HFMA CRCR | 172 Questions And Answers
Through what document does a hospital establish compliance standards? Correct Answer -
code of conduct
What is the purpose OIG work plant? Correct Answer - Identify Acceptable compliance
programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window
rule? Correct Answer - Non-diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do? Correct 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 Correct Answer - They must be billed separately to the part B Carrier
what is a recurring or series registration? Correct Answer - One registration record is
created for multiple days of service
What are nonemergency patients who come for service without prior notification to the provider
called? Correct Answer - Unscheduled patients
Which of the following statement apply to the observation patient type? Correct Answer -
It is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient Correct
Answer - Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? Correct Answer -
Complete the scheduling process correctly based on service requeste
The Time needed to prepare the patient before service is the difference between the patients
arrival time and which of the following? Correct Answer - Procedure time
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: Correct Answer - Documentation of the medical
necessity for the test
What is the advantage of a pre-registration program Correct Answer - It reduces
processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry Correct Answer -
The responsible party's full legal name, date of birth, and social security number
, Which of the following statements is true about third-party payments? Correct Answer -
The payments are received by the provider from the payer responsible for reimbursing the
provider for the patient's covered services.
Which provision protects the patient from medical expenses that exceed the pre-set level
Correct Answer - stop loss
what documentation must a primary care physician send to HMO patient to authorize a visit to a
specialist for additional testing or care? Correct Answer - Referral
Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the provider may
not ask about a patient's insurance information if it would delay what? Correct Answer -
Medical screening and stabilizing treatment
Which of the following is a step in the discharge process? Correct Answer - Have a case
management service complete the discharge plan
The hospital has a APC based contract for the payment of outpatient services. Total anticipated
charges for the visit are $2,380. The approved APC payment rate is $780. Where will the
patients benefit package be applied? Correct Answer - To the approved APC payment
rate
A patient has met the $200 individual deductible and $900 of the $1000 co-insurance
responsibility. The co-insurance rate is 20%. The estimated insurance plan responsibility is
$1975.00. What amount of coinsurance is due from the patient? Correct Answer -
$100.00
When is a patient considered to be medically indigent? Correct Answer - The patient's
outstanding medical bills exceed a defined dollar amount or percentage of assets.
What patient assets are considered in the financial assistance application? Correct Answer -
Sources of readily available funds , vehicles, campers, boats and saving accounts
If the patient cannot agree to payment arrangements, What is the next option? Correct Answer
- Warn the patient that unpaid accounts are placed with collection agencies for further
processing
What core financial activities are resolved within patient access? Correct Answer -
scheduling , pre-registration, insurance verification and managed care processing
What is an unscheduled direct admission? Correct Answer - A patient who arrives at the
hospital via ambulance for treatment in the emergency department
When is it not appropriate to use observation status? Correct Answer - As a substitute for
an inpatient admission
Through what document does a hospital establish compliance standards? Correct Answer -
code of conduct
What is the purpose OIG work plant? Correct Answer - Identify Acceptable compliance
programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window
rule? Correct Answer - Non-diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do? Correct 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 Correct Answer - They must be billed separately to the part B Carrier
what is a recurring or series registration? Correct Answer - One registration record is
created for multiple days of service
What are nonemergency patients who come for service without prior notification to the provider
called? Correct Answer - Unscheduled patients
Which of the following statement apply to the observation patient type? Correct Answer -
It is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient Correct
Answer - Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? Correct Answer -
Complete the scheduling process correctly based on service requeste
The Time needed to prepare the patient before service is the difference between the patients
arrival time and which of the following? Correct Answer - Procedure time
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: Correct Answer - Documentation of the medical
necessity for the test
What is the advantage of a pre-registration program Correct Answer - It reduces
processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry Correct Answer -
The responsible party's full legal name, date of birth, and social security number
, Which of the following statements is true about third-party payments? Correct Answer -
The payments are received by the provider from the payer responsible for reimbursing the
provider for the patient's covered services.
Which provision protects the patient from medical expenses that exceed the pre-set level
Correct Answer - stop loss
what documentation must a primary care physician send to HMO patient to authorize a visit to a
specialist for additional testing or care? Correct Answer - Referral
Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the provider may
not ask about a patient's insurance information if it would delay what? Correct Answer -
Medical screening and stabilizing treatment
Which of the following is a step in the discharge process? Correct Answer - Have a case
management service complete the discharge plan
The hospital has a APC based contract for the payment of outpatient services. Total anticipated
charges for the visit are $2,380. The approved APC payment rate is $780. Where will the
patients benefit package be applied? Correct Answer - To the approved APC payment
rate
A patient has met the $200 individual deductible and $900 of the $1000 co-insurance
responsibility. The co-insurance rate is 20%. The estimated insurance plan responsibility is
$1975.00. What amount of coinsurance is due from the patient? Correct Answer -
$100.00
When is a patient considered to be medically indigent? Correct Answer - The patient's
outstanding medical bills exceed a defined dollar amount or percentage of assets.
What patient assets are considered in the financial assistance application? Correct Answer -
Sources of readily available funds , vehicles, campers, boats and saving accounts
If the patient cannot agree to payment arrangements, What is the next option? Correct Answer
- Warn the patient that unpaid accounts are placed with collection agencies for further
processing
What core financial activities are resolved within patient access? Correct Answer -
scheduling , pre-registration, insurance verification and managed care processing
What is an unscheduled direct admission? Correct Answer - A patient who arrives at the
hospital via ambulance for treatment in the emergency department
When is it not appropriate to use observation status? Correct Answer - As a substitute for
an inpatient admission
