Download HFMA CRCR Exam | (2024/ 2025) Questions and Verified Answers and more Exams Ethics in PDF only on Docsity!
HFMA CRCR Exam | (202 4 / 2025 ) Questions
and Verified Answers
QUESTION
Annually, the OIG publishes a work plan of compliance issues and objectives that will be focused on throughout the following year. Identify which option is NOT a work plan task mentioned in this course. Answer: Standard Unique Employer Identifier
QUESTION
In order to promote the use of correct coding methods on a national basis and prevent payment errors due to improper coding, CMS developed what? Answer: The Correct Coding Initiative (CCI)
QUESTION
Ethics violations vary. Typical violations include: Answer: Financial misconduct Overcharging Theft of property Falsifying records to boost reimbursement Miscoding claims
QUESTION
What do business/organizational ethics represent? Answer:
Principles and standards by which organizations operate.
QUESTION
What is the intended outcome of collaborations made through an ACO delivery system? Answer: To ensure appropriateness of care, elimination of duplicate services, and prevention of medical errors for a population of patients.
QUESTION
Which of these statements describes the new methodology for the determination of net patient service revenue: Answer: Net patient service revenue is defined as the total incurred charges, less the explicit price concession, less any applicable implicit price concession(s) as applied to the specific portfolio of accounts.
QUESTION
What are KPIs? Answer: Key performance indicators, which set standards for accounts receivable (A/R) and provide a method of measuring the collection and control of A/R.
QUESTION
Name the guideline that Medicare established to determine which diagnoses, signs, or symptoms are payable. Answer: Local Coverage Determinations
QUESTION
Which option is NOT a specific managed care requirement? Answer: Preferred Provider Organization
QUESTION
Below are 5 major steps involved in determining a surgical case price estimate for an uninsured patient. Match the step to the appropriate number. Answer: 1 Verify patient is not eligible for Medicaid. 2 Obtain total charges for hospital portion of case and identify network status of additional providers. 3 Apply organization's self pay discount, if applicable. 4 Share results with patient and explain discount applied. 5 Come to a financial resolution with patient and document resolution in patient's record.
QUESTION
What is the first component of a pricing determination? Answer: Verification of the patient's insurance eligibility and benefits
QUESTION
What is the purpose of financial counseling? Answer: To educate the patient on his/her health plan coverage and financial responsibility for healthcare services
QUESTION
What does EMTALA require hospitals to do?
Answer: To provide a medical screening examination and stabilizing treatment to every person presenting at an ED and requesting medical evaluation or treatment.
QUESTION
In what manner do case managers assist revenue cycle staff? Answer: Providing assistance with written appeals to health plans related to utilization and other care issues.
QUESTION
Why is it critical that a chargemaster is reviewed and updated regularly? Answer: To ensure it supports and represents the services provided within the organization.
QUESTION
What is the responsibility of HIM? Answer: To maintain all patient medical records
QUESTION
UB- 04 Claim Form Answer: This form contains 81 form locators and is used by institutional providers (hospitals, hospice, rural health clinics, skilled nursing facilities, etc.) for submitting claims.
Answer: An originating site is the location of the patient at the time the service is furnished. This could be an office of a physician or APP, hospital (including CAH), Rural Health Clinic, Federally Qualified Health Center, hospital-based or CAH-based Renal Dialysis Centers, Skilled Nursing Facilities and Community Mental Health Centers.
QUESTION
Distant Site Practitioner Answer: Practitioners at the distant site who may furnish and receive payment for covered telehealth services. This may include physicians, nurse practitioners, physician assistants, nurse-midwives, clinical nurse specialists, certified registered nurse anesthetists, clinical psychologist, clinic social workers and registered dietitians.
QUESTION
Which statement is NOT a unique billing rule specific to providers? Answer: A patient may be balance billed for whatever amount the non-contracting physician charges above the health plan's reimbursement amount.
