CRCR Exam 2023 With 100% Correct Answers

Patient Centric Revenue Cycle - Correct answer-This includes all the major processing steps required to process a pt account from the request for service through closing the account with a zero balance and purging it from the system pre-service - Correct answer-this is the period in which scheduling and pre-access takes place, including different steps that will be completed pre-service - Correct answer-what is it when the requested service is screened for medical necessity, health plan coverage & benefits are verified, and pre-auth is obtained scheduled patient- Time of Service - Correct answer-what is it when a final account review is completed prior to the patient's arrival? (Pre-reg record is activated, consents are signed, and co-payments and other amounts are collected) express arrival - Correct answer-pre-processed patient's can report to this, which is a desk located in a centralized access, upon their arrival. post-service - Correct answer-this includes account activities that occur after the patient is d/c until the account reaches a zero balance post-service - Correct answer-Final coding of all services, perparation and submission of claims, payment processing and balance billing are all included and finalized when? Patient Financial Communications Best Practices - Correct answer-This brings consistency, clarity, and transparency to patient financial communications Patient Financial Communications Best Practices - Correct answer-this outlines steps to help patient's understand the cost of services they receive, their insurance coverage, and their individual responsibility (review Patient Financial Comm. Best Practice document) true - Correct answer-true or false: Conversations should occur in a location and manner that are sensitive to the patient's needs timely discussions - Correct answer-this type of discussion will help ensure that patient's understand their financial obligation and that providers are aware of the patient's ability to pay guarantor - Correct answer-the person responsible for payment of the bill true - Correct answer-true or false: A financial counselor or supervisor should be involved for complex situations such as uninsured or underinsured patient's false; NO patient financial discussions should occur before a patient is screened and stabilized - Correct answer-true or false: You MUST obtain basic registration info and insurance coverage before the patient is cared for in the ED. true - Correct answer-true or false: When the provider takes the initiative to communicate financial matters with the patient, it actually take a burden off the patient. false; Technology evaluation may be performed by ANY qualified individual or organization, internal or external - Correct answer-true or false: Technology evaluation can ONLY be done by a qualified individual, internal to the facililty HFMA's Adopter Program - Correct answer-this program is a recognition for providers who implement and support the best practices are eligible and encouraged to apply Code of Conduct - Correct answer-Through what document does a hospital est. compliance standards? Identify acceptable compliance programs in various provider setting - Correct answerwhat is the purpose OIG work plan? non-diagnostic services provided on Tuesday through Friday - Correct answer-If a Medicare pt is admitted on Friday, what services fall within the 3-day DRG window rule? reports a specific circumstance that affects a procedure or service without changing the code or its definition. - Correct answer-What does a modifier allow a provider to do? they must be billed separately to the Part B carrier - Correct answer-if OP diagnostic services are provided within 3 day of admission of a medicare beneficiary to an IPPS (Inpatient Prospective Payment system) hospital, what must happen? One registration record is created for multiple days of service - Correct answer-What is recurring or series registration? unscheduled patients - Correct answer-what are non-emergency pt who come for service w/o prior notification to the provider called? used to evaluate the need for an IP admission - Correct answer-Which of the following statements apply to the Obs patient type? physician, nursing, and pharmacy - Correct answer-which services are hospice programs required to provide on a around-the-clock patient?q complete the scheduling process correctly based on service requested - Correct answer-Scheduler instructions are used to prompt the scheduler to do what? procedure time - Correct answer-This is the time needed to prepare the patient before services is the difference between the patients arrival time? Documentation of the medical necessity for the test - Correct answer-Medicare guidelines require that when a test is ordered for which an LCD (local cover determination) or NCD (national coverage determination) exists, the info on the order must include what? it reduces processing times at the time of service - Correct answer-what is an advantage of a pre-registration program? the responsible party's full legal name, DOB, and SSN - Correct answer-what data is required to est. a new MPI (Master patient index) entry? parents are received by the provider from the payer responsible for reimbursing the provider for the pt covered services - Correct answer-which of the following statements is true about third-party payments? stop loss - Correct answer-which provision protects the patient from medical expenses that exceed pre-set level? referral - Correct answer-What is it called when a PCP send an HMO (health maintenance organization) pt to authorize a visit to a specialist for additional testing or care? Medical screening and stabilizing - Correct answer-under the EMTALA (emergency medical treatment and labor act) regulations, the provider may not ask the patient about their ins info if it would delay what? to the approved APC rate - Correct answer-the hospital has a APC (ambulatory payment classification) - based contract for the payment of OP 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? $100 - Correct answer-a patient has met their $200 deductible and $900 of the $1000 coins responsibility. the coins rate is 20%. The estimated ins plan responsibility is $1975.00. What amount of coins is due from the patient? the pt outstanding medical bills exceed a defined dollar amount or percentage of assets - Correct answer-when is a pt considered to be medically indigent? sources of readily available funds, such as