CRCR Exam- Bundle (Graded A) 2023

What are collection agency fees based on? - Answer-A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - Answer-Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between t...

What do Case Managers do? - Answer-Monitor high resource cases to ensure effective utilization What is HIM responsible for? - Answer-all pt medical records: transcribe, coding, release to biling, answer requests for documentation What is utilization management responsible for? - Answer-manage ...

HMO (Health Maintenance Organization) - Answer-A group of medical providers is identified to furnish services at lower than usual fees PPO Preferred Provider Organization - Answer-a health plan that provides comprehensive healthcare services, within a designated population on a prepayment basis ...

Pre-Service (Step 2) - Answer-2. The encounter record is generated, and the patient and guarantor information is obtained and/or updated as required. Pre-Service (Step 3) - Answer-3. The requested service is screened for medical necessity; health plan coverage and benefits are verified, and pre-a...

835 Record - Answer-A standard electronic message between a health plan and provider sending remittance data on a claim to the provider. 837 Record - Answer-A standard electronic message between a provider and health plan sending data on a claim to the health plan. AAR - Answer-After-hours act...

Consents are signed as part of the post service process. (True or Flase) - Answer-False Patient service costs are calculated in the pre-service process for scheduled patients.(True or False) - Answer-True The patient is scheduled and registered for service is a time of service activity (True o...

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 compliance, essential and integral component, fosters an environment, (all of the abo...

HFMA patient financial communications best practices call for annual training for all staff EXCEPT - Answer-A. Patient access B. Customer service representatives **C. Nursing D. Staff who engage in patient financial communications discussions What is required for the UB-04/837-I, used by Rural...

qAAR - Answer-After-hours activity report ABN - Answer-Advance Beneficiary Notice ACC - Answer-Ambulatory care center Access - Answer-Ability to receive hospital; physician or other medical services without regard to an individual's ability to pay Accounts receivable (A/R) - Answer-Money...

The 501(r) regulations require not-for-profit providers 501(c) (3) to do which of the following activities? A. Complete a community needs assessment and develop a discount program for patient balances after insurance payment. B. Pursue extraordinary collection activities with all patients eligible...

Which option is NOT a main HFMA Healthcare Dollars and Sense revenue cycle initiative? A) Patient Financial Communications B) Medical Account Resolution C) Price Transparency D) Process Compliance - Answer-D) Process Compliance Approximately what ______% of billing information is obtained du...

code of conduct - Answer-hospital establish compliance standards. Purpose of OIG work plan? - Answer-communicate issues that will be reviewed during the year for compliance with Medicare regulations Medicare pt. admitted on Friday, what services fall within the three day window rule? - Answer-...

Important revenue cycle activities in the pre-service stage include; - Answer-Obtaining or updating patient and guarantor information In the pre-service stage, the cost of the scheduled service is identified and the patient's health plan and benefits are used to calculate; - Answer-The amount th...

Types of Unscheduled Patients - Answer-Urgent (ED) patients, Walk-in OP, Observation patients, and newborns. Resource Coordination - Answer-The process of reserving rooms and/or equipment, ordering devices or supplies, and ensuring that professional staff (physicians, nurses, and/or technicians) ...