HFMA CRCR Exam Study Guide Questions And
Answers Verified 100% Correct
Any healthcare insurance plan that provides or ensures comprehensive
health maintenance and treatment services for an enrolled group of
persons on a monthly fee is known as: - ANSWER- HMO
Ambulance services are billed directly to the health plan for: -
ANSWER- Services provided before a patient is admitted and for
ambulance rides arranged to pick up the patient from the hospital after
discharge to take him/her home or to another facility.
Any provider that has filed a timely cost report may appeal in an adverse
final decision received from the Medicare Administrative Contractor
(MAC), the appeal may be filed with: - ANSWER- The Provider
Reimbursement Review Board.
For scheduled payments, important revenue cycle activities in the time-
of-service stage DO Not include: - ANSWER- Obtaining or updating
patient and guarantor information
Hospital can only convert an inpatient case to observation if: -
ANSWER- The hospital utilization review committee determines before
the patient is discharged and prior to billing that an observation setting
would be more appropriate.
Hospital need which of the following information sets to assess a
patient's financial status? - ANSWER- Demographic, Income, Assets
and Expenses.
,HIPAA privacy rules require covered entities to take all, of the following
actions EXCEPT: - ANSWER- Use only designated software platforms
to secure patient date.
When Recovery Audit Contractors (RAC) identify improper payments
as overpayment. the claims processing contractor must: - ANSWER-
Send a demand letter to the provider to recover the over payment
amount.
Which HIPPA transaction set provides electronic processing of
8insurance verification requests and responses? - ANSWER- The
270271 set
Across all care settings, if a patient consents to a financial discussion
during a medical encounter to expedite discharge, the HFMA best
practice is to: - ANSWER- Support that choice, providing that the
discussion does not interfere with patient care or disrupt patient flow.
A scheduled inpatient represents an opportunity for the provider to do
which of the following? - ANSWER- Complete registration and
insurance approval before service
The Medicare Bundled Payments for Care Initiative (BCP) is designed
to: - ANSWER- Align incentives between hospitals, physicians, and
non-physician providers in-order to better coordinate patient care.
To maximize the value derived from customer complaints, all consumer
complaints should be: - ANSWER- Tracked and shared to improve
customer experience
The soft cost of a dissatisfied customer is: - ANSWER- The customer
passing on information about their negative experience to potential
, patients or through social media channels.
Applying the contracted payment methodology to the total charges
yields: - ANSWER- An estimate price
The importance of medical records maintained by HIM is that the patient
records: - ANSWER- Are the primary source for clinical data required
for reimbursement by health plans and liability payers
Important Revenue Cycle Activities in the pre-service stage include: -
ANSWER- Obtaining or updating patient and guarantor information
In the pre-service stage, the cost of the schedule services is identified
and the patient's health plan and benefits are used to calculate: -
ANSWER- The amount the patient may be expected to pay after
insurance.
The disadvantage of outsourcing includes all, of the following Except -
ANSWER- Reduces internal staffing costs and a reliance on outsourced
staff.
Marinating routine contact with health plan or liability payer, making
sure all required information is provided and all needed approvals are
obtained is the responsibility of who: - ANSWER- Case Management
A claim is denied for the following reasons EXCEPT: - ANSWER- The
submitted claim does not have the physician signature
All Hospitals are required to establish a written financial assistance
policy that applies to: - ANSWER- All emergency and medically
necessary care
Answers Verified 100% Correct
Any healthcare insurance plan that provides or ensures comprehensive
health maintenance and treatment services for an enrolled group of
persons on a monthly fee is known as: - ANSWER- HMO
Ambulance services are billed directly to the health plan for: -
ANSWER- Services provided before a patient is admitted and for
ambulance rides arranged to pick up the patient from the hospital after
discharge to take him/her home or to another facility.
Any provider that has filed a timely cost report may appeal in an adverse
final decision received from the Medicare Administrative Contractor
(MAC), the appeal may be filed with: - ANSWER- The Provider
Reimbursement Review Board.
For scheduled payments, important revenue cycle activities in the time-
of-service stage DO Not include: - ANSWER- Obtaining or updating
patient and guarantor information
Hospital can only convert an inpatient case to observation if: -
ANSWER- The hospital utilization review committee determines before
the patient is discharged and prior to billing that an observation setting
would be more appropriate.
Hospital need which of the following information sets to assess a
patient's financial status? - ANSWER- Demographic, Income, Assets
and Expenses.
,HIPAA privacy rules require covered entities to take all, of the following
actions EXCEPT: - ANSWER- Use only designated software platforms
to secure patient date.
When Recovery Audit Contractors (RAC) identify improper payments
as overpayment. the claims processing contractor must: - ANSWER-
Send a demand letter to the provider to recover the over payment
amount.
Which HIPPA transaction set provides electronic processing of
8insurance verification requests and responses? - ANSWER- The
270271 set
Across all care settings, if a patient consents to a financial discussion
during a medical encounter to expedite discharge, the HFMA best
practice is to: - ANSWER- Support that choice, providing that the
discussion does not interfere with patient care or disrupt patient flow.
A scheduled inpatient represents an opportunity for the provider to do
which of the following? - ANSWER- Complete registration and
insurance approval before service
The Medicare Bundled Payments for Care Initiative (BCP) is designed
to: - ANSWER- Align incentives between hospitals, physicians, and
non-physician providers in-order to better coordinate patient care.
To maximize the value derived from customer complaints, all consumer
complaints should be: - ANSWER- Tracked and shared to improve
customer experience
The soft cost of a dissatisfied customer is: - ANSWER- The customer
passing on information about their negative experience to potential
, patients or through social media channels.
Applying the contracted payment methodology to the total charges
yields: - ANSWER- An estimate price
The importance of medical records maintained by HIM is that the patient
records: - ANSWER- Are the primary source for clinical data required
for reimbursement by health plans and liability payers
Important Revenue Cycle Activities in the pre-service stage include: -
ANSWER- Obtaining or updating patient and guarantor information
In the pre-service stage, the cost of the schedule services is identified
and the patient's health plan and benefits are used to calculate: -
ANSWER- The amount the patient may be expected to pay after
insurance.
The disadvantage of outsourcing includes all, of the following Except -
ANSWER- Reduces internal staffing costs and a reliance on outsourced
staff.
Marinating routine contact with health plan or liability payer, making
sure all required information is provided and all needed approvals are
obtained is the responsibility of who: - ANSWER- Case Management
A claim is denied for the following reasons EXCEPT: - ANSWER- The
submitted claim does not have the physician signature
All Hospitals are required to establish a written financial assistance
policy that applies to: - ANSWER- All emergency and medically
necessary care
