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ANSWERS LATEST VERSION VERIFIED RATIONALE
GRADED A+
With the advent of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to - ansAssist patients in understanding their insurance coverage and their financial obligation With any remaining open balances, after insurance payments have been posted, the account financial liability is - ansPotentially transferred to the patient Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? - ansRegistration staff may routinely contact managed are plans for prior authorizations before the patient is seen by the on-duty physician Which option is a government-sponsored health care program that is financed through taxes and general revenue funds - ansMedicare Which option is a benefit of pre-registering a patient for services - ansThe patient arrival process is expedited, reducing wait times and delays Which of the following is usually covered on a Conditions of Admission form - ansRelease of information Which of the following is required for participation in Medicaid? - ansMeet income and assets requirements Which of the following is required for participation in Medicaid - ansMeet Income and Assets Requirements Which of the following is NOT included in the Standardized Quality Measures? - ans Which of the following is NOT contained in a collection agency agreement? - ansA mutual hold-harmless clause Which of the following is NOT a factor in self-pay follow-up? - ansThe type of patient (inpatient, out- patient) Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) - ansRegistration staff members routinely contact managed care plans for prior authorizations before the patient is seen by the on duty physician Which of the following in NOT included in the Standardized Quality Measures - ansCost of services Which department supports/collaborates with the revenue cycle? - ansInformation Technology When there is a request for service, the scheduling staff member must confirm the patient's unique identification information to - ansEnsure that she/he accesses the correct information in the historical database When there is a request for service the scheduling staff member must confirm the patient's - ansEnsure that she/he accesses the correct information in the historical database
ANSWERS LATEST VERSION VERIFIED RATIONALE
GRADED A+
When recovery audit contractors (RAC) identify improper payments as over payments the claims processing contractor must - ansSend a demand letter to the provider to recover the over payment amount When Recovery Audit Contractors (RAC) identify improper payments as over payments, the - ansSend a demand letter to the provider to recover the over payment amount When primary payment is received, the actual reimbursement - ansIs compared to the expected reimbursement, the remaining contractual adjustments are posted, and secondary claims are submitted When billing Rural Health Clinic services on a UB-04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521). Although codes are collapsed into a single revenue code, it is still important to list the appropriate CPT codes as part - ansThese codes will be used to determine medical necessity and useful in determining what happened during the encounter What type of account adjustment results from the patient's unwillingness to pay a self-pay balance? - ansBad debt adjustment What is required for the UB- 0 4/837-I, used by Rural Health Clinics to generate payment from Medicare? - ansRevenue codes What is likely to occur if credit balances are not identified separately from debit balances in accounts receivable? - ansThe accounts receivable level would be understated What is Continuum of Care? - ansThe coordination and linkage of resources needed to avoid the duplication of services and the facilitation of a seamless movement among care settings What are some core elements if a board-approved financial assistance policy? - ansEligibility, application process, and nonpayment collection activities Vital to accurate calculations of a patient's self-pay amount is - ans Unless the patient encounter is an emergency, it is more efficient and effective to - ansCollect all information after the patient has been discharged 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? - ansMedical screening and stabilizing treatment Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the providermay not ask about a patient's insurance information if it would delay what? - ansMedical screening and stabilizing treatment To provide a patient with information that is meaningful to them, all of the following factors must be included EXCEPT - ansThe actual physician reimbursement
ANSWERS LATEST VERSION VERIFIED RATIONALE
GRADED A+
The physician who wrote the order for an inpatient service and is in charge of the patients - ansThe attending physician The patient discharge process begins when - ansThe physician writes the discharge order The Office of Inspector General (OIG) was created - ansDetect and prevent fraud, waste, and abuse The office of inspector general (OIG) publishes a compliance work plan - ansAnnually The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physicians to do all of the following EXCEPT: - ansObtain higher compensation for physicians The nightly room charge will be incorrect if the patient's - ansTransfer from ICU to the Medical/Surgical floor is not reflected in the registration system. The most common resolution methods for credit balances include all of the following EXCEPT: - ansDesignate the overpayment for charity care The most accurate way to validate patient information is to - ansrequire clinical staff to verify information at each treatment encounter The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: - ansJudicial review by a federal district court The legal authority to request and analyze provider claim documentation to ensure that - ansThe Office of the U.S. Inspector General (OIG) The important Message from Medicare provides beneficiaries information concerning their - ansRight to appeal a discharge decision if the patient disagrees with the plan The importance of medical records being maintained by HIM is that the patient records - ansAre the primary source for clinical data required for reimbursement by health plans and liability payers The importance of Medical records being maintained by HIM is that the patient records: - ansAre the primary source for clinical data required for reimbursement The impact of denials on the revenue cycle includes all of the following EXCEPT - ansPatient outcomes The ICD-10 codes set and CPT/HCPCS code sets combines provide - ansThe specificity and coding needed to support reimbursement claims The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to - ansMedicare and Medicaid payments The HCAHPS (hospital consumer assessment of healthcare providers and systems) initiative - ansProvide a standardized method for evaluating patient's perspective on hospital care.
