HFMA CRCR FINAL EXAM AND PRACTICE EXAM

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HFMA CRCR FINAL EXAM AND PRACTICE EXAM

TEST BANK WITH 300 MULTIPLE CHOICE | ACTUAL REAL

EXAM QUESTIONS WITH DETAILED ANSWERS | EXPERT

VERIFIED | GUARANTEED PASS | GRADED A | LATEST

UPDATE

1. 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

2. 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 for Medicare

d) Review by the Medicare Appeals Council (Appeals Council) - B

3. 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

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• 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

5. 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

6. 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 if the patient has insurance

and how much reimbursement can be expected

b) The fact that charge master lists the total charge, not net charges that reflect charges after a

payer's contractual adjustment

c) That hospitals don't want to be put in the position of "guaranteeing" price without having

room for additional charges that may arise in the course of treatment

d) 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 and assist in obtaining required

patient financial data

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b) Have a patient financial responsibilities kit ready for the patient, containing all of the

required registration forms and instructions

c) Support that choice, providing that the discussion does not interfere with patient care or

disrupt patient flow

d) 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 of regulations 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 those services 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 providers c) 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

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• HMO
• PPO
• GPO - B

• In a Chapter 7 Straight Bankruptcy filing

• The court liquidates the debtor's nonexempt property, pays creditors, and discharges the

debtor from the debt

b) The court liquidates the debtor's nonexempt property, pays creditors, and begins to pay off

the largest claims first. All claims are paid some portion of the amount owed

c) The court vacates all claims against a debtor with the understanding that the debtor may

not apply for credit without court supervision

d) The court establishes a creditor payment schedule with the longest outstanding claims paid

first - A

14. The core financial activities resolved within patient access include:

• Scheduling, pre-registration, insurance verification and managed care processing

b) Scheduling, insurance verification, clinical discharge processing and payment posting of

point of service receipts

c) Scheduling, registration, charge entry and managed care processing

d) Scheduling, pre-registration, registration, medical necessity screening and patient refunds -

A

• Which of the following is NOT contained in a collection agency agreement?

• A clear understanding that the provider retains ownership of any outsourced activities

b) Specific language as to who will pay legal fees, if needed c) An annual renewal clause

d) A mutual hold-harmless clause - D

• Maintaining routine contact with the health plan or liability payer, making sure all

required information is provided and all needed approvals are obtained is the

responsibility of: