HFMA SET 1 QUESTIONS AND ANSWERS
Define Revenue Cycle - (ANSWER)REVENUE CYCLE ----- is the series of events and services provided prior
to, during, and after the course of treatment
Departments that contribute to the Revenue Cycle. - (ANSWER)Departments that contribute to the
Revenue Cycle.
1. Access
2. Health information management/ Medical records
3. Case-management
4. Patient Care Services
5. Patient Financial Services
What led the creation of revenue management services? - (ANSWER)The emphasis on the revenue cycle
has resulted in the need to organize its components differently and created a new business unit known
as revenue integrity or revenue management services.
Benefit of Electronic transactions? - (ANSWER)Electronic transactions."------ transactions are associated
with revenue capture and collection activities. The implementation of electronic data interchange (EDI)
allows actions previously conducted by telephone/ manual methods to be performed electronically (
improves workflow).
5010 Transaction Set Function? - (ANSWER)5010 Transaction Set------new transaction processing system
with new transaction standards. These standards will:
a. Offer healthcare providers enhanced information.
b. Require providers to provide payers with additional data to facilitate claim payments.
6 Transactions associated with the revenue cycle include: - (ANSWER)6 Transactions associated with the
revenue cycle include:
a. Claim/Encounter (837-I, 837-P, 837-COB, 837-P COB, NCPD).
b. Remittance (835).
,HFMA SET 1 QUESTIONS AND ANSWERS
c. Claim Status Inquiry/Response (276/277).
d. Eligibility Inquiry/Response (270/271).
e. Healthcare Services Review (278) Pre-certification and Referrals.
f. Acknowledgment (999)
Which of the following would be a hard cost of customer dissatisfaction?
Loss of future revenue Negative word-of-mouth advertising Decisions of future patients to use another
facility Decisions of current patients to use other facilities for future ancillary services - (ANSWER)loss of
future revenue
Define hard cost and soft cost. - (ANSWER)1. Hard Cost -the loss of future revenue
2. Soft Cost- Negative word-of-mouth advertising that may influence others not to use the hospital.
Single greatest reason for an inability to bill and collect accounts receivable in a timely manner? -
(ANSWER)Single greatest reason for an inability to bill and collect accounts receivable in a timely
manner:
Inadequate and incorrect information received from the admitting/patient access department
The Access department's policies and procedures should also address the what 3 topics: - (ANSWER)...
The key is the timing of the collection of the financial data and payment is? - (ANSWER)...
When certain services are not covered, a Medicare patient should be issued a/an __________to notify
the patient that they may be responsible for payment. - (ANSWER)ABN---Advance Beneficiary Notice of
Non-Coverage (ABN)
Examples of when Medicare is secondary include: - (ANSWER)...
,HFMA SET 1 QUESTIONS AND ANSWERS
The COBRA benefit is provided to employees or their family members if they lose coverage due to a
number
of reasons, such as the following: (list 4) - (ANSWER)The COBRA benefit is provided to employees or
their family members if they lose coverage due to a number of reasons, such as the following:
Loss of employment
Reduction in hours worked
Divorce
Death of the supporting spouse
The time required for gathering information has the highest return when the investment is made
_________.
Before the patient's arrival
After discharge
When the first bill comes off
After the account goes to collections - (ANSWER)Before the patient's arrival
What are the 4 things included in claims adjudication? - (ANSWER)Claims adjudication includes the
following:
1.Determination of benefits levels and coverage
2. Coordination of benefits
3.Subrogation of third-party liability claims
4.Generation of appropriate explanation of benefit forms
, HFMA SET 1 QUESTIONS AND ANSWERS
What are the twin goals of financial counseling? - (ANSWER)The twin goals of financial counseling are:
That the provider understands upfront a patient's ability to pay, and
That the patient understands his or her financial responsibility to the provider.
Accounts receivable (A/R) personnel must become key participants in the POS collection process.
Is this statement true or false? - (ANSWER)False
Which of the following is true of deposits?
A deposit should be requested to secure payment when precise charge calculations are not practical.
Deposit policies should be reviewed and approved by the CFO.
To facilitate calculation of deposits, credit references should be readily available.
To facilitate internal reporting, deposit payments should be held in the general fund. - (ANSWER)A
deposit should be requested to secure payment when precise charge calculations are not practical.
In __________, a provider arranges for patients to obtain loans through a local bank.
