HFMA CRCR (CERTIFIED REVENUE CYCLE REPRESENTATIVE)
EXAM | QUESTIONS AND ANSWERS | VERIFIED ANSWERS
GRADED A+ | LATEST EXAM UPDATE
In what situation(s) should a provider NOT use a modifier? - CORRECT
ANSWER - - CPT already indicates 2-4 lesions
- CPT indicates multiple extremities
What are other names for Three-Day Payment Window? - CORRECT
ANSWER - ALL OF THE ABOVE
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
What happens during the post-service stage? - CORRECT ANSWER - Final
coding, preparation and submission of claims, payment processing, balance
billing and resolution.
What are the below tasks part of?
- Educate patients
- Coordinate to avoid duplicate patient contacts
- Be consistent in key aspects of account resolution
- Follow best practices for communication - CORRECT ANSWER - Best
practices created by the Medical Debt Task Force
Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue
cycle initiative? - CORRECT ANSWER - Process Compliance
,Which option is NOT a continuum of care provider?
A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility - CORRECT ANSWER - B. Health Plan
Contracting
What is "implied certification"? - CORRECT ANSWER - When it is implied
that a provider met all compliance standards before submitting a claim
Which of the following are essential elements of an effective compliance
program?
A. Established compliance standards and procedures.
B. Designation of a compliance officer employed within the Billing
Department.
C. Oversight of personnel by high-level personnel.
D. Automatic dismissal of any employee excluded from participation in a
federal healthcare program.
E. Reasonable methods to achieve compliance with standards, including
monitoring systems and hotlines. - CORRECT ANSWER - A. Established
compliance standards and procedures.
C. Oversight of personnel by high-level personnel.
E. Reasonable methods to achieve compliance with standards, including
monitoring systems and hotlines.
,When was Health Information Technology for Economic and Clinical Health
(HITECH) Act signed into law? - CORRECT ANSWER - FEB 17, 2009
When did HITECH Act become effective? - CORRECT ANSWER - 2013
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. Payments to Physicians for Co-Surgery Procedures
B. Denials and Appeals in Medicare Part D
C. Medicare Hospital Payments for Claims Involving the Acute- and Post-
Acute-Care Transfer Policies
D. Standard Unique Employer Identifier - CORRECT ANSWER - D. Standard
Unique Employer Identifier
What Plan are the tasks below a part of?
- Medicare Payments Made Outside of the Hospice Benefit
- Denials and Appeals in Medicare Part C and Part D
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits -
CORRECT ANSWER - The 2020 OIG Work Plan
When was the Preservation of Access to Care for Medicare Beneficiaries and
Pension Relief Act signed into law? - CORRECT ANSWER - JUNE 25 2010
What is the Medicare DRG Three-Day Payment Window? - CORRECT
ANSWER - All Diagnostic services provided to a Medicare patient by a
hospital on the Date of the patient's Inpatient admission or during the 3 calendar
days (or in the case of a non-IPPS hospital: 1 calendar day) immediately
, BEFORE the Date of Admission are REQUIRED to be included on the bill for
the IP stay (unless there is no Part A coverage)
Do Outpatient Non-Diagnostic Services qualify for separate payments if
provided with the Three-Day Payment Window? - CORRECT ANSWER - No
What is modifier 59? - CORRECT ANSWER - Used to identify CPTs OTHER
THAN E&M services, NOT normally reported together, but are appropriate
under the circumstances.
Documentation must support a different session, different procedure or surgery,
different site or organ system, separate.
What is condition code 51? - CORRECT ANSWER - Code noted on the
separate UB-04 OP claim, thus indicating the charge is unrelated to the
admission.
What kind of hospitals are the following:
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's
hospitals for examples - CORRECT ANSWER - Non-IPPS hospitals
What are the 3 types of medical necessity screenings and noncoverage
notifications required in the Medicare program? - CORRECT ANSWER - 1.
Advanced Beneficiary Notice of Noncoverage (ABN) for Part B services.
