CPAR Exam Prep 2026 (Georgia HFMA) answered 100% correctly

CPAR Exam Prep 2026 (Georgia HFMA) answered 100% correctly Federal Poverty Guidelines The basis for determining qualifications for indigent and/or charity care is the ___________ 75% What percentage of denials are traced back to the front end? Clinical denial A claim that fails to meet established coverage guidelines or the care fails to meet certain medical necessity criteria as establish by the payer is what kind of denial?Examples: No pre-authorization/no pre-certification was obtained (either before or after service was provided) -Post-billing medical necessity review failed to deem care as medically necessary -May include downgrade of inpatient status (level of care or length of stay), -pre-existing condition may be excluded, procedure deemed experimental and not approved, emergency care deemed to be non-emergent in nature. Technical denial A claim that fails to contain the necessary information required for the payer to process the claim. Also known as "administrative"denials, such denials are generally linked to claims that were incorrectly filed. Examples: Claim not submitted per payer's timely filing guidelines (Note: There is no one set guideline for commercial and managed care payers; these are contract specific and may be product (HMO vs. PPO) specific) -Service was out-of-network and insured's plan does not pay when out-of-network o Improper bill type used to file claim -Wrong demographic information (name, birth date, relationship to insured, policy number missing or invalid)