HFMA CRCR EXAM LATEST EXAM 170+
QUESTIONS AND CORRECT ANSWERS(VERIFIED
ANSWERS)
What are collection agency fees based on? - answer-A percentage of dollars
collected
Self-funded benefit plans may choose to coordinate benefits using the gender
rule or what other rule? - answer-Birthday
In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers? - answer-Case rates
What customer service improvements might improve the patient accounts
department? - answer-Holding staff accountable for customer service during
performance reviews
What is a primary responsibility of the Recover Audit Contractor? - answer-To
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - answer-Comply with state
statutes concerning reporting credit balance
,Insurance verification results in what? - answer-The accurate identification of
the patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - answer-CMS 1500
What activities are completed when a scheduled pre-registered patient arrives
for service? - answer-Registering the patient and directing the patient to the
service area
In addition to being supported by information found in the patient's chart, a
CMS 1500 claim must be coded using what? - answer-HCPCS (Healthcare
Common Procedure Coding system)
What results from a denied claim? - answer-The provider incurs rework and
appeal costs
Why does the financial counselor need pricing for services? - answer-To
calculate the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - answer-
Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? - answer-Appeal
conditions specified in the individual payer's contract
,The important message from Medicare provides beneficiaries with information
concerning what? - answer-Right to appeal a discharge decision if the patient
disagrees with the services
Through what document does a hospital establish compliance standards? -
answer-Code of conduct
How does utilization review staff use correct insurance information? - answer-
To obtain approval for inpatient days and coordinate services
When is it not appropriate to use observation status? - answer-As a substitute
for an inpatient admission
What is a serious consequence of misidentifying a patient in the MPI? -
answer-The services will be documented in the wrong record
When a patient reports directly to a clinical department for service, what will
the clinical department staff do? - answer-Redirect the patient to the patient
access department for registration
What process can be used to shorten claim turnaround time? - answer-Send
high-dollar hard-copy claims with required attachments by overnight mail or
registered mail
, What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do?
- answer-Inform a Medicare beneficiary that Medicare may not pay for the
order or service
What type of account adjustment results from the patient's unwillingness to
pay for a self-pay balance? - answer-Bad debt adjustment
What is the initial hospice benefit? - answer-Two 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim?
- answer-If the patient requires ambulance transportation to a skilled nursing
facility
How should a provider resolve a late-charge credit posted after an account is
billed? - answer-Post a late-charge adjustment to the account
an increase in the dollars aged greater than 90 days from date of service
indicate what about accounts - answer-They are not being processed in a
timely manner
What is an advantage of a preregistration program? - answer-It reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? - answer-
Medically unnecessary services and custodial care
QUESTIONS AND CORRECT ANSWERS(VERIFIED
ANSWERS)
What are collection agency fees based on? - answer-A percentage of dollars
collected
Self-funded benefit plans may choose to coordinate benefits using the gender
rule or what other rule? - answer-Birthday
In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers? - answer-Case rates
What customer service improvements might improve the patient accounts
department? - answer-Holding staff accountable for customer service during
performance reviews
What is a primary responsibility of the Recover Audit Contractor? - answer-To
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - answer-Comply with state
statutes concerning reporting credit balance
,Insurance verification results in what? - answer-The accurate identification of
the patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - answer-CMS 1500
What activities are completed when a scheduled pre-registered patient arrives
for service? - answer-Registering the patient and directing the patient to the
service area
In addition to being supported by information found in the patient's chart, a
CMS 1500 claim must be coded using what? - answer-HCPCS (Healthcare
Common Procedure Coding system)
What results from a denied claim? - answer-The provider incurs rework and
appeal costs
Why does the financial counselor need pricing for services? - answer-To
calculate the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - answer-
Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? - answer-Appeal
conditions specified in the individual payer's contract
,The important message from Medicare provides beneficiaries with information
concerning what? - answer-Right to appeal a discharge decision if the patient
disagrees with the services
Through what document does a hospital establish compliance standards? -
answer-Code of conduct
How does utilization review staff use correct insurance information? - answer-
To obtain approval for inpatient days and coordinate services
When is it not appropriate to use observation status? - answer-As a substitute
for an inpatient admission
What is a serious consequence of misidentifying a patient in the MPI? -
answer-The services will be documented in the wrong record
When a patient reports directly to a clinical department for service, what will
the clinical department staff do? - answer-Redirect the patient to the patient
access department for registration
What process can be used to shorten claim turnaround time? - answer-Send
high-dollar hard-copy claims with required attachments by overnight mail or
registered mail
, What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do?
- answer-Inform a Medicare beneficiary that Medicare may not pay for the
order or service
What type of account adjustment results from the patient's unwillingness to
pay for a self-pay balance? - answer-Bad debt adjustment
What is the initial hospice benefit? - answer-Two 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim?
- answer-If the patient requires ambulance transportation to a skilled nursing
facility
How should a provider resolve a late-charge credit posted after an account is
billed? - answer-Post a late-charge adjustment to the account
an increase in the dollars aged greater than 90 days from date of service
indicate what about accounts - answer-They are not being processed in a
timely manner
What is an advantage of a preregistration program? - answer-It reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? - answer-
Medically unnecessary services and custodial care
