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HFMA CRCR ACTUAL EXAM LATEST EXAM 170+ QUESTIONS AND CORRECT ANSWERS(VERIFIED ANSWERS) GRADE A+
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HFMA CRCR ACTUAL EXAM LATEST EXAM 170+ QUESTIONS AND CORRECT ANSWERS(VERIFIED ANSWERS) GRADE A+
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HFMA CRCR ACTUAL EXAM LATEST EXAM 170+ QUESTIONS AND CORRECTANSWERS(VERIFIED ANSWERS) GRADE A+
• The disadvantages of outsourcing include all of the following EXCEPT:
• The impact of customer service or patient relations
• The impact of loss of direct control of accounts receivable services
• Increased costs due to vendor ineffectiveness
• Reduced internal staffing costs and a reliance on outsourced staff - D
The Medicare fee-for service appeal process for both beneficiaries and providers
• includes all of the following levels EXCEPT:
• Medical necessity review by an independent physician's panel
• Judicial review by a federal district court
• Redetermination by the company that handles claims
forMedicare
d) Review by the Medicare Appeals Council (Appeals Council) - B
• Business ethics, or organizational ethics represent:
• The principles and standards by which organizations operate
• Regulations that must be followed by law
• Definitions of appropriate customer service
• The code of acceptable conduct - A
•A portion of the accounts receivable inventory which has NOT qualified for billing
includes:
• Charitable pledges
• Accounts created during pre-registration but not activated
• Accounts coded but held within the suspense period
• Accounts assigned to a pre-collection agency - A
Local Coverage Determinations (LCD) and National Coverage Determinations
(NCD)are
• Medicare established guideline(s) used to determine:
• Medicare and Medicaid provider eligibility
• Medicare outpatient reimbursement rates
• Which diagnoses, signs, or symptoms are reimbursable
• What Medicare reimburses and what should be referred
to Medicaid - C
• Days in A/R is calculated based on the value of:
• The total accounts receivable on a specific date
, • Total anticipated revenue minus expenses
• The time it takes to collect anticipated revenue
• Total cash received to date - C
•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:
• That hospitals don't want to establish a price without
knowing ifthe patient has insurance and how much reimbursement
can be expected
• The fact that charge master lists the total charge, not net
chargesthat reflect charges after a payer's contractual
adjustment
• That hospitals don't want to be put in the position of
"guaranteeing" price without having room for additional
chargesthat may arise in the course of treatment
• Their reluctance to share proprietary information - B
•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:
• Make sure that the attending staff can answer questions
andassist in obtaining required patient financial data
• Have a patient financial responsibilities kit ready for the
patient, containing all of the required registration forms and
instructions
• Support that choice, providing that the discussion does
not interfere with patient care or disrupt patient flow
• Decline such request as finance discussions can disrupt
patient care and patient flow - C
• A comprehensive "Compliance Program" is defined as
• Annual legal audit and review for adherence to regulations
• Educating staff on regulations
• Systematic procedures to ensure that the provisions
ofregulations imposed by a government agency are being
met d) The development of operational policies that
correspond to regulations - C
• Case Management requires that a case manager be assigned
• To patients of any physician requesting case management
• To a select patient group
• To every patient
• To specific cases designated by third party contractual agreement - B
, •Pricing transparency is defined as readily available information on the price of
healthcare services, that together with other information, help define the value of
thoseservices and enable consumers to
• Identify, compare, and choose providers that offer the
desired level of value
b) Customize health care with a personally chosen mix of
providersc) Negotiate the cost of health plan premiums
d) Verify the cost of individual clinicians - A
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
• MSO
• HMO
• PPO
• GPO - B
• In a Chapter 7 Straight Bankruptcy filing
• The court liquidates the debtor's nonexempt property,
payscreditors, and discharges the debtor from the debt
• The court liquidates the debtor's nonexempt property, pays
creditors, and begins to pay off the largest claims first. All
claimsare paid some portion of the amount owed
• The court vacates all claims against a debtor with the
understanding that the debtor may not apply for credit
withoutcourt supervision
• The court establishes a creditor payment schedule with
the longest outstanding claims paid first - A
• The core financial activities resolved within patient access include:
• Scheduling, pre-registration, insurance verification and
managedcare processing
• Scheduling, insurance verification, clinical discharge
processingand payment posting of point of service receipts
• Scheduling, registration, charge entry and managed
careprocessing
• Scheduling, pre-registration, registration, medical
necessityscreening and patient refunds - A
• Which of the following is NOT contained in a collection agency agreement?
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