HFMA CRCR exam 2024 with 100% correct answers over 400 questions
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Course
HFMA CRCR
Institution
HFMA CRCR
HFMA CRCR exam 2024 with 100% correct answers
over 400 questions
Through what document does a hospital establish compliance standards? -
CORRECT ANSWER code of conduct
Which of the following statement apply to the observation patient type? -
CORRECT ANSWER It is used to evaluate the need for...
HFMA CRCR exam 2024 with 100% correct answers
over 400 questions
Through what document does a hospital establish compliance standards? -
CORRECT ANSWER code of conduct
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
,Patients who require periodic skilled nursing or therapeutic care receive services
from what type of program? - CORRECT ANSWER Home health agency
Every patient who is new to the healthcare provider must be offered what? -
CORRECT ANSWER A printed copy of the provider privacy notice
Which of the following statements apples to self insured insurance plans? -
CORRECT ANSWER The employer provides a traditional HMO health plan
In addition to the member's identification number, what information is recorded in
a 270 transaction - CORRECT ANSWER Name
What process does a patient's health plan use to retroactively collect payments
from liability automobile or worker's compensation plan? - CORRECT ANSWER
Subrogation
In what type of payment methodology is a lump sum of bundled payment
negotiated between the payer and some or all providers? - CORRECT ANSWER
DRG/Case rate
What Restriction does a managed care plan place on locations that must be used
if the plan is to pay for the service provided? - CORRECT ANSWER Site of
service limitation
Which of the following statements applies to private rooms? - CORRECT ANSWER
If the medical necessity for a private room is documented in the chart. The
patients insurance will be billed for the differential
Which of the following is true about screening a beneficiary of possible
MSP(Medicare secondary payer) situations? - CORRECT ANSWER It is necessary
to ask the patient each of the MSP questions
Which of the following is not true of Medicare Advantage Plans? - CORRECT
ANSWER A patient must have both Medicare Part A and B benefits to be eligible
for a Medicare Advantage plan
Which of the following is a valid reason for a payer to deny a claim? - CORRECT
ANSWER Failure to complete authorization
, Which of the following statements is NOT a possible consequence of selecting
the wrong patient in the MPI(master patient index) - CORRECT ANSWER Claim
is paid in full
Which of the following statements is true of a Medicare Advantage Plan? -
CORRECT ANSWER This plan supplements Part A and Part B benefits
Which is the following is not a characteristic of Medicaid HMO plan? - CORRECT
ANSWER Medicaid-eligible patients are never required to join a Medicaid HMO
plan
Which of the following is violation of the EMTALA ? - CORRECT ANSWER
Registration staff members routinely contact managed care plans for prior
authorizations before the patients is seen by the on duty physician
Which of the following statements is true of the important message from
Medicare notification requirements? - CORRECT ANSWER Notification can be
issued no earlier than 7 days before admission and no more than 2 days before
discharge.
What is the self pay balance after insurance - CORRECT ANSWER The portion of
the adjudicated claim that is due from the patient
Which of the following options is an alternative to valid long term payment plans -
CORRECT ANSWER Bank loans
The patient has the following benefit plan $400 per family member deductible, to
a maximum of $1200 per year and $2000 per family member co insurance, 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 that family could incur during the calendar year? - CORRECT
ANSWER $6000
What type of plan restricts benefits for non-emergency care to approve providers
only? - CORRECT ANSWER A POS (point of service )plan
What does scheduling allow provider staff to do? - CORRECT ANSWER Review
the appropriateness of the service requested
When an adult patient is covered by both his own and his spouse health insurance
plan, which of the statements is true? - CORRECT ANSWER The patients
insurance plan is primary
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