HFMA CRCR EXAM LATEST EXAM 170+ QUESTIONS AND CORRECT ANSWERS(VERIFIED ANSWERS)
IF outpatient diagnostic services are provided within three days of the admission of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these charges - ANSWER- They...
HFMA CRCR EXAM LATEST 2023 -2024 EXAM 170+ QUESTIONS AND CORRECT ANSWERS( VERIFIED ANSWERS ) IF outpatient diagnostic services are provided within three days of the admission of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these charges - ANSWER - They must be billed separately to the part B Carrier what is a recurring or series registration? - ANSWER - One registration record is created for multiple days of service What are nonemergency patients who come for service without prior notification to the pr ovider called? - ANSWER - Unscheduled patients Which of the following statement apply to the observation patient type? - ANSWER - It is used to evaluate the need for an inpatient admission which services are hospice programs required to provide around the clock patient - ANSWER - Physician, Nursing, Pharmacy Scheduler instructions are used to prompt the scheduler to do what? - ANSWER - Complete the scheduling process correctly based on service requeste The Time needed to prepare the patient before service i s the difference between the patients arrival time and which of the following? - ANSWER - Procedure time Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include: - ANSWER - Documentation of the medical necessity for the test What is the advantage of a pre -registration program - ANSWER - It reduces processing times at the time of service What date are required to establish a new MPI(Master patient Index) entry - ANSWER - The responsible party's full legal name, date of birth, and social security number Which of the following statements is true about third -party payments? - ANSWER - The payments are received by the provider from the payer responsible for reimbursing the provider for the patient's covered services. Which provision protects the patient from medical expenses that exceed the pre-set level - ANSWER - stop loss what documentation must a primary care physician send to HMO patient to authorize a visit to a specialist for additional testing or care? - ANSWER - Referral Under EMTALA (Emergency Medical Treatment and Labor Act) regula tions, the provider may not ask about a patient's insurance information if it would delay what? - ANSWER - Medical screening and stabilizing treatment Which of the following is a step in the discharge process? - ANSWER - Have a case management service compl ete the discharge plan The hospital has a APC based contract for the payment of outpatient services. Total anticipated charges for the visit are $2,380. The approved APC payment rate is $780. Where will the patients benefit package be applied? - ANSWER - To the approved APC payment rate 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 fr om the patient? - ANSWER - $100.00 When is a patient considered to be medically indigent? - ANSWER - The patient's outstanding medical bills exceed a defined dollar amount or percentage of assets. What patient assets are considered in the financial assista nce application? - ANSWER - Sources of readily available funds , vehicles, campers, boats and saving accounts If the patient cannot agree to payment arrangements, What is the next option? - ANSWER - Warn the patient that unpaid accounts are placed with coll ection agencies for further processing What core financial activities are resolved within patient access? - ANSWER - scheduling , pre -registration, insurance verification and managed care processing What is an unscheduled direct admission? - ANSWER - A patient who arrives at the hospital via ambulance for treatment in the emergency department When is it not appropriate to use observation status? - ANSWER - As a substitute for an inpatient admission Patients who require periodic skilled nursing or therapeutic care receive services from what type of program? - ANSWER - Home health agency Every patient who is new to the healthcare provider must be offered what? - ANSWER - A printed copy of the provider pri vacy notice
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