In-house financing
A bank financing agreement
Charity care
Define Revenue Cycle - (ANSWER)REVENUE CYCLE ----- is the series of events and services provided prior
to, during, and after the course of treatment
Departments that contribute to the Revenue Cycle. - (ANSWER)Departments that contribute to the
Revenue Cycle.
1. Access
2. Health information management/ Medical records
3. Case-management
4. Patient Care Services
5. Patient Financial Services
What led the creation of revenue management services? - (ANSWER)The emphasis on the revenue cycle
has resulted in the need to organize its components differently and created a new business unit known
as revenue integrity or revenue management services.
Benefit of Electronic transactions? - (ANSWER)Electronic transactions."------ transactions are associated
with revenue capture and collection activities. The implementation of electronic data interchange (EDI)
allows actions previously conducted by telephone/ manual methods to be performed electronically (
improves workflow).
5010 Transaction Set Function? - (ANSWER)5010 Transaction Set------new transaction processing system
with new transaction standards. These standards will:
a. Offer healthcare providers enhanced information.
b. Require providers to provide payers with additional data to facilitate claim payments.
6 Transactions associated with the revenue cycle include: - (ANSWER)6 Transactions associated with the
revenue cycle include:
a. Claim/Encounter (837-I, 837-P, 837-COB, 837-P COB, NCPD).
b. Remittance (835).
,HFMA SET 1 QUESTIONS AND ANSWERS
c. Claim Status Inquiry/Response (276/277).
d. Eligibility Inquiry/Response (270/271).
e. Healthcare Services Review (278) Pre-certification and Referrals.
f. Acknowledgment (999)
Which of the following would be a hard cost of customer dissatisfaction?
Loss of future revenue Negative word-of-mouth advertising Decisions of future patients to use another
facility Decisions of current patients to use other facilities for future ancillary services - (ANSWER)loss of
future revenue
Define hard cost and soft cost. - (ANSWER)1. Hard Cost -the loss of future revenue
2. Soft Cost- Negative word-of-mouth advertising that may influence others not to use the hospital.
Single greatest reason for an inability to bill and collect accounts receivable in a timely manner? -
(ANSWER)Single greatest reason for an inability to bill and collect accounts receivable in a timely
manner:
Inadequate and incorrect information received from the admitting/patient access department
The Access department's policies and procedures should also address the what 3 topics: - (ANSWER)...
The key is the timing of the collection of the financial data and payment is? - (ANSWER)...
When certain services are not covered, a Medicare patient should be issued a/an __________to notify
the patient that they may be responsible for payment. - (ANSWER)ABN---Advance Beneficiary Notice of
Non-Coverage (ABN)
Examples of when Medicare is secondary include: - (ANSWER)...
,HFMA SET 1 QUESTIONS AND ANSWERS
The COBRA benefit is provided to employees or their family members if they lose coverage due to a
number
of reasons, such as the following: (list 4) - (ANSWER)The COBRA benefit is provided to employees or
their family members if they lose coverage due to a number of reasons, such as the following:
Loss of employment
Reduction in hours worked
Divorce
Death of the supporting spouse
The time required for gathering information has the highest return when the investment is made
_________.
Before the patient's arrival
After discharge
When the first bill comes off
After the account goes to collections - (ANSWER)Before the patient's arrival
What are the 4 things included in claims adjudication? - (ANSWER)Claims adjudication includes the
following:
1.Determination of benefits levels and coverage
2. Coordination of benefits
3.Subrogation of third-party liability claims
4.Generation of appropriate explanation of benefit forms
, HFMA SET 1 QUESTIONS AND ANSWERS
What are the twin goals of financial counseling? - (ANSWER)The twin goals of financial counseling are:
That the provider understands upfront a patient's ability to pay, and
That the patient understands his or her financial responsibility to the provider.
Accounts receivable (A/R) personnel must become key participants in the POS collection process.
Is this statement true or false? - (ANSWER)False
Which of the following is true of deposits?
A deposit should be requested to secure payment when precise charge calculations are not practical.
Deposit policies should be reviewed and approved by the CFO.
To facilitate calculation of deposits, credit references should be readily available.
To facilitate internal reporting, deposit payments should be held in the general fund. - (ANSWER)A
deposit should be requested to secure payment when precise charge calculations are not practical.
In __________, a provider arranges for patients to obtain loans through a local bank.
In-house financing
A bank financing agreement
Charity care
