HFMA CRCR EXAM ACTUAL

HFMA CRCR EXAM (ACTUAL / )

QUESTIONS AND CORRECT VERIFIED

ANSWERS (GRADED A+)

Through what document does a hospital establish compliance standards? -<<>>>code of conduct

What is the purpose OIG work plant? - <<>>>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? - <<>>>Non-diagnostic service provided on Tuesday through Friday

What does a modifier allow a provider to do? - <<>>>Report a specific circumstance that affected a procedure or service without changing the code or its definition

Ambulance services are billed directly to the health plan for: -

<<>>>Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility. 1 / 3

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: -<<>>>The Provider Reimbursement

Review Board.

For scheduled payments, important revenue cycle activities in

the time-of-service stage DO Not include: -

<<>>>Obtaining or updating patient and guarantor information

Hospital can only convert an inpatient case to observation if: -

<<>>>The hospital utilization review committee determines before the patient is discharged and prior to billing that an observation setting would be more appropriate.

Hospital need which of the following information sets to assess a patient's financial status? - <<>>>Demographic, Income, Assets and Expenses.

HIPAA privacy rules require covered entities to take all, of

the following actions EXCEPT: -<<>>>Use only

designated software platforms to secure patient date.

• / 3

When Recovery Audit Contractors (RAC) identify improper payments as overpayment. the claims processing contractor

must: -<<>>>Send a demand letter to the provider

to recover the over payment amount.

Which HIPPA transaction set provides electronic processing of 8insurance verification requests and responses? - <<>>>The 270-271 set

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: -<<>>>Support that

choice, providing that the discussion does not interfere with patient care or disrupt patient flow.

A scheduled inpatient represents an opportunity for the provider to do which of the following? - <<>>>Complete registration and insurance approval before service

The Medicare Bundled Payments for Care Initiative (BCP) is

designed to: -<<>>>Align incentives between

hospitals, physicians, and non-physician providers in-order to better coordinate patient care.

• / 3