CRCR Exam: Questions & Answers
Which of the following statements are true of HFMA's Patient Financial
Communications Best Practices?
(Ans - The best practices were developed specifically to help patients
understand the cost of services, their individual insurance benefits and their
responsibility for balance after insurance if any
The patient experience includes all of the following except:
(Ans - The average number of positive mentions received by the health
system or practice and the public comments refuting unfriendly posts on
social media sites
Corporate compliance programs play an important role in protecting the
integrity of operations and ensuring compliance with federal and state
requirements. The Code of Conduct is:
(Ans - A critical tool to ensure the compliance with the organization's
compliance standards and procedures, an essential and integral
component of the organization's culture, fosters and environment where
concerns and questions may be raised without fear of retaliation or
retribution
Specific to Medicare fee-for-service patients, which of the following payers
have always been liable for payment?
(Ans - Public health service programs, federal grant programs, VA
programs, black lung program services and workers comp claims
Provider policies and procedures should be in plan to reduce the risk of
ethics violations. Examples of ethics violations are:
(Ans - Financial misconduct, overcharging and miscoding claims, theft of
property and falsifying records to boost reimbursement, financial
misconduct and applying policies in an inconsistent manner
,Providers are now being reimbursed with a focus on the value of the
services provided, rather than volume, which requires collaboration among
providers.
What is the intended outcome of collaborations made through an ACO
delivery system for a population of patients?
(Ans - To eliminate duplicate services, prevent medical errors and ensure
appropriateness of care
What is the new terminology now employed in the calculation of net patient
service revenues?
(Ans - Explicit price concessions and implicit price concessions
What are the two KPIs used to monitor performance related to the
production and submission of claims to third party payers and patients
(self-pay)?
(Ans - Elapsed days from discharge to final bill and elapsed days from final
bill to claim/bill submission
What are the three traditional steps of the Revenue Cycle?
(Ans - Pre-service, time-of-service and post-service
What are the steps during pre-service?
(Ans –
1. The patient is scheduled and pre-registered for service
2. The encounter record is generated and the patient/guarantor information
is obtained or updated
3. The requested service is screened for med necessity; insurance is
verified and pre-auths obtained
4. The cost is identified and insurance benefits are used to calculate the
price of the services to the patient
5. If the service is deemed not med necessary additional processing is
done
6. The patient is notified of their financial responsibility including
copay/deductible and their eligibility for financial assistance is assessed
,What happens for scheduled patients at the time of service?
(Ans –
1. Pre-registration record is activated, consents are signed and
copays/balances are collected
2. Positive patient identification is completed and an armband is given
3. Alternatively, scheduled patients can report to an express arrival desk
What happens for unscheduled patients at the time of service?
(Ans - Comprehensive registration and financial processing is completed at
the time-of-service. The process mirrors the work that was completed for
scheduled patients prior to service
What are the nine steps of time-of-service processing for unscheduled
patients?
(Ans –
1. Creation of the registration record
2. Order review to ensure compliance with the rules for what makes a
complete order
3. Validation of the health plan and identification of any amount the patient
is currently due
4. Completion of med necessity screening, if necessary
5. Review and completion of pre-cert requirements for the order
6. Identification of all charges related to the order and applied insurance
benefits to calculate amount due
7. If a balance is due, financial conversation occurs
8. If all is well, patient gets service
9. Charges are entered as services are rendered
What is the overview for the three steps of the revenue cycle?
(Ans –
1. Pre-service: the patient is scheduled and registered for service; patient
service costs are calculated
2. Time-of-service: case management and discharge planning services are
provided; consents are signed
, 3. Post-service: Bill sent electronically to health plan, patient account is
monitored for payment
What are the goals of the engaged consumer portion of the rev cycle?
(Ans - Ease of access, improved customer service and improved quality of
care
What are the goals of the engaged patient portion of the rev cycle?
(Ans - Improve the information and choices for the patient regarding care
and financial decisions
What are the goals of the satisfied customer portion of the rev cycle?
(Ans - Appropriate payment, effective and efficient account resolution and
decreased cost to collect
What are the Healthcare Dollar and Sense initiatives?
(Ans - Patient financial communication best practices, best practices for
price transparency, medical account resolution. Overall to help make sense
of price and value in healthcare
What is the best practice for when and where to have patient financial
discussions?
(Ans –
1. No discussion before patient is screened and stabilized in the ER
2. If in an emergency medical condition, the conversation occurs in the
discharge process
3. In a non-emergency situation, occurs in registration or discharge process
in an area that does not disturb others
4. When possible, have financial conversations before services are
rendered
5. Have discussions as early as possible
Which of the following statements are true of HFMA's Patient Financial
Communications Best Practices?
