HFMA Study Guide Exam Questions and Answers 100% Pass

HFMA Study Guide Exam Questions and Answers 100% Pass Through what document does a hospital establish compliance standards? - ANSWER -Code of Conduct What is the purpose of the OIG work plan? - ANSWER -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? - ANSWER -Diagnostic services and related charges provided on the Wednesday, Thursday and Friday before admission What does a modifier allow a provider to do? - ANSWER -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? - ANSWER -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? - ANSWER -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? - ANSWER -One registration record is created for multiple days of service 2 | P a g e Created by Grace Amelia © 2025, All Rights Reserved. What are non-emergency patients who come for service without prior notification to the provider called? - ANSWER -Unscheduled patients Which of the following statements apply to the observation patient type? - ANSWER -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? - ANSWER - Physician, nursing, and pharmacy What is the purpose of the initial step in the outpatient testing scheduling process? - ANSWER - 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? - ANSWER -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? - ANSWER -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? - ANSWER -Documentation of the medical necessity for the test What is an advantage of a preregistration program? - ANSWER -It reduces processing times at the time of service What data are required to establish a new MPI (master patient index) entry? - ANSWER -The patient's full legal name, date of birth, and sex Which HIPAA transaction set provides electronic processing of insurance verification requests and responses? - ANSWER -The 270-271 set 3 | P a g e Created by Grace Amelia © 2025, All Rights Reserved. A mother and father both cover their 16-year-old child as a dependent on their health insurance plans, which both follow the birthday rule. The mother's date of birth is January 19, 1968; the father's date of birth is July 19, 1967. Whose plan is the primary payer? - ANSWER -The mother's plan Which of the following statements is true about third-party payments? - ANSWER -The payments are received by the provider from the payer responsible for reimbursing the provider for the patient's covered services What is a co-payment? - ANSWER -The fixed amount that is due for a specific service A patient's annual out-of-pocket limitation is $3,000, excluding the deductible. To date this calendar year the patient has satisfied the $500 deductible and has paid $2,300 in coinsurance to various providers. For the balance of the calendar year, what is the maximum amount of coinsurance the patient will owe? - ANSWER -$700