CRCR Multiple Choice
The disadvantages of outsourcing include all of the following EXCEPT:
a) The impact of customer service or patient relations
b) The impact of loss of direct control of accounts receivable services
c) Increased costs due to vendor ineffectiveness
d) Reduced internal staffing costs and a reliance on outsourced staff - ANSD
The Medicare fee-for service appeal process for both beneficiaries and providers
includes all of the following levels EXCEPT:
a) Medical necessity review by an independent physician's panel
b) Judicial review by a federal district court
c) Redetermination by the company that handles claims for
Medicare
d) Review by the Medicare Appeals Council (Appeals Council) - ANSB
Business ethics, or organizational ethics represent:
a) The principles and standards by which organizations operate
b) Regulations that must be followed by law
c) Definitions of appropriate customer service
d) The code of acceptable conduct - ANSA
A portion of the accounts receivable inventory which has NOT qualified for billing
includes:
a) Charitable pledges
b) Accounts created during pre-registration but not activated
c) Accounts coded but held within the suspense period
d) Accounts assigned to a pre-collection agency - ANSA
Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are
Medicare established guideline(s) used to determine:
a) Medicare and Medicaid provider eligibility
b) Medicare outpatient reimbursement rates
c) Which diagnoses, signs, or symptoms are reimbursable
d) What Medicare reimburses and what should be referred to
Medicaid - ANSC
Days in A/R is calculated based on the value of:
,a) The total accounts receivable on a specific date
b) Total anticipated revenue minus expenses
c) The time it takes to collect anticipated revenue
d) Total cash received to date - ANSC
Patients are contacting hospitals to proactively inquire about costs and fees prior to
agreeing to service. The problem for hospitals in providing such information is:
a) That hospitals don't want to establish a price without knowing if
the patient has insurance and how much reimbursement can be
expected
b) The fact that charge master lists the total charge, not net charges
that reflect charges after a payer's contractual adjustment
c) That hospitals don't want to be put in the position of
"guaranteeing" price without having room for additional charges
that may arise in the course of treatment
d) Their reluctance to share proprietary information - ANSB
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) Make sure that the attending staff can answer questions and
assist in obtaining required patient financial data
b) Have a patient financial responsibilities kit ready for the patient,
containing all of the required registration forms and instructions
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 - ANSC
A comprehensive "Compliance Program" is defined as
a) Annual legal audit and review for adherence to regulations
b) Educating staff on regulations
c) Systematic procedures to ensure that the provisions of
regulations imposed by a government agency are being met
d) The development of operational policies that correspond to
regulations - ANSC
Case Management requires that a case manager be assigned
a) To patients of any physician requesting case management
b) To a select patient group
, c) To every patient
d) To specific cases designated by third party contractual agreement - ANSB
Pricing transparency is defined as readily available information on the price of
healthcare services, that together with other information, help define the value of those
services and enable consumers to
a) Identify, compare, and choose providers that offer the desired
level of value
b) Customize health care with a personally chosen mix of providers
c) Negotiate the cost of health plan premiums
d) Verify the cost of individual clinicians - ANSA
Any healthcare insurance plan that provides or ensures comprehensive health
maintenance and treatment services for an enrolled group of persons based on a
monthly fee is known as a
a) MSO
b) HMO
c) PPO
d) GPO - ANSB
In a Chapter 7 Straight Bankruptcy filing
a) The court liquidates the debtor's nonexempt property, pays
creditors, and discharges the debtor from the debt
b) The court liquidates the debtor's nonexempt property, pays
creditors, and begins to pay off the largest claims first. All claims
are paid some portion of the amount owed
c) The court vacates all claims against a debtor with the
understanding that the debtor may not apply for credit without
court supervision
d) The court establishes a creditor payment schedule with the
longest outstanding claims paid first - ANSA
The core financial activities resolved within patient access include:
a) Scheduling, pre-registration, insurance verification and managed
care processing
b) Scheduling, insurance verification, clinical discharge processing
and payment posting of point of service receipts
c) Scheduling, registration, charge entry and managed care
processing
d) Scheduling, pre-registration, registration, medical necessity
