HFMA Study Guide Exam Questions
and Answers12
Through what document does a hospital establish compliance standards? - ANSWERS-Code of
Conduct
What is the purpose of the OIG work plan? - ANSWERS-Communicate issues that will be
reviewed during the year for compliance with Medicare regulations
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window
rule? - ANSWERS-Diagnostic services and related charges provided on the Wednesday, Thursday
and Friday before admission
What does a modifier allow a provider to do? - ANSWERS-Report a specific circumstance that
affected a procedure or service without changing the code or its definition
If outpatient diagnostic services are provided within three days of the admission of a Medicare
beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to
these charges? - ANSWERS-They must be combined with the inpatient bill and paid under the
MS-DRG (diagnosis-related group) system
Why is the OIG (Office of Inspector General) pursuing the Medicare Secondary Payer (MSP)
initiative? - ANSWERS-It reviews Medicare payments for beneficiaries who have other insurance
and assesses the effectiveness of procedures in preventing inappropriate Medicare payments
for beneficiaries with other insurance coverage
What is a recurring or series registration? - ANSWERS-One registration record is created for
multiple days of service
, What are non-emergency patients who come for service without prior notification to the
provider called? - ANSWERS-Unscheduled patients
Which of the following statements apply to the observation patient type? - ANSWERS-It is used
to evaluate the need for an inpatient admission
Which services are hospice programs required to provide on an around-the-clock basis? -
ANSWERS-Physician, nursing, and pharmacy
What is the purpose of the initial step in the outpatient testing scheduling process? - ANSWERS-
Identify the correct patient in the provider's database or add the patient to the database
Scheduler instructions are used to prompt the scheduler to do what? - ANSWERS-Complete the
scheduling process correctly based on service requested
The time needed to prepare the patient before service is the difference between the patient's
arrival time and which of the following? - ANSWERS-Schedule time
Medicare guidelines require that when a test is ordered for which an LCD (local coverage
determination) or NCD (national coverage determination) exists, the information provided on
the order must include which of the following? - ANSWERS-Documentation of the medical
necessity for the test
What is an advantage of a preregistration program? - ANSWERS-It reduces processing times at
the time of service
What data are required to establish a new MPI (master patient index) entry? - ANSWERS-The
patient's full legal name, date of birth, and sex
and Answers12
Through what document does a hospital establish compliance standards? - ANSWERS-Code of
Conduct
What is the purpose of the OIG work plan? - ANSWERS-Communicate issues that will be
reviewed during the year for compliance with Medicare regulations
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window
rule? - ANSWERS-Diagnostic services and related charges provided on the Wednesday, Thursday
and Friday before admission
What does a modifier allow a provider to do? - ANSWERS-Report a specific circumstance that
affected a procedure or service without changing the code or its definition
If outpatient diagnostic services are provided within three days of the admission of a Medicare
beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to
these charges? - ANSWERS-They must be combined with the inpatient bill and paid under the
MS-DRG (diagnosis-related group) system
Why is the OIG (Office of Inspector General) pursuing the Medicare Secondary Payer (MSP)
initiative? - ANSWERS-It reviews Medicare payments for beneficiaries who have other insurance
and assesses the effectiveness of procedures in preventing inappropriate Medicare payments
for beneficiaries with other insurance coverage
What is a recurring or series registration? - ANSWERS-One registration record is created for
multiple days of service
, What are non-emergency patients who come for service without prior notification to the
provider called? - ANSWERS-Unscheduled patients
Which of the following statements apply to the observation patient type? - ANSWERS-It is used
to evaluate the need for an inpatient admission
Which services are hospice programs required to provide on an around-the-clock basis? -
ANSWERS-Physician, nursing, and pharmacy
What is the purpose of the initial step in the outpatient testing scheduling process? - ANSWERS-
Identify the correct patient in the provider's database or add the patient to the database
Scheduler instructions are used to prompt the scheduler to do what? - ANSWERS-Complete the
scheduling process correctly based on service requested
The time needed to prepare the patient before service is the difference between the patient's
arrival time and which of the following? - ANSWERS-Schedule time
Medicare guidelines require that when a test is ordered for which an LCD (local coverage
determination) or NCD (national coverage determination) exists, the information provided on
the order must include which of the following? - ANSWERS-Documentation of the medical
necessity for the test
What is an advantage of a preregistration program? - ANSWERS-It reduces processing times at
the time of service
What data are required to establish a new MPI (master patient index) entry? - ANSWERS-The
patient's full legal name, date of birth, and sex