QUESTION
Which of the following statements does not apply to billing during the COVID- 19 public health emergency: Answer: Telemedicine claims are not payable if the patient conducts the telemedicine visit from home.
QUESTION
Which concept is NOT a contracted payment model?
Answer: Stop-Loss Provision
QUESTION
Sue Smith came into the hospital. Her insurance provider sent an EFT directly into the hospital's account at the bank. John, the hospital representative, receives an electronic Level 2 ERA. What should he do next? Answer: Manually match the ERA to the patient account.
QUESTION
What is EFT? Answer: The electronic transfer of funds from payer to payee through the banking system.
QUESTION
1 Determine overpayment amount; issue refund check to patient. 2 Submit corrected claim to payer or remove credit charges from patient's account. 3 Notify payer, send refund or complete take back form as directed by payer. 4 Determine correct primary, notify incorrect payer of overpayment. Answer: 1 Inaccurate upfront collections 2 Late charge credits processing 3 Duplicate payments 4 Primary and secondary payers both paying as primary
QUESTION
Which statement is false regarding credit balances?
Answer: All of the above: A critical tool to ensure the compliance with the organization's compliance standards and procedures. An essential and integral component of the organization's culture. Fosters an environment where concerns and questions may be raised without fear of retaliation or retribution
QUESTION
Specific to Medicare fee-for-service patients, which of the following payers have always been liable for payment? Answer: Public health service programs, Federal grant programs, veteran affairs programs, black lung program services and work-related injuries and accidents (worker's compensation claims)
QUESTION
Provider policies and procedures should be in one place to reduce the risk of ethics violations. Examples of ethics violations include: Answer: All of the above: Financial misconduct, overcharging and miscoding claims. Theft of property and falsifying records to boost reimbursement. Financial misconduct and applying policies in an inconsistent manner.
QUESTION
Providers are now being reimbursed with a focus on the value of the services provided, rather than volume, which requires collaboration among providers. What is the intended outcome of collaborations made through an ACO delivery system for a population of patients? Answer: To eliminate duplicate services, prevent medical errors and ensure appropriateness of care
QUESTION
Historically, the revenue cycle has dealt with contractual adjustments, bad debt and charity deductions from gross revenue. Although deductions continue to exist, the definition of net revenue has been modified through the implementation of ASC 606. Developed by the Financial Accounting Standards Board (FASB), this change became effective in 2018. What is the new terminology now employed in the calculation of net patient service revenues? Answer: Explicit price concessions and implicit price concessions
QUESTION
Key Performance indicators set standards for A/R and provide a method for measuring the control and collection of A/R. What are the two KPI's used to monitor performance related to the production and submission of claims to third party players and patients (self-pay)? Answer: Elapsed days from discharge to final bill and elapsed days from final bill to claim/ bill submission
QUESTION
Be able to explain the sequence and content of the activities that occur in each critical segment of the revenue cycle Answer: Revenue cycle includes all processing steps required to process a patient account from the request for service through closing the account with a zero balance and purging it from the system Scheduling and pre-access processing set the stage for effective patient communication and data collection. During the pre-service segment, different steps will be completed, and the information will move from point to point Pre-Service Time-of-Service Post-Service
QUESTION
Important Activities of HIM Answer: Ensuring the security and completion of electronic and hardcopy medical records.
The same rate is paid per day regardless of the volume or intensity of service and is also paid when the patient is receiving hospital care for a condition unrelated to the terminal condition.
QUESTION
Continuous Home Care Answer: The continuous home care rate is divided by 24 hours to obtain the hourly rate.
QUESTION
Inpatient Respite Care Answer: Payment for respite care may be made for a maximum of five days at a time including the date of admission but not including the date of discharge. This is payment to hospitalize the patient for a short period in order to relieve the caregivers for a time period. Payment for the sixth and any subsequent day is paid at the routine home care rate.
