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QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) 100% COMPLETE
When does a hospital add ambulance charges to the Medicare inpatient claim?
- ANSWER- If the patient requires ambulance transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account isbilled? - ANSWER-
Post a late-charge adjustment to the account
an increase in the dollars aged greater than 90 days from date of service indicate what about
accounts - ANSWER- They are not being processed in a timely manner
What is an advantage of a preregistration program? - ANSWER- It reduces processing times at
the time of service
What are the two statutory exclusions from hospice coverage? - ANSWER- Medically
unnecessary services and custodial care
What core financial activities are resolved within patient access? - ANSWER- Scheduling,
insurance verification, discharge processing, and payment of point-of-
service receipts
What statement applies to the scheduled outpatient? - ANSWER- The services donot involve an
overnight stay
How is a mis-posted contractual allowance resolved? - ANSWER- Comparing the contract
reimbursement rates with the contract on the admittance advice to identifythe correct amount
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What type of patient status is used to evaluate the patient's need for inpatient care?
- ANSWER- Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - ANSWER- Medically necessary inpatient hospital services for
at least 3 consecutive days before the skilled nursing care admission
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - ANSWER-
When the patient is the insured
What are non-emergency patients who come for service without prior notification to the provider
called? - ANSWER- Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what is the
status of the subscriber's spouse? - ANSWER- Neither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act,
establishes what? - ANSWER- Disclosure rules for consumer credit sales and consumer loans
What is a principal diagnosis? - ANSWER- Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - ANSWER- Lower accounts
receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - ANSWER- 50% of
the current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) isnot billable as
an RHC services? - ANSWER- Inpatient care
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What code indicates the disposition of the patient at the conclusion of service?
-ANSWER- Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - ANSWER- They result
in lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient andthe third party
payer, who is responsible for payment? - ANSWER- Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: - ANSWER- A valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are expanding to
allow patients to do what? - ANSWER- Access their information and perform functions on-line
What date is required on all CMS 1500 claim forms? - ANSWER- onset date of current illness
What does scheduling allow provider staff to do - ANSWER- Review appropriateness of the
service request
What code is used to report the provider's most common semiprivate room rate?
-ANSWER- Condition code
Regulations and requirements for coding accountable care organizations, whichallows providers
to begin creating these organizations, were finalized in: - ANSWER- 2012
What is a primary responsibility of the Recover Audit Contractor? - ANSWER- To correctly
identify proper payments for Medicare Part A & B claims
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How must providers handle credit balances? - ANSWER- Comply with state statutes concerning
reporting credit balance
Insurance verification results in what? - ANSWER- The accurate identification of the patient's
eligibility and benefits
What form is used to bill Medicare for rural health clinics? - ANSWER- CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for service? -
ANSWER- Registering the patient and directing the patient to the service area
In addition to being supported by information found in the patient's chart, a CMS 1500 claim
must be coded using what? - ANSWER- HCPCS (Healthcare Common Procedure Coding
system)
What results from a denied claim? - ANSWER- The provider incurs rework and appeal costs
Why does the financial counselor need pricing for services? - ANSWER- To calculate the
patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - ANSWER- Hospital-
based mammography centers
How are disputes with nongovernmental payers resolved? - ANSWER- Appeal conditions
specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information concerning what?
- ANSWER- Right to appeal a discharge decision if the patient disagrees with the services
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