Exam (elaborations)
CRCR FINAL EXAM
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Exam of 27 pages for the course CRCR at CRCR (CRCR FINAL EXAM)
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CRCR FINAL EXAMWhich of the following statements are true of HFMA's Patient Financial
Communications Best Practices? - ANSWER The best practices were developed
specifically to help patients understand the cost of services, their individual insurance
benefits and their responsibility for balance after insurance if any
The patient experience includes all of the following except: - ANSWER The average
number of positive mentions received by the health system or practice and the public
comments refuting unfriendly posts on social media sites
Corporate compliance programs play an important role in protecting the integrity of
operations and ensuring compliance with federal and state requirements. The Code
of Conduct is: - ANSWER A critical tool to ensure the compliance with the
organization's compliance standards and procedures, an essential and integral
component of the organization's culture, fosters and environment where concerns
and questions may be raised without fear of retaliation or retribution
Specific to Medicare fee-for-service patients, which of the following payers have
always been liable for payment? - ANSWER Public health service programs, federal
grant programs, VA programs, black lung program services and workers comp
claims
Provider policies and procedures should be in plan to reduce the risk of ethics
violations. Examples of ethics violations are: - ANSWER Financial misconduct,
overcharging and miscoding claims, theft of property and falsifying records to boost
reimbursement, financial misconduct and applying policies in an inconsistent manner
Providers are now being reimbursed with a focus on the value of the services
provided, rather than volume, which requires collaboration among providers.
What is the intended outcome of collaborations made through an ACO delivery
system for a population of patients? - ANSWER To eliminate duplicate services,
prevent medical errors and ensure appropriateness of care
What is the new terminology now employed in the calculation of net patient service
revenues? - ANSWER Explicit price concessions and implicit price concessions
What are the two KPIs used to monitor performance related to the production and
submission of claims to third party payers and patients (self-pay)? - ANSWER
Elapsed days from discharge to final bill and elapsed days from final bill to claim/bill
submission
What are the three traditional steps of the Revenue Cycle? - ANSWER Pre-service,
time-of-service and post-service
What are the steps during pre-service? - ANSWER 1. The patient is scheduled and
pre-registered for service
,2. The encounter record is generated and the patient/guarantor information is
obtained or updated
3. The requested service is screened for med necessity; insurance is verified and
pre-auths obtained
4. The cost is identified and insurance benefits are used to calculate the price of the
services to the patient
5. If the service is deemed not med necessary additional processing is done
6. The patient is notified of their financial responsibility including copay/deductible
and their eligibility for financial assistance is assessed
What happens for scheduled patients at the time of service? - ANSWER 1. Pre-
registration record is activated, consents are signed and copays/balances are
collected
2. Positive patient identification is completed and an armband is given
3. Alternatively, scheduled patients can report to an express arrival desk
What happens for unscheduled patients at the time of service? - ANSWER
Comprehensive registration and financial processing is completed at the time-of-
service. The process mirrors the work that was completed for scheduled patients
prior to service
What are the nine steps of time-of-service processing for unscheduled patients? -
ANSWER 1. Creation of the registration record
2. Order review to ensure compliance with the rules for what makes a complete
order
3. Validation of the health plan and identification of any amount the patient is
currently due
4. Completion of med necessity screening, if necessary
5. Review and completion of pre-cert requirements for the order
6. Identification of all charges related to the order and applied insurance benefits to
calculate amount due
7. If a balance is due, financial conversation occurs
8. If all is well, patient gets service
9. Charges are entered as services are rendered
What is the overview for the three steps of the revenue cycle? - ANSWER 1. Pre-
service: the patient is scheduled and registered for service; patient service costs are
calculated
2. Time-of-service: case management and discharge planning services are provided;
consents are signed
3. Post-service: Bill sent electronically to health plan, patient account is monitored for
payment
What are the goals of the engaged consumer portion of the rev cycle? - ANSWER
Ease of access, improved customer service and improved quality of care
What are the goals of the engaged patient portion of the rev cycle? - ANSWER
Improve the information and choices for the patient regarding care and financial
decisions
, What are the goals of the satisfied customer portion of the rev cycle? - ANSWER
Appropriate payment, effective and efficient account resolution and decreased cost
to collect
What are the Healthcare Dollar and Sense initiatives? - ANSWER Patient financial
communication best practices, best practices for price transparency, medical
account resolution. Overall to help make sense of price and value in healthcare
What is the best practice for when and where to have patient financial discussions? -
ANSWER 1. No discussion before patient is screened and stabilized in the ER
2. If in an emergency medical condition, the conversation occurs in the discharge
process
3. In a non-emergency situation, occurs in registration or discharge process in an
area that does not disturb others
4. When possible, have financial conversations before services are rendered
5. Have discussions as early as possible
What are the typical elements of the best practices of financial discussions? -
ANSWER In ED settings, inform patients that quality of care will not be affected by
prior balances or insurance status. For elective services, patients are expected to
make payments toward past balances. Once patient is stabilized, information can be
collected and reviewed for insurance benefits and financial assistance programs.
What are the best practices for financial counseling? - ANSWER 1. Discussing
patient share: Patient should be provided list of providers that require separate
payments and told that estimates may vary from actual cost. Patients should be
asked if they want info about payment/financial assistance options
2. Prior balance policies: Clear policies about prior balances that should be available
to the public
3. Balance resolution: Policies that work toward amicable resolution with the patient
What are the best practices for the provider/patient conversation? - ANSWER Have
compassion, use standard language and have written follow-up
What is the framework for complying with the best practices for financial
conversations? - ANSWER Annual training, training included well rounded material,
annual observation/tracking of process, metrics reporting, technology support
verification and feedback/response
What is price transparency? - ANSWER Pricing information available to patients
based on hospital service based on CPT/DRG, the patient's health plan and the
patient's benefit plan
What is the ACA? (not the affordable care act) - ANSWER The Association of Credit
and Collections Professionals International
What is the workflow for medical account resolution? - ANSWER 1. Educate patients
and follow best practices for communication
2. Make all bills and other communications clear, concise, correct and patient-
friendly
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