRCR Review 36 Questions With Answers 2022/2023 Which option is NOT a main HFMA Healthcare Dollars and Sense revenue cycle initiative? A) Patient Financial Communications B) Medical Account Resol... ution C) Price Transparency D) Process Compliance - CORRECT ANSWERSD) Process Compliance Approximately what ______% of billing information is obtained during the registration process (Patient Access). - CORRECT ANSWERS40% What is the objective of the HCAHPS initiative? A) To conduct evaluations concerning patients' perspective on hospital care. B) To provide a standardization method for evaluating patients' perspective on hospital care. C) To provide clear communication and good customer service, which will give the provider a competitive edge. D) To make certain that during registration key information is verified by means of a picture ID and insurance card. - CORRECT ANSWERSB) To provide a standardization method for evaluating patients' perspective on hospital care. Which option is NOT a department that supports and collaborates with the revenue cycle? A) Finance B) Clinical Services C) Information Technology D) Assisted Living Services - CORRECT ANSWERSD) Assisted Living Services What must a SNF have to participate in the Medicare Program? - CORRECT ANSWERSA written transfer agreement with one of more participating hospitals providing for the transfer of patients between the hospital and SNF. In order to qualify for Medicare Coverage of Home Health Service a patient must meet 2 conditions. - CORRECT ANSWERS1) An MD must certify that a patient is confined to his/her residence (Not necessarily bedridden). Leaving the home would be a considerable effort 2) Hospitals and SNFs may not be considered a place of residence for purposes of home health coverage. Which options is NOT a continuum of care provider? A) Physician B) Skilled Nursing Facility (SNF) C) Health Plan Contracting D) Hospice - CORRECT ANSWERSC) Health Plan Contracting Which of the following are essential elements of an effective compliance program? A) Oversight of personnel by high-level personnel. B) Established compliance standards and procedures. C) Designation of a compliance offices employees within the Billing department. D) Reasonable methods to achieve compliance with standards, including monitoring systems and hotlines. E) Automatic dismissal of any employee excluded from participating in a federal healthcare program. - CORRECT ANSWERSA, B, and D A) Oversight of personnel by high-level personnel. B) Established compliance standards and procedures. D) Reasonable methods to achieve compliance with standards, including monitoring systems and hotlines. What is the OIG? - CORRECT ANSWERSThe Office of the Inspector General Annually, the OIG publishes a work plan of compliance issues and objectives that will be focused on throughout the following year. Identify which option is NOT a work plan task mentioned in this course. A) Standard Unique Employer Identifier B) Provider-based status C) Medical devices D) Reconciliation of outlier payments - CORRECT ANSWERSA) Standard Unique Employer Identifier All diagnostic services provided to a MCR beneficiary by a hospital (or entity owned by the hospital) on the date of the beneficiary's inpatient admission or during the ____ calendar days immediately preceding the date of the admission are required to be included on the inpatient bill. - CORRECT ANSWERS3 IN order to promote the use of correct coding methods on a national basis and prevent payment errors due to improper coding, the Centers for Medicare and Medicaid Services (CMS) developed what? A) The Correct Coding Initiative (CCI) B) The Advance Beneficiary Notice of Noncoverage C) The Medicare Secondary Payer (MSP) D) Modifiers - CORRECT ANSWERSA) The Correct Coding Initiative (CCI) What do business/organizational ethics represent? A) An employee's actions influenced by experiences and value system. B) The patient privacy standard within health care C) A healthcare provider's practices and principles D) Principals and standards by which organizations operate. - CORRECT ANSWERSD) Principals and standards by which organizations operate. What is the intended outcome of the collaborations made throughout an ACO delivery system? A) To create cost-containment provisions to reform the healthcare delivery system. B) To ensure appropriateness of care, elimination of duplicate services, and prevention of medicare errors for a population of patients. C) To provide financial incentives to physicians for reporting quality data to CMS. D) To reform the healthcare system into a system to rewards greater value, improves the quality of care and increases efficiency in the delivery of services. - CORRECT ANSWERSB) To ensure appropriateness of care, elimination of duplicate services, and prevention of medicare errors for a population of patients. Which option is NOT a reserve amount on a providers' financial