What does EMTALA require hospitals to do? - ✔✔ANSW✔✔.. **A. To provide a medical screening
examination and stabilizing treatment to every person presenting at an ED and requesting medical
evaluation or treatment.
B. To initially triage patients, where a "quick" registration record is generated to specifically allow
order entry.
C. To complete a standardized form signed by all patients that is used to inform the patient about the
admission and conditions which must be agreed upon.
D. To confirm information that may be used to identify the patient in the provider's MPI, which
includes the patient's full, legal name, SSN, and/or date of birth.
In what manner do case managers assist revenue cycle staff? - ✔✔ANSW✔✔.. A. By reviewing a
patient's individual case and recommend treatment changes.
B. With monitoring the progression of high resource consumptive cases.
C. By estimating how long the patient will be in the hospital and what the expected outcome will be.
,**D. Providing assistance with written appeals to health plans related to utilization and other care
issues.
Why is it critical that a chargemaster is reviewed and updated regularly? - ✔✔ANSW✔✔.. **A. To
ensure it supports and represents the services provided within the organization.
B. To ensure the most appropriate measure of the utilization of resources.
C. So the CPT databases can have the most current and accurate information.
D. Because charge descriptions can vary greatly between providers.
What is the responsibility of HIM? - ✔✔ANSW✔✔.. **A. To maintain all patient medical records
B. To make information available instantly and securely to authorized users
C. To denote the medical procedures performed by a healthcare provider on a patient
D. To substantiate health insurance claims filed by the patient, the physician, and the provider
What are claim edits? - ✔✔ANSW✔✔.. A. Various data sources including Medicare and Medicaid
bulletins and manuals, individual health plan manuals
B. A multi-stakeholder collaboration of more than 130 organizations — providers, health plans,
vendors, and government agencies
**C. Rules developed to verify the accuracy and completeness of claims based on each health plan's
policies
D. The submission, receipt, and processing of automated claims, thereby eliminating mail time and
reducing data entry time
Which statement is NOT a unique billing rule specific to providers? - ✔✔ANSW✔✔.. A. Overall
aggregate payments made to a hospice are subject to a "cap amount", calculated by the MAC at the
end of the hospice cap period.
B. With the exception of physician services, Medicare reimbursement for hospice care is made at one
of four pre-determined rates for each day of hospice care.
C. When billing services on a UB-04/837-I, specific CPT codes are collapsed into a single revenue code
(520 or 521).
**D. A patient may be balance billed for whatever amount the non-contracting physician charges
above the health plan's reimbursement amount.
,Which of the following statements does not apply to billing during the COVID-19 public health
emergency: - ✔✔ANSW✔✔.. A. Hospitals may change a sub-acute unit into an acute care unit
without advanced approval from CMS.
**B. Telemedicine claims are not payable if the patient conducts the telemedicine visit from home.
C. CMS developed the concept of hospitals without walls to increase ICU and med-surge inpatient
capacity during the COVID-19 pandemic.
D. Cost sharing has been waived for testing for COVID-19 in the ED, physician office, urgent care
center or other ambulatory location.
What are collection agency fees based on? - ✔✔ANSW✔✔.. A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other
rule? - ✔✔ANSW✔✔.. Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated between the
payer and some or all providers? - ✔✔ANSW✔✔.. Case rates
What customer service improvements might improve the patient accounts department? -
✔✔ANSW✔✔.. Holding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
✔✔ANSW✔✔.. Inform a Medicare beneficiary that Medicare may not pay for the order or service
What type of account adjustment results from the patient's unwillingness to pay for a self-pay
balance? - ✔✔ANSW✔✔.. Bad debt adjustment
What is the initial hospice benefit? - ✔✔ANSW✔✔.. Two 90-day periods and an unlimited number
of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - ✔✔ANSW✔✔.. If
the patient requires ambulance transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account is billed? -
✔✔ANSW✔✔.. Post a late-charge adjustment to the account
, an increase in the dollars aged greater than 90 days from date of service indicate what about
accounts - ✔✔ANSW✔✔.. They are not being processed in a timely manner
What is an advantage of a preregistration program? - ✔✔ANSW✔✔.. It reduces processing times at
the time of service
What are the two statutory exclusions from hospice coverage? - ✔✔ANSW✔✔.. Medically
unnecessary services and custodial care
What core financial activities are resolved within patient access? - ✔✔ANSW✔✔.. Scheduling,
insurance verification, discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - ✔✔ANSW✔✔.. The services do not involve
an overnight stay
How is a mis-posted contractual allowance resolved? - ✔✔ANSW✔✔.. Comparing the contract
reimbursement rates with the contract on the admittance advice to identify the correct amount
What type of patient status is used to evaluate the patient's need for inpatient care? -
✔✔ANSW✔✔.. Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary
has received what? - ✔✔ANSW✔✔.. Medically necessary inpatient hospital services for at least 3
consecutive days before the skilled nursing care admission
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? -
✔✔ANSW✔✔.. When the patient is the insured
What are non-emergency patients who come for service without prior notification to the provider
called? - ✔✔ANSW✔✔.. Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what is the status
of the subscriber's spouse? - ✔✔ANSW✔✔.. Neither enrolled not entitled to benefits
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