QUESTION
General Inpatient Care Answer: Payment at the general inpatient rate is made when general inpatient care is provided.
QUESTION
Benefit Period Answer: A benefit period is a period of time for measuring the use of hospital insurance benefits. A patient is eligible for 100 days of care in a SNF during the benefit period. As long as a person continues to be entitled to hospital insurance (Part A), there is no limit on the number of benefit periods a patient may have. The term "benefit period" is synonymous with "spell of illness".
QUESTION
Care in a SNF Care in a SNF is covered if all of the following four factors are met: Answer: The patient requires skilled nursing services or skilled rehabilitation services. The patient requires skilled services on a daily basis. As a practical matter, the daily skilled services can be provided only on an inpatient basis in a SNF. Ancillary services (example, lab, pharmacy, X-ray) are available if needed on an emergency basis.
QUESTION
SNF Billing in Sequence Answer: When a patient remains an inpatient of a SNF for over 30 days, the SNF is permitted to submit a bill every 30 days.
QUESTION
Benefits of Pre-Registration Answer: The process of pre-registration ensures that patient access staff will have complete and valid information needed to finalize any remaining pre-access activities, including: Medicare Secondary Payer screening Medical necessity screening Insurance verification Pre-certification/authorization Managed care requirement resolution; and financial education/resolution
Health Care Patient Services
QUESTION
1 Consents are signed as part of the post-service process. 2 Patient service costs are calculated in the pre-service process for scheduled patients. 3 The patient is scheduled and registered for service is a time of service activity. 4 The patient account is monitored for payment is a time-of-service activity. 5 Case management and discharge planning services are a post service activity. 6 Sending the bill electronically to the health plan is a time-of-service activity. Answer: 1 False 2 True 3 False 4 False 5 False 6 False
QUESTION
What happens during the post-service stage? Answer: Final coding of all services, preparation and submission of claims, payment and balance billing a resolution.
QUESTION
The following statement describes the best practices established by the Medical Debt Task Force. Answer:
- Follow best practices for communication.
- Be consistent in key aspects of account resolution.
- Coordinate to avoid duplicate patient contracts.
- Educate patients.
Answer: Answer: Answer: Answer: Answer:
QUESTION
Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle initiative? Process Compliance
QUESTION
What is the objective of the HCAHPS initiative? To provide a standardized method for evaluating patients' perspective on hospital care.
QUESTION
Which option is NOT a department that supports and collaborates with the revenue cycle? Assisted Living Services
QUESTION
Which option is NOT a continuum of care provider? Health Plan Contracting
QUESTION
Demographics Complete patient demographics information (full legal name, address, date of birth, Social Security number, gender, race, ethnicity, marital status, contact telephone numbers, employment status, employer, employer address and telephone number).
QUESTION
Which option is NOT a type of denial. Answer: Contractual adjustment
QUESTION
Which option is NOT a lien type? Answer: Subrogation
QUESTION
Which Items are required components of a financial assistance policy? Answer: Concise statement of the hospital's mission Guidelines for bad debt or previous unpaid accounts Installment arrangement guidelines Payment Methods A clearly defined financial assistance statement
QUESTION
Which activity is not considered when initiating self-pay follow up and account resolution activities? Answer: Patient Open Balance Billing
QUESTION
Which option is NOT a required component of a FAP?
Answer: Out of Network Providers
QUESTION
Match the title to the appropriate consumer credit protection act component. Answer: Truth in lending act - Title 1 Restrictions on garnishment - Title III Fair debt collections practices act - Title VIII Fair credit reporting Act - Title VI
QUESTION
Which is not a bankruptcy type governed by thee 1979 bankruptcy act? Answer: Creditor priority
QUESTION
Which evaluation criteria demonstrates reputation expectations? Answer: The employment of staff who have documented experience working in financial areas of health care.
QUESTION
Agency fees are: Answer: The cost to the provider for collecting agency monies offset by the return on baddest accounts.