statement? A) Bad Debts B) Contractual Allowance Accounts C) Contra-Account Amounts D) Charity Care - CORRECT ANSWERSC) Contra-Account Amounts What are KPIs? A) Days in A/R is calculated based on the value of the total accounts receivable into 30, 60, 90, 120 days and over categories, based on the date of service/discharge. C) Benchmarks which are used to compete Key Performance indicators is an organization to an agreed upon average expected standard within the same industry. D) Key Performance Indicators which set standards for accounts receivables (A/R) and provide a method for measuring the collection and control of A/R. - CORRECT ANSWERSD) Key Performance Indicators which set standards for accounts receivables (A/R) and provide a method for measuring the collection and control of A/R. Which patients are considered scheduled? A) Observation Patients B) Emergency Departments Patients C) Hospice Care D) Recurring/Series Patients - CORRECT ANSWERSD) Recurring/Series Patients Name the guideline that Medicare established to determine which diagnoses, signs, or symptoms are payable. A) Scheduling Instructions B) Patient Identifiers C) Local Coverage Determinations D) Advance Beneficiary Notice - CORRECT ANSWERSC) Local Coverage Determinations What is the purpose of insurance verification? A) To identify information that does not have to be collected from the patient. B) To ensure accuracy of the health plan information. C) To complete guarantor information if the guarantor is not the patient. D) To effectively complete the MSP screening process. - CORRECT ANSWERSB) To ensure accuracy of the health plan information. Which option is a federally-aided, state-operated program to provide health and long-term care coverage? A) Self-Insured Plans B) Medicaid C) Medicare D) Liability Coverage - CORRECT ANSWERSB) Medicaid Match each type of plan with the statements below. (HMO, PPO, POS, CDHP0> A) A health plan that provides comprehensive healthcare services, within a designated population, on a pre-payment basis. B) A group of medical providers is identified to furnish services at lower than usual fees. C) Members can refer themselves outside of the plan and still get some coverage. D) Subscriber agrees to a high initial deductible, in return for lower premiums. - CORRECT ANSWERSA) HMO- A health plan that provides comprehensive healthcare services, within a designated population, on a pre-payment basis. B) PPO - A group of medical providers is identified to furnish services at lower than usual fees. C) POS - Members can refer themselves outside of the plan and still get some coverage. D) CDHP - Subscriber agrees to a high initial deductible, in return for lower premiums. Which option is NOT a specific managed care requirement? A) Notification B) Referrals C) Preferred Provider Organization D) Discharge Planning - CORRECT ANSWERSC) Preferred Provider Organization What is the first component of a pricing determination? A) Use a worksheet or other tool for guidance in determining an estimate B) Verification of the patient's insurance eligibility and benefits. C) Identify the service or test involved D) Inform the patient that physician services are or are not included. - CORRECT ANSWERSB) Verification of the patient's insurance eligibility and benefits. What is the purpose of financial counseling? A) To educate the patient on his/her health plan coverage and financial responsibility for healthcare services B) To address the most appropriate ways to conduct financial interactions at every point. C) To train staff on how to request payment and conduct conversations. D) To help the patient understand exactly how a contracted health plan will resolve their benefit package. - CORRECT ANSWERSA) To educate the patient on his/her health plan coverage and financial responsibility for healthcare services What does EMTALA require hospitals to do? A) To initially triage patients, where a "quick" registration record is generated to specifically allow order entry. B) To complete a standardized form signed by all patients that is used to inform the patient about the admission and conditions with must be agreed upon. C) To confirm information that may be used to identify the patient in the provider's MPI, which includes the patient's full, legal name, SSN, and/or date of birth. D) To provide a medical screening examination and stabilizing treatment to every person presenting at an ED and requesting medical evaluation or treatment. - CORRECT ANSWERSD) To provide a medical screening examination and stabilizing treatment to every person presenting at an ED and requesting medical evaluation or treatment. In what manner do case managers assist revenue cycle staff? A) By reviewing a patient's individual case and recommend treatment changes. B) With monitoring the progression of high resource consumptive cases. C) By estimating how long the patient will be in