vehicles, campers, boats and savings accounts - Correct answer-what patient assets are considered in the financial assistance applications? warn the pt that any unpaid accounts are placed with collection agencies for further processing - Correct answer-if the pt cannot agree to payment arrangements, what is the next option? scheduling, pre-reg, ins verification, and managed care processing - Correct answerwhat core financial activities are resolved within patient access? a pt who arrives at the hospital via EMS for treatment in the ER - Correct answer-what is an unscheduled direct admission? as a substitute for an IP admission - Correct answer-when is not appropriate to use observation status? home health - Correct answer-parents who require periodic skilled nursing or therapeutic care receive services from what type of program? printed copy of the providers privacy notice - Correct answer-every pt who is new to the healthcare provider must be offered what? the employer provides a traditional HMP health plan - Correct answer-which of the following statements applies to self-insured ins plans? Subrogation - Correct answer-what process does a pt health plan use to retroactively collect payments from liability, automobile, or workers comp plans? DRG rates (diagnosis-related groups) - Correct answer-what type of payment methodology is a lump sum or bundled payment negotiated b/w the payer and some or all providers? site-of-service limitation - Correct answer-what restriction does a managed care plan place on locations that must be used if the plan is to pay for the service provided? if medical necessity for a private room is documented in the chart, pt ins will be billed for the differential, pay per the contract - Correct answer-which of the following statements applies to private rooms? a pt must have both medicare part A & B benefits to be eligible for a medicare advantage plan - Correct answer-which of the following is NOT true of Medicare advantage plans? failure to complete authorization - Correct answer-what is a valid reason for a payor to deny a claim? claim is paid in full - Correct answer-which of the following statements is NOT a possible consequence of selecting the wrong pt in the MPI (master patient index)? medicaid-eligible pt are neve4r required to join a medicaid HMO plan - Correct answerwhich of the following is not a characteristic of a medicaid HMP plan? registration staff members routinely contact managed care plans for prior auth before the pt is seen by the on-duty physician - Correct answer-what is a violation of the EMTALA (Emergency medical treatment and labor act)? notification can be issued no earlier than 7 days before admission and no more than 2 days before discharge - Correct answer-which of the following statements is TRUE of the important message from medicare notification requirements? self-pay balance - Correct answer-this is the portion of the adjudication claim that is due from the patient after claim is paid bank loans - Correct answer-which of the following options is an alternative to valid long-term payment plans? $6,000 - Correct answer-the pt has the following benefit plan : $400 per family member deductible, maximum of $1200 per year and $2000 per family member coins, to a family maximum of $6000 per year, excluding the deductible. Five family members are enrolled in this benefit plan. What is the maximum out-of-pocket expense that the family could incur during the calendar year? POS (point-of-service) plan - Correct answer-what type of plan restricts benefits for nonemergency car to approve providers only? review the appropriateness of the service requested - Correct answer-what does scheduling allow provider staff to do? the pt ins plan is primary - Correct answer-when an adult pt is covered by both his own and his spouses health ins plan, which of the statements is true? august 9, 2010 - Correct answer-Mrs. Jones, a medicare beneficiary, was admitted to the hospital on June 20, 2010. As of the admission date, she had only used 8 IP days in the current benefit period. If she is not discharged, on what date will Mrs. Jones exhaust her full coverage days? income and asset - Correct answer-In order to meet eligibility guidelines for medicaid benefits, the beneficiary must fall into specific need category and meet what other types of requirements? they are calculated quarterly - Correct answer-fee-for-service plans pay claims based on a % of charges. How are patients out of pocket costs calculated? certain % of charges ate4r patient meets policy annual deductible - Correct answerindemnity plans usually reimburse what? quality assurance - Correct answer-dept that need to be included in Charge master3 Maintenance include all EXCEPT what? submit a standardized transaction to any of the health plans with which it conducts business - Correct answer-using HIPPA standardized transaction sets allow providers to what? cost of services - Correct answer-which of the following is NOT included in the standardized quality measures? encourage new ACOs to form in rural and underserved areas - Correct answer-the ACO investment model will test the use of per-paid shared savings to do what? HMO - Correct answer-this type of ins plan provides comprehensive health maintenance and treatment services for an enrolled group of persons on a monthly fee services provided before admission and for the rides to take them home after discharge or to transfer to another facility. - Correct answer-EMS services are billed directly to the health plan for what? the provider reimbursement review board - Correct answer-any provider that files a timely cost report may appeal in an adverse final decision recited from the Medicare Admin Contractor (MAC), the appeal may be filed with what? obtaining or updating pt and guarantor info - Correct answer-for SCHEDULED payments, important rev cycle activities in the time-of=service state DO NOT include what? the hospital UR committee determines before the pt is d/c and prior to billing that an obsveration setting would be more appropriate - Correct answer-hospital can only convert an inpatient case to observation if what? used only designated software platforms to secure pt date - Correct answer-HIPAA privacy rules require covered entities to take all, of the following EXCEPT what? send a demand letter to provider to recover the over payment - Correct answer-when recovery audit contractors (RAC) identify payments as overpayments, the claims processing contractor must do what?