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HFMA CRCR Exam | Questions and Verified
Answers| 202 4 / 202 5 New Update |100%
Correct
QUESTION
In what type of payment methodology is a lump sum of bundled payment negotiated between the payer and some or all providers? Answer: DRG/Case rate
QUESTION
What Restriction does a managed care plan place on locations that must be used if the plan is to pay for the service provided? Answer: Site of service limitation
QUESTION
Which of the following statements applies to private rooms? Answer: If the medical necessity for a private room is documented in the chart. The patients insurance will be billed for the differential
QUESTION
Which of the following is true about screening a beneficiary of possible MSP(Medicare secondary payer) situations? Answer: It is necessary to ask the patient each of the MSP questions
QUESTION
Which of the following is not true of Medicare Advantage Plans? Answer: A patient must have both Medicare Part A and B benefits to be eligible for a Medicare Advantage plan
QUESTION
Which of the following is a valid reason for a payer to deny a claim? Answer: Failure to complete authorization
QUESTION
Which of the following statements is NOT a possible consequence of selecting the wrong patient in the MPI(master patient index) Answer: Claim is paid in full
QUESTION
Which of the following statements is true of a Medicare Advantage Plan? Answer: This plan supplements Part A and Part B benefits
QUESTION
Which is the following is not a characteristic of Medicaid HMO plan?
The patient has the following benefit plan $400 per family member deductible, to a maximum of $1200 per year and $2000 per family member co insurance, to a family maximum of $6000 per year excluding the deductible. Five family members are enrolled in this benefit plan. What is the maximum out of pocket expense that that family could incur during the calendar year? Answer: $
QUESTION
What type of plan restricts benefits for non-emergency care to approve providers only? Answer: A POS (point of service )plan
QUESTION
What does scheduling allow provider staff to do? Answer: Review the appropriateness of the service requested
QUESTION
When an adult patient is covered by both his own and his spouse health insurance plan, which of the statements is true? Answer: The patients insurance plan is primary
QUESTION
Mrs. Jones , a Medicare beneficiary was admitted to the hospital on June 20,2010. As of the admission date, she had only used 8 inpatient days in the current benefit period. If she is not discharge on what date will Mr jones exhaust her full coverage days.
Answer: August 9, 2010
QUESTION
In order to meet eligibility guidelines for healthcare benefits, Medicaid beneficiaries must fall into a specified need category and meet what other types of requirements Answer: Income and assets
QUESTION
Fee for service plans pay claims based on a percentage of charges. How are patients out of pocket cost calculated? Answer: They are calculated quarterly
QUESTION
Indemnity plans usually reimburse what? Answer: A certain percentage of charges after patient meets policy's annual deductible.
QUESTION
Departments that need to be included in Charge master maintenance include all EXCEPT Answer: Quality Assurance
QUESTION
Using HIPPA standardized transaction sets allow providers to:
QUESTION
Any provider that has filed a timely cost report may appeal in an adverse final decision received from the Medicare Administrative Contractor (MAC), the appeal may be filed with: Answer: The Provider Reimbursement Review Board.
QUESTION
For scheduled payments, important revenue cycle activities in the time-of-service stage DO Not include: Answer: Obtaining or updating patient and guarantor information
QUESTION
Hospital can only convert an inpatient case to observation if: Answer: The hospital utilization review committee determines before the patient is discharged and prior to billing that an observation setting would be more appropriate.
QUESTION
Hospital need which of the following information sets to assess a patient's financial status? Answer: Demographic, Income, Assets and Expenses.
QUESTION
HIPAA privacy rules require covered entities to take all, of the following actions EXCEPT: Answer: Use only designated software platforms to secure patient date.
QUESTION
When Recovery Audit Contractors (RAC) identify improper payments as overpayment. the claims processing contractor must: Answer: Send a demand letter to the provider to recover the over payment amount.
QUESTION
Which HIPPA transaction set provides electronic processing of 8insurance verification requests and responses? Answer: The 270 - 271 set
QUESTION
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: Answer: Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow.
QUESTION
A scheduled inpatient represents an opportunity for the provider to do which of the following? Answer: Complete registration and insurance approval before service
QUESTION
The Medicare Bundled Payments for Care Initiative (BCP) is designed to:
QUESTION
Important Revenue Cycle Activities in the pre-service stage include: Answer: Obtaining or updating patient and guarantor information
QUESTION
In the pre-service stage, the cost of the schedule services is identified and the patient's health plan and benefits are used to calculate: Answer: The amount the patient may be expected to pay after insurance.
QUESTION
The disadvantage of outsourcing includes all, of the following Except Answer: Reduces internal staffing costs and a reliance on outsourced staff.
