HFMA CRCR Test Exam Questions And Answers Verified 100% Correct

HFMA CRCR Test Exam Questions And Answers Verified 100% Correct What does scheduling allow provider staff to do? - ANSWER Review the appropriateness of the service requested When an adult patient is covered by both his own and his spouse health insurance plan, which of the statements is true? - ANSWER The patients insurance plan is primary Mrs. Jones , a Medicare beneficiary was admitted to the hospital on June 20,2010. As of the admission date, she had only used 8 inpatient days in the current benefit period. If she is not discharge on what date will Mr jones exhaust her full coverage days. - ANSWER August 9, 2010 In order to meet eligibility guidelines for healthcare benefits, Medicaid beneficiaries must fall into a specified need category and meet what other types of requirements - ANSWER Income and assets Fee for service plans pay claims based on a percentage of charges. How are patients out of pocket cost calculated? - ANSWER They are calculated quarterly Indemnity plans usually reimburse what? - ANSWER A certain percentage of charges after patient meets policy's annual deductible. Departments that need to be included in Charge master maintenance include all EXCEPT - ANSWER Quality Assurance Using HIPPA standardized transaction sets allow providers to: - ANSWER Submit a standardized transaction to any of the health plans with which it conducts business. Which of the following is NOT included in the standardized quality measures? - ANSWER Cost of services The ACO investment model will test the use of pre-paid shared savings to: - ANSWER Encourage new ACOs to form in rural and underserved areas. 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 270-271 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 Examples of ethics violation that impact the revenue cycle include all of the following EXCEPT: - ANSWER Seeking payment options for self-pay Verbal orders from a physician for a service(s) are: - ANSWER Acceptable if given to "qualified" staff as defined in a hospitals policies and procedures Medicare has established guidelines called Local Coverage Determination (LCD) and National Coverage Determination (NCD) that establish: - ANSWER What serviced or