2024 LATEST CRCR HFMA SET 1 (QUESTIONS AND ANSWERS)

Define Revenue Cycle - ANSWER REVENUE CYCLE ----- is the series of events and services provided prior to, during, and after the course of treatment Departments that contribute to the Revenue Cycle. - ANSWER Departments that contribute to the Revenue Cycle. 1. Access 2. Health information management/ Medical records 3. Case-management 4. Patient Care Services 5. Patient Financial Services What led the creation of revenue management services? - ANSWER The emphasis on the revenue cycle has resulted in the need to organize its components differently and created a new business unit known as revenue integrity or revenue management services. Benefit of Electronic transactions? - ANSWER Electronic transactions."------ transactions are associated with revenue capture and collection activities. The implementation of electronic data interchange (EDI) allows actions previously conducted by telephone/ manual methods to be performed electronically ( improves workflow). 5010 Transaction Set Function? - ANSWER 5010 Transaction Set------new transaction processing system with new transaction standards. These standards will: a. Offer healthcare providers enhanced information. b. Require providers to provide payers with additional data to facilitate claim payments. 6 Transactions associated with the revenue cycle include: - ANSWER 6 Transactions associated with the revenue cycle include: a. Claim/Encounter (837-I, 837-P, 837-COB, 837-P COB, NCPD). b. Remittance (835). c. Claim Status Inquiry/Response (276/277). d. Eligibility Inquiry/Response (270/271). e. Healthcare Services Review (278) Pre-certification and Referrals. f. Acknowledgment (999) Which of the following would be a hard cost of customer dissatisfaction? Loss of future revenue Negative word-of-mouth advertising Decisions of future patients to use another facility Decisions of current patients to use other facilities for future ancillary services - ANSWER loss of future revenue Define hard cost and soft cost. - ANSWER 1. Hard Cost -the loss of future revenue 2. Soft Cost- Negative word-of-mouth advertising that may influence others not to use the hospital. Single greatest reason for an inability to bill and collect accounts receivable in a timely manner? - ANSWER Single greatest reason for an inability to bill and collect accounts receivable in a timely manner: Inadequate and incorrect information received from the admitting/patient access department The Access department's policies and procedures should also address the what 3 topics: - ANSWER ... The key is the timing of the collection of the financial data and payment is? - ANSWER ... When certain services are not covered, a Medicare patient should be issued a/an __________to notify the patient that they may be responsible for payment. - ANSWER ABN---Advance Beneficiary Notice of Non-Coverage (ABN) Examples of when Medicare is secondary include: - ANSWER ... The COBRA benefit is provided to employees or their family members if they lose coverage due to a number of reasons, such as the following: (list 4) - ANSWER The COBRA benefit is provided to employees or their family members if they lose coverage due to a number of reasons, such as the following: Loss of employment Reduction in hours worked Divorce Death of the supporting spouse The time required for gathering information has the highest return when the investment is made _________. Before the patient's arrival After discharge When the first bill comes off After the account goes to collections - ANSWER Before the patient's arrival What are the 4 things included in claims adjudication? - ANSWER Claims adjudication includes the following: 1.Determination of benefits levels and coverage 2. Coordination of benefits 3.Subrogation of third-party liability claims 4.Generation of appropriate explanation of benefit forms What are the twin goals of financial counseling? - ANSWER The twin goals of financial counseling are: That the provider understands upfront a patient's ability to pay, and That the patient understands his or her financial responsibility to the provider. Accounts receivable (A/R) personnel must become key participants in the POS collection process. Is this statement true or false? - ANSWER False Which of the following is true of deposits? A deposit should be requested to secure payment when precise charge calculations are not practical. Deposit policies should be reviewed and approved by the CFO. To facilitate calculation of deposits, credit references should be readily available. To facilitate internal reporting, deposit payments should be held in the general fund. - ANSWER A deposit should be requested to secure payment when precise charge calculations are not practical. In __________, a provider arranges for patients to obtain loans through a local bank. In-house financing A bank financing agreement Charity care Bad debt write-off - ANSWER In-house financing ----a provider arranges for patients to obtain loans through a local bank.