2. SNF ABN for Part A SNF services.
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
EXAM | QUESTIONS AND ANSWERS | VERIFIED ANSWERS
GRADED A+ | LATEST EXAM UPDATE
In what situation(s) should a provider NOT use a modifier? - CORRECT
ANSWER - - CPT already indicates 2-4 lesions
- CPT indicates multiple extremities
What are other names for Three-Day Payment Window? - CORRECT
ANSWER - ALL OF THE ABOVE
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
What happens during the post-service stage? - CORRECT ANSWER - Final
coding, preparation and submission of claims, payment processing, balance
billing and resolution.
What are the below tasks part of?
- Educate patients
- Coordinate to avoid duplicate patient contacts
- Be consistent in key aspects of account resolution
- Follow best practices for communication - CORRECT ANSWER - Best
practices created by the Medical Debt Task Force
Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue
cycle initiative? - CORRECT ANSWER - Process Compliance
,Which option is NOT a continuum of care provider?
A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility - CORRECT ANSWER - B. Health Plan
Contracting
What is "implied certification"? - CORRECT ANSWER - When it is implied
that a provider met all compliance standards before submitting a claim
Which of the following are essential elements of an effective compliance
program?
A. Established compliance standards and procedures.
B. Designation of a compliance officer employed within the Billing
Department.
C. Oversight of personnel by high-level personnel.
D. Automatic dismissal of any employee excluded from participation in a
federal healthcare program.
E. Reasonable methods to achieve compliance with standards, including
monitoring systems and hotlines. - CORRECT ANSWER - A. Established
compliance standards and procedures.
C. Oversight of personnel by high-level personnel.
E. Reasonable methods to achieve compliance with standards, including
monitoring systems and hotlines.
,When was Health Information Technology for Economic and Clinical Health
(HITECH) Act signed into law? - CORRECT ANSWER - FEB 17, 2009
When did HITECH Act become effective? - CORRECT ANSWER - 2013
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. Payments to Physicians for Co-Surgery Procedures
B. Denials and Appeals in Medicare Part D
C. Medicare Hospital Payments for Claims Involving the Acute- and Post-
Acute-Care Transfer Policies
D. Standard Unique Employer Identifier - CORRECT ANSWER - D. Standard
Unique Employer Identifier
What Plan are the tasks below a part of?
- Medicare Payments Made Outside of the Hospice Benefit
- Denials and Appeals in Medicare Part C and Part D
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits -
CORRECT ANSWER - The 2020 OIG Work Plan
When was the Preservation of Access to Care for Medicare Beneficiaries and
Pension Relief Act signed into law? - CORRECT ANSWER - JUNE 25 2010
What is the Medicare DRG Three-Day Payment Window? - CORRECT
ANSWER - All Diagnostic services provided to a Medicare patient by a
hospital on the Date of the patient's Inpatient admission or during the 3 calendar
days (or in the case of a non-IPPS hospital: 1 calendar day) immediately
, BEFORE the Date of Admission are REQUIRED to be included on the bill for
the IP stay (unless there is no Part A coverage)
Do Outpatient Non-Diagnostic Services qualify for separate payments if
provided with the Three-Day Payment Window? - CORRECT ANSWER - No
What is modifier 59? - CORRECT ANSWER - Used to identify CPTs OTHER
THAN E&M services, NOT normally reported together, but are appropriate
under the circumstances.
Documentation must support a different session, different procedure or surgery,
different site or organ system, separate.
What is condition code 51? - CORRECT ANSWER - Code noted on the
separate UB-04 OP claim, thus indicating the charge is unrelated to the
admission.
What kind of hospitals are the following:
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's
hospitals for examples - CORRECT ANSWER - Non-IPPS hospitals
What are the 3 types of medical necessity screenings and noncoverage
notifications required in the Medicare program? - CORRECT ANSWER - 1.
Advanced Beneficiary Notice of Noncoverage (ABN) for Part B services.
2. SNF ABN for Part A SNF services.
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
