CRCR Practice Questions with complete solutions.

CRCR Practice Questions with complete solutions. 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 for financial assistance. C. Implement a financial assistance program for uninsured and underinsured patients. D. Discount all charges to self-pay patients to an amount generally billed to all other patients. - correct answer. A. Complete a community needs assessment and develop a discount program for patient balances after insurance payment The accurate capture of charges remains critically important because: A. Of the potential of fraud and abuse charges from erroneous billing. B. Charges remain one of the few consistent indicators available to monitor resource use. C. Charges are means of measuring physician productivity. D. Charges provide the data used in activity based costing. - correct answer. B. Charges remain one of the few consistent indicators available to monitor resource use The ACO investment model will test the use of pre-paid shared savings to: A. Invest in treatment protocols that reduce costs to Medicare B. Attract physicians to participate in the ACO payment system. C. Raise quality ratings in designated hospitals. D. Encourage new ACOs to form in rural and underserved areas. - correct answer. D. Encourage new ACOs to form in rural and underserved areas Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite discharge, the HFMA best practice is to: A. Have a patient financial responsibilities kit ready for the patient, containing all of the required registration forms and instructions. B. Make sure that the attending staff can answer questions and assist in obtaining required patient financial data. C. Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow. D. Decline such request as finance discussions can disrupt patient care and patient flow. - correct answer. C. Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow Activities completed when the scheduled, pre-registered patient arrives for service includes: A. Verifying insurance, activating the record and directing the patient to the service area. B. Scanning the driver's license or other phot identification and directing the patient to the financial counselor. C. Activating the record, obtaining signatures and finalizing financial issues. D. Registering the patient and directing the patient to the service area. - correct answer. C. Activating the record, obtaining signatures and The activity which results in the accurate recording of patient bed and level of care assessment, patient transfer and patient discharge status on a real-time basis is known as: A. Utilization review B. Case Management C. Census Management D. Patient through-put - correct answer. A. Utilization review or B. Case Management An advantage of a pre-registration program is: A. The markets value of such a program B. The ability to eliminate no-show appointments. C. The opportunity to reduce processing times at the time of service. D. The opportunity to reduce corporate compliance failures within the registration process. - correct answer. C. The opportunity to reduce processing times at the time of service. The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can: A. Obtain price estimates for medical services B. Negotiate the price of medical services with providers C. Purchase qualified health benefit plans regardless of insured's health status D. Meet federal mandates for insurance coverage and obtain the corresponding tax deduction - correct answer. C. Purchase qualified health benefit plans regardless of insured's health status. All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT: A. Offered in an outpatient setting B. Medically unnecessary C. Not delivered in a Medicare licensed care setting. D. Services and procedures that are custodial in nature - correct answer. C. Not delivered in a Medicare licensed care setting All of the following are reference resources used to help guide in the application for business ethics EXCEPT: A. Consumer satisfaction reports B. Mission & Value Statements C. Code of Ethics / Code of Conduct D. Compliance Office & Policies - correct answer. A. Consumer satisfaction reports All of the following are steps in safeguarding collections EXCEPT: A. Placing collections in a lock-box for posting review the next business day. B. Posting the payment to the patient's account C. Completing balancing activities D. Issuing receipts - correct answer. A. Placing collections in a lock-box for posting review the next business day All of the following are steps in verifying insurance EXCEPT: A. Sequencing plans involved in a coordination of benefits (COB) situation. B. The patient signing the statement of financial responsibility. C. Identifying and documenting the patient's health plan benefits D. Confirming the patient's eligibility for benefits - correct answer. B. The patient signing the statement of financial responsibility All of the following information is used to identify a patient EXCEPT: A. Date of Birth B. Gender C. Social Security Number D. Address - correct answer. D. Address All of the following information should be reviewed as part of schedule finalization EXCEPT: A. The estimated patient financial obligations B. The service to be provided C. The arrival time and procedure time D. The patient's preparation instructions - correct answer. A. The estimated patient financial obligations Ambulance services are billed directly to the health plan for : A. All pre-admission emergency transports B. Transport deemed medically necessary by the attending paramedic-ambulance crew C. Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility D. The portion of the bill outside of the patient's self-pay - correct answer. C. Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or the another facility Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons on a monthly fee is known as a: A. HMO B. PPO C. MSO D. GPO - correct answer. A. HMO Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with: A. The Provider Reimbursement Review Board B. The Department of Health and Human Services Provider Relations Division C. A court appointed federal mediator D. The Office of the Inspector General - correct answer. A. The Provider Reimbursement Review Board Applying the contracted payment methodology to the total charges yields: A. An estimated price B. An anticipated health plan payment C. A price justified revenue accrual D. A pricing agreement - correct answer. A. An estimated price Appropriate training for the patient financial counselling staff must cover all of the following EXCEPT: A. Patient financial communications best practices specific to staff role B. Financial assistance policies C. Documenting the conversation in the medical record D. Available patient financing options - correct answer. C. Documenting the conversation in the medical record The basis for qualification in Medicaid is typically: A. The Federal Poverty Guidelines B. Financial need as demonstrated by the prior two-years federal income tax fillings C. The patient's score on the Internal Revenue Service's Personal Wealth and Spending indicator D. Bank statements for the previous 18 months - correct answer. A. The Federal Poverty Guidelines Because 501(r) regulations focus on identifying potentially eligible financial assistance patients, hospitals must: A. Capture their experience with such patients to properly budget B. Hold financial conversations with patients as soon as possible C. Build the necessary processes to handle the potentially lengthy payment schedules D. Expedite payment processing of normal accounts receivables to protect cash flow - correct answer. B. Hold financial conversations with patients as soon as possible Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implementation, identifying and processing accounts and: A. Obtain the patients income tax statements from the prior 2 years B. Having the account triaged for any partial payment possibilities C. Monitor compliance D. Assist in arranging for a commercial bank loan - correct answer. C. Monitor compliance The benefit of a Medicare Advantage Plan is: A. It is a less costly plan compared to traditional Medicare B. Patients may retain a primary care physician and see another physician for a second opinion at no charge C. Patients generally have their entire Medicare-covered healthcare through the plan and do not need to worry about "Part A" or "Part B' benefits D. Patients receive significant discounting on services contracted by the federal government - correct answer. C. Patients generally have their entire Medicare-covered healthcare through the plan and do not need to worry about "Part A" or "Part B" benefits A benefit period begins: A. With admission as an inpatient B. Upon the day the coverage premium is paid C. The first day in which a patient is furnished extended care services in the period the patient is entitled to hospital insurance D. Immediately once authorization for treatment is provided by the health plan - correct answer. C. The first day in which a patient is furnished extended care services in the period the patient is entitled to hospital insurance The best practice in billing is to generate bills and financial information that is: A. Timely and specifies the patient's next steps B. Clear, concise, correct and patient-friendly C. Comprehensive and all-inclusive D. Direct in summarizing charges and in requesting prompt payment - correct answer. B. Clear, concise, correct and patient-friendly Case management requires that a case manager be assigned: A. To a select group of resource intensive patient cases B. To every patient C. To specific cases designated by third-party contractual agreement D. To patients of any physician requesting case management - correct answer. B. To every patient Claims edits are: A. Rules developed to verify the accuracy of claims based on each health plan's policies B. The specific reimbursement areas of a claim that are denied by the health plan C. Special addendums to the claim allowing the provider to submit additional documentation D. Triggers in the health plan claim adjudication system that disallows reimbursement - correct answer. A. Rules developed to verify the accuracy of claims based on each health plan's policies Claims with dates of service received later than one year beyond the date of service, will be: A. Denied by Medicare B. The full responsibility of the patient C. The provider's responsibility but can be deemed charity care D. Fully paid with interest - correct answer. A. Denied by Medicare A "Compliance Program" is defined as: A. Educating staff on regulations B. The development of operational policies that correspond to regulations C. Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met D. Annual legal audit and review for adherence to regulations - correct answer. C. Systematic procedures to ensure that provisions of regulations imposed by government agency are being met The concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits: A. Billing B. Account resolution C. Claims Processing D. Third-party invoicing - correct answer. C. Claims processing Concurrent review and discharge planning: A. Occurs during service B. Is performed by the health plan during the time of service