QUESTION
Marinating routine contact with health plan or liability payer, making sure all required information is provided and all needed approvals are obtained is the responsibility of who: Answer: Case Management
QUESTION
A claim is denied for the following reasons EXCEPT: Answer: The submitted claim does not have the physician signature
QUESTION
All Hospitals are required to establish a written financial assistance policy that applies to: Answer: All emergency and medically necessary care
QUESTION
Examples of ethics violation that impact the revenue cycle include all of the following EXCEPT: Answer: Seeking payment options for self-pay
QUESTION
Verbal orders from a physician for a service(s) are: Answer: Acceptable if given to "qualified" staff as defined in a hospitals policies and procedures
QUESTION
Medicare has established guidelines called Local Coverage Determination (LCD) and National Coverage Determination (NCD) that establish: Answer: What serviced or healthcare items are covered under Medicare?
QUESTION
A decision on whether a patient should be admitted as an inpatient or become an outpatient observation patient requires medical judgement based on all of the following EXCEPT:
Answer: Answer: Answer: Answer: Answer:
QUESTION
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? $100.
QUESTION
When is a patient considered to be medically indigent? The patient's outstanding medical bills exceed a defined dollar amount or percentage of assets.
QUESTION
What patient assets are considered in the financial assistance application? Sources of readily available funds , vehicles, campers, boats and saving accounts
QUESTION
If the patient cannot agree to payment arrangements, What is the next option? Warn the patient that unpaid accounts are placed with collection agencies for further processing
QUESTION
What core financial activities are resolved within patient access? scheduling , pre-registration, insurance verification and managed care processing
QUESTION
What is an unscheduled direct admission? Answer: A patient who arrives at the hospital via ambulance for treatment in the emergency department
QUESTION
When is it not appropriate to use observation status? Answer: As a substitute for an inpatient admission
QUESTION
Patients who require periodic skilled nursing or therapeutic care receive services from what type of program? Answer: Home health agency
QUESTION
Every patient who is new to the healthcare provider must be offered what? Answer: A printed copy of the provider privacy notice
QUESTION
Which of the following statements apples to self insured insurance plans? Answer: The employer provides a traditional HMO health plan
Answer: Purchase health benefits plans regardless of insured's health status
QUESTION
Before classifying and subsequently writing off an account to financial assistance or bad debit, the hospital must establish policy define appropriate criteria, implement procedures for identifying accounts and: Answer: Monitor compliance
QUESTION
The Electronic Remittance Advice (ERA) data sets are: Answer: A standardized for that provides 3rd party payment details to providers
QUESTION
The first and most critical step in registering a patient, whether scheduled or unscheduled is: Answer: Verifying the patient's identification
QUESTION
The standard claim form used for the billing by hospitals, nursing facilities, and other inpatient services is called the: Answer: UB- 04
QUESTION
A four-digit number code established by the National Uniform Billing Committee (NUBC) that categorizes/classifies a line in the charge master is known as: Answer: Revenue codes
QUESTION
Internal controls addressing coding and reimbursement charges are put in place to guard against: Answer: Compliance fraud by "upcoding"
QUESTION
The 501(R) regulations require non-for-profit providers (501) ©(3) organizations to do which of the following activities: Answer: Complete a community needs assessment and develop a discount program for patient's balances after insurance payment
QUESTION
During pre-registration, a search for the patient's MRI number is initiated using which of the following data sets: Answer: Patient's full legal name and date of birth or the patient's Social Security number
QUESTION
To maximize the value derived from customer complaints, all consumer complaints should be:
Claims with the dates of service received later than one calendar year beyond the date of service will be: Answer: Denied by Medicare
QUESTION
in the pre-service stage, the requested service is screened for medical necessity, health plan coverage and benefits are verified and: Answer: Pre-authorization are obtained
QUESTION
For scheduled patients, important revenue cycle activities in the time-of - service stage DO NOT include: Answer: Final bill is presented for payment
QUESTION
If a medical service authorization, who is typically responsible for obtaining the authorization: Answer: The provider scheduling
QUESTION
Concurrent review and discharge planning Answer: Occurs during service
QUESTION
The fundamental approach in managing denials is: Answer: To analyze the type and sources of denials and consider process changes to eliminate further denials
QUESTION
The first thing a health plan does when processing a claim is: Answer: Check if the patient is a health plan beneficiary and what is the coverage
QUESTION
Outsourcing options should be evaluated as Answer: Any other business service purchase
QUESTION
Insurance verification results in which of the following: Answer: The accurate identification of the patient's eligibility and benefits
QUESTION
EMTLA and HFMA best practices specify that in an Emergency Department setting: Answer: No patient financial discussions should occur before a patient is screened and stabilized