The disadvantages of outsourcing include all of the following EXCEPT:
a) The impact of customer service or patient relations
b) The impact of loss of direct control of accounts receivable services
c) Increased costs due to vendor ineffectiveness
d) Reduced internal staffing costs and a reliance on outsourced staff - ANSD
The Medicare fee-for service appeal process for both beneficiaries and providers
includes all of the following levels EXCEPT:
a) Medical necessity review by an independent physician's panel
b) Judicial review by a federal district court
c) Redetermination by the company that handles claims for
Medicare
d) Review by the Medicare Appeals Council (Appeals Council) - ANSB
Business ethics, or organizational ethics represent:
a) The principles and standards by which organizations operate
b) Regulations that must be followed by law
c) Definitions of appropriate customer service
d) The code of acceptable conduct - ANSA
A portion of the accounts receivable inventory which has NOT qualified for billing
includes:
a) Charitable pledges
b) Accounts created during pre-registration but not activated
c) Accounts coded but held within the suspense period
d) Accounts assigned to a pre-collection agency - ANSA
Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are
Medicare established guideline(s) used to determine:
a) Medicare and Medicaid provider eligibility
b) Medicare outpatient reimbursement rates
c) Which diagnoses, signs, or symptoms are reimbursable
d) What Medicare reimburses and what should be referred to
Medicaid - ANSC
Days in A/R is calculated based on the value of:
,a) The total accounts receivable on a specific date
b) Total anticipated revenue minus expenses
c) The time it takes to collect anticipated revenue
d) Total cash received to date - ANSC
Patients are contacting hospitals to proactively inquire about costs and fees prior to
agreeing to service. The problem for hospitals in providing such information is:
a) That hospitals don't want to establish a price without knowing if
the patient has insurance and how much reimbursement can be
expected
b) The fact that charge master lists the total charge, not net charges
that reflect charges after a payer's contractual adjustment
c) That hospitals don't want to be put in the position of
"guaranteeing" price without having room for additional charges
that may arise in the course of treatment
d) Their reluctance to share proprietary information - ANSB
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) Make sure that the attending staff can answer questions and
assist in obtaining required patient financial data
b) Have a patient financial responsibilities kit ready for the patient,
containing all of the required registration forms and instructions
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 - ANSC
A comprehensive "Compliance Program" is defined as
a) Annual legal audit and review for adherence to regulations
b) Educating staff on regulations
c) Systematic procedures to ensure that the provisions of
regulations imposed by a government agency are being met
d) The development of operational policies that correspond to
regulations - ANSC
Case Management requires that a case manager be assigned
a) To patients of any physician requesting case management
b) To a select patient group
, c) To every patient
d) To specific cases designated by third party contractual agreement - ANSB
Pricing transparency is defined as readily available information on the price of
healthcare services, that together with other information, help define the value of those
services and enable consumers to
a) Identify, compare, and choose providers that offer the desired
level of value
b) Customize health care with a personally chosen mix of providers
c) Negotiate the cost of health plan premiums
d) Verify the cost of individual clinicians - ANSA
Any healthcare insurance plan that provides or ensures comprehensive health
maintenance and treatment services for an enrolled group of persons based on a
monthly fee is known as a
a) MSO
b) HMO
c) PPO
d) GPO - ANSB
In a Chapter 7 Straight Bankruptcy filing
a) The court liquidates the debtor's nonexempt property, pays
creditors, and discharges the debtor from the debt
b) The court liquidates the debtor's nonexempt property, pays
creditors, and begins to pay off the largest claims first. All claims
are paid some portion of the amount owed
c) The court vacates all claims against a debtor with the
understanding that the debtor may not apply for credit without
court supervision
d) The court establishes a creditor payment schedule with the
longest outstanding claims paid first - ANSA
The core financial activities resolved within patient access include:
a) Scheduling, pre-registration, insurance verification and managed
care processing
b) Scheduling, insurance verification, clinical discharge processing
and payment posting of point of service receipts
c) Scheduling, registration, charge entry and managed care
processing
d) Scheduling, pre-registration, registration, medical necessity
