HFMA CRCR EXAM 172 Questions with Answers 2023,100% CORRECT
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HFMA CRCR
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HFMA CRCR
HFMA CRCR EXAM 172 Questions with Answers 2023
Through what document does a hospital establish compliance standards? - CORRECT ANSWERS code of conduct
What is the purpose OIG work plant? - CORRECT ANSWERS Identify Acceptable compliance programs in various provider setting
If a Medicare p...
through what document does a hospital establish compliance standards
what is the purpose oig work plant
if a medicare patient is admitted on friday
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HFMA CRCR EXAM 172 Questions with Answers 2023
Through what document does a hospital establish compliance standards? -
CORRECT ANSWERS code of conduct
What is the purpose OIG work plant? - CORRECT ANSWERS Identify Acceptable
compliance programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the three-day
DRG window rule? - CORRECT ANSWERS Non-diagnostic service provided on
Tuesday through Friday
What does a modifier allow a provider to do? - CORRECT ANSWERS Report a
specific circumstance that affected a procedure or service without changing the
code or its definition
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 - CORRECT ANSWERS They must be
billed separately to the part B Carrier
what is a recurring or series registration? - CORRECT ANSWERS One registration
record is created for multiple days of service
What are nonemergency patients who come for service without prior notification
to the provider called? - CORRECT ANSWERS Unscheduled patients
Which of the following statement apply to the observation patient type? -
CORRECT ANSWERS It is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient
- CORRECT ANSWERS Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? - CORRECT
ANSWERS Complete the scheduling process correctly based on service requeste
,The Time needed to prepare the patient before service is the difference between
the patients arrival time and which of the following? - CORRECT ANSWERS
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: - CORRECT ANSWERS
Documentation of the medical necessity for the test
What is the advantage of a pre-registration program - CORRECT ANSWERS It
reduces processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry -
CORRECT ANSWERS 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? - CORRECT
ANSWERSThe 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 - CORRECT ANSWERSstop loss
what documentation must a primary care physician send to HMO patient to
authorize a visit to a specialist for additional testing or care? - CORRECT
ANSWERSReferral
Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the
provider may not ask about a patient's insurance information if it would delay
what? - CORRECT ANSWERSMedical screening and stabilizing treatment
Which of the following is a step in the discharge process? - CORRECT
ANSWERSHave a case management service complete 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? - CORRECT
ANSWERSTo 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 from the
patient? - CORRECT ANSWERS$100.00
When is a patient considered to be medically indigent? - CORRECT ANSWERSThe
patient's outstanding medical bills exceed a defined dollar amount or percentage
of assets.
What patient assets are considered in the financial assistance application? -
CORRECT ANSWERSSources of readily available funds , vehicles, campers, boats
and saving accounts
If the patient cannot agree to payment arrangements, What is the next option? -
CORRECT ANSWERSWarn the patient that unpaid accounts are placed with
collection agencies for further processing
What core financial activities are resolved within patient access? - CORRECT
ANSWERSscheduling , pre-registration, insurance verification and managed care
processing
What is an unscheduled direct admission? - CORRECT ANSWERSA patient who
arrives at the hospital via ambulance for treatment in the emergency department
When is it not appropriate to use observation status? - CORRECT ANSWERSAs a
substitute for an inpatient admission
Patients who require periodic skilled nursing or therapeutic care receive services
from what type of program? - CORRECT ANSWERSHome health agency
Every patient who is new to the healthcare provider must be offered what? -
CORRECT ANSWERSA printed copy of the provider privacy notice
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