HFMA CRCR
Pre-Service activities - Answer-1. Requested service is screened for med necessity, health coverage/benefits verified, preauthorization obtained and estimate to patient oop costs generated within guidelines of NSA and state regulations.
2. Patient notified of financial responsibility...
HFMA CRCR
Through what document does a hospital establish compliance standards? - Answer-code of
conduct
What is the purpose OIG work plant? - 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? - Answer-Non-diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do? - 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 - Answer-They must be billed separately to the part B Carrier
what is a recurring or series registration? - 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? - Answer-Unscheduled patients
Which of the following statement apply to the observation patient type? - Answer-It is used to
evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient - Answer-
Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? - 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? - 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: - Answer-Documentation of the medical necessity for the
test
What is the advantage of a pre-registration program - Answer-It reduces processing times at the
time of service
What date are required to establish a new MPI(Master patient Index) entry - 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? - 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 -
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? - 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? - Answer-Medical
screening and stabilizing treatment
Which of the following is a step in the discharge process? - 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? - 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? - Answer-$100.00
When is a patient considered to be medically indigent? - 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? - 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? - Answer-Warn
the patient that unpaid accounts are placed with collection agencies for further processing
What core financial activities are resolved within patient access? - Answer-scheduling , pre-
registration, insurance verification and managed care processing
What is an unscheduled direct admission? - 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? - Answer-As a substitute for an inpatient
admission
Patients who require periodic skilled nursing or therapeutic care receive services from what type
of program? - Answer-Home health agency
Every patient who is new to the healthcare provider must be offered what? - Answer-A printed
copy of the provider privacy notice
Which of the following statements apples to self insured insurance plans? - 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 - Answer-Name
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