the hospital and what the expected outcome will be. D) Providing assistance with written appeals to health plans related to utilization and other care issues. - CORRECT ANSWERSD) Providing assistance with written appeals to health plans related to utilization and other care issues. Why is it critical that a chargemaster is reviewed and updated regularly? A) So the CPT databases can have the most current and accurate information. B) To ensure it supports and represents the services provided within the organization. C) Because charge descriptions can vary greatly between providers. D) To ensure the most appropriate measure of the utilization of resources. - CORRECT ANSWERSB) To ensure it supports and represents the services provided within the organization. What is the responsibility of HIM? A) To denote the medical procedures performed by a healthcare provider on a patient. B) To substantiate health insurance claims filed by the patient, the physician, and the provider. C) To make information available instantly and securely to authorized users. D) To maintain all patient medical records. - CORRECT ANSWERSD) To maintain all patient medical records. What are claim edits? A) Various data sources including Medicare and Medicaid bulletins and manuals, individual health plan manuals. B) The submission, receipt, and processing of automated claims, thereby eliminating maintenance time and reducing data entry time. C) A multi-stakeholder collaboration of more than 130 organizations - providers, health plans, vendors, and government agencies. D) Rules developed to verify the accuracy and completeness of claims based on each health plan's policies. - CORRECT ANSWERSD) Rules developed to verify the accuracy and completeness of claims based on each health plan's policies. Hospice benefits for a Medicare beneficiary who is in a SNF cover professional management of an individual's hospice care and the room and board for the individual. (T/F) - CORRECT ANSWERSFalse - It does not cover room and board. For which levels of hospice care is only one rate applied to each day? (select all that apply) A) Routine Home Care B) Continuous Home Care C) Inpatient Respite Care D) General Inpatient Care - CORRECT ANSWERSA, C, and D. - Home care is determined by the number of furnished hours. Which statement is NOT a unique billing requirement for different provider types? A) Overall aggregate payments made to a hospice are subject to a "cap amount", calculated by the MAC at the end of the hospice cap period. B) a patient may be balance billed for whatever amount the non-contractiting physician charges above the health plan's reimbursement amount. C) When billing services on a UB04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521) D) With the exception of physician services, Medicare reimbursement for hospice care is made at one of four pre-determined rates for each day of hospice care. - CORRECT ANSWERSB) a patient may be balance billed for whatever amount the non-contractiting physician charges above the health plan's reimbursement amount. Which option is NOT a general billing requirement? A) A day begins at midnight and ends 24 hours later, this is called the midnight-to-midnight method of counting days. B) When billing services on a UB04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521) C) Providers typically submit a single claim for an inpatient or outpatient episode of care, or a series of recurring claim for repeat outpatient services for the same condition. D) Claims on or after January 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare. - CORRECT ANSWERSB) When billing services on a UB04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521) Which concept is NOT a contracted payment model? A) Percentage Discount B) Stop-Loss Provision C) Capitation D) Per Diem Payment - CORRECT ANSWERSB) Stop-Loss Provision What s an EFT? A) A standardized healthcare claim payment/advice known as the 835 format. B) The establishment of internal audits by personnel outside the involved department. C) A process that requires the separation of duties when processing patient payments D) The electronic transfer of funds from he payer to the payee through the banking system. - CORRECT ANSWERSD) The electronic transfer of funds from he payer to the payee through the banking system. Which statement is NOT true regarding credit balances? A) A small credit policy should be matched by a similar policy for small debit balances. B) Hospital generated statements should be sent to patients regarding small credit balances. C) There are no CMS hospital compliance requirements regarding credit balances. D) Tracking reports should be developed to identify internal charge credits versus external charge credits. - CORRECT ANSWERSC) There are no CMS hospital compliance requirements regarding credit balances. [Show More]

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