(Ans - The best practices were developed specifically to help patients
understand the cost of services, their individual insurance benefits and their
responsibility for balance after insurance if any
The patient experience includes all of the following except:
(Ans - The average number of positive mentions received by the health
system or practice and the public comments refuting unfriendly posts on
social media sites
Corporate compliance programs play an important role in protecting the
integrity of operations and ensuring compliance with federal and state
requirements. The Code of Conduct is:
(Ans - A critical tool to ensure the compliance with the organization's
compliance standards and procedures, an essential and integral
component of the organization's culture, fosters and environment where
concerns and questions may be raised without fear of retaliation or
retribution
Specific to Medicare fee-for-service patients, which of the following payers
have always been liable for payment?
(Ans - Public health service programs, federal grant programs, VA
programs, black lung program services and workers comp claims
Provider policies and procedures should be in plan to reduce the risk of
ethics violations. Examples of ethics violations are:
(Ans - Financial misconduct, overcharging and miscoding claims, theft of
property and falsifying records to boost reimbursement, financial
misconduct and applying policies in an inconsistent manner
,Providers are now being reimbursed with a focus on the value of the
services provided, rather than volume, which requires collaboration among
providers.
What is the intended outcome of collaborations made through an ACO
delivery system for a population of patients?
(Ans - To eliminate duplicate services, prevent medical errors and ensure
appropriateness of care
What is the new terminology now employed in the calculation of net patient
service revenues?
(Ans - Explicit price concessions and implicit price concessions
What are the two KPIs used to monitor performance related to the
production and submission of claims to third party payers and patients
(self-pay)?
(Ans - Elapsed days from discharge to final bill and elapsed days from final
bill to claim/bill submission
What are the three traditional steps of the Revenue Cycle?
(Ans - Pre-service, time-of-service and post-service
What are the steps during pre-service?
(Ans –
1. The patient is scheduled and pre-registered for service
2. The encounter record is generated and the patient/guarantor information
is obtained or updated
3. The requested service is screened for med necessity; insurance is
verified and pre-auths obtained
4. The cost is identified and insurance benefits are used to calculate the
price of the services to the patient
5. If the service is deemed not med necessary additional processing is
done
6. The patient is notified of their financial responsibility including
copay/deductible and their eligibility for financial assistance is assessed
,What happens for scheduled patients at the time of service?
(Ans –
1. Pre-registration record is activated, consents are signed and
copays/balances are collected
2. Positive patient identification is completed and an armband is given
3. Alternatively, scheduled patients can report to an express arrival desk
What happens for unscheduled patients at the time of service?
(Ans - Comprehensive registration and financial processing is completed at
the time-of-service. The process mirrors the work that was completed for
scheduled patients prior to service
What are the nine steps of time-of-service processing for unscheduled
patients?
(Ans –
1. Creation of the registration record
2. Order review to ensure compliance with the rules for what makes a
complete order
3. Validation of the health plan and identification of any amount the patient
is currently due
4. Completion of med necessity screening, if necessary
5. Review and completion of pre-cert requirements for the order
6. Identification of all charges related to the order and applied insurance
benefits to calculate amount due
7. If a balance is due, financial conversation occurs
8. If all is well, patient gets service
9. Charges are entered as services are rendered
What is the overview for the three steps of the revenue cycle?
(Ans –
1. Pre-service: the patient is scheduled and registered for service; patient
service costs are calculated
2. Time-of-service: case management and discharge planning services are
provided; consents are signed
, 3. Post-service: Bill sent electronically to health plan, patient account is
monitored for payment
What are the goals of the engaged consumer portion of the rev cycle?
(Ans - Ease of access, improved customer service and improved quality of
care
What are the goals of the engaged patient portion of the rev cycle?
(Ans - Improve the information and choices for the patient regarding care
and financial decisions
What are the goals of the satisfied customer portion of the rev cycle?
(Ans - Appropriate payment, effective and efficient account resolution and
decreased cost to collect
What are the Healthcare Dollar and Sense initiatives?
(Ans - Patient financial communication best practices, best practices for
price transparency, medical account resolution. Overall to help make sense
of price and value in healthcare
What is the best practice for when and where to have patient financial
discussions?
(Ans –
1. No discussion before patient is screened and stabilized in the ER
2. If in an emergency medical condition, the conversation occurs in the
discharge process
3. In a non-emergency situation, occurs in registration or discharge process
in an area that does not disturb others
4. When possible, have financial conversations before services are
rendered
5. Have discussions as early as possible