ANSWERS LATEST VERSION VERIFIED RATIONALE
GRADED A+
The first thing a health plan does when processing a claim is - ansCheck if the patient is a health plan beneficiary and what is the coverage The first and most critical step in registering a patient, whether scheduled or unscheduled, is - ansVerifying the patient's identification The Electronic Remittance Advice (ERA) data set is : - ansA standardized form that provides third party payment details to providers The disadvantages of outsourcing include all of the following EXCEPT: - ansReduced internal staffing costs and a reliance on outsourced staff The Correct Coding Initiative Program consists of - ansEdits that are implemented within providers' claim processing systems The core financial activities resolved within patient access include: - ansScheduling, pre-registration, insurance verification and managed care processing The benefit of Medicare Advantage Plan is - ansPatients generally have their Medicare-coverage healthcare through the plan and do not need to worry about "part a" or "part b" benefits The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can - ansPurchase qualified health benefit plans regardless of insured's The advantages to using a third-party collection agency include all of the following EXCEPT - ansProviders pay pennies on each dollar collected The activity which results in the accurate recording of patient bed and level of care assessment, patient transfer and patient discharge status on a real-time basis is known as - ansCase management The ACO investment model will test the use of pre-paid shared savings to - ansEncourage new ACOs to form in rural and underserved areas The 501(r) regulations require not-for-profit providers (501(c)(3) organizations) to do which of the following activities. - ansComplete a community needs assessment and develop a discount program for patient balances after insurance payment Telemed seeks to improve a patient's health by - ansPermitting 2-way real time interactive communication between the patient and the clinical professional Successful account resolution begins with - ansCollecting all deductibles and copayments during the pre- service stage Since passage of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to - ansAssist patients in understanding their insurance coverage and their financial obligation
ANSWERS LATEST VERSION VERIFIED RATIONALE
GRADED A+
Once the price is estimated in the pre-service stage, a provider's financial best practice is to - ansExplain to the patient their financial responsibility and to determine the plan for payment Once the EMTALA requirements are satisfied - ansThe remaining registration processing is initiated at the bedside or in a registration area Net Accounts Receivable is - ansThe amount an entity is reasonably confident of collecting from overall accounts receivable. Most major health plans including Medicare and Medicaid, offer - ansElectronic and/or web portal verification Medicare will only pay for tests and services that - ansMedicare determines are "reasonable and necessary" Medicare patients are NOT required to produce a physician order to receive which of these services - ansScreening Mammography, flu vaccine or pneumonia vaccine Medicare Part B has an annual deductible, and the beneficiary is responsible for - ansA co-insurance payment for all Part B covered services Medicare Part B has an annual deductible and the beneficiary is responsible for - ansa co-insurance payment for all Part B covered services Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish - ansWhat services or healthcare items are covered under Medicare Medicare beneficiaries remain in the same "benefit period" - ansUntil the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days 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: - ansCase Management Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare established guideline(s) used to determine: - ansWhich diagnoses, signs, or symptoms are reimbursable Key performance indicators (KPIs) set standards for accounts receivables (A/R) and - ansProvide a method of measuring the collection and control of A/R Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and - ansProvide a method of measuring the collection and control of A/R It is important to have high registration quality standards because - ansInaccurate or incomplete patient data will delay payment or cause denials
ANSWERS LATEST VERSION VERIFIED RATIONALE
GRADED A+
It is important to calculate reserves to ensure - ansStable financial operations and accurate financial reporting Internal controls addressing coding and reimbursement changes are put in place to guard against - ansCompliance fraud by upcoding Insurance verification results in which of the following - ansThe accurate identification of the patient's eligibility and benefits Indemnity plans usually reimburse: - ansA certain percentage of the charges after the patient meets the policy's annual deductible Incorrect data gathering can cause all of the following EXCEPT - ansThe inability to discuss quality with physicians In the pre-service stage, the requested service is screened for medical necessity, health - ansPre- authorization are obtained In the balance resolution process, providers should: - ansAsk the patient if he or she would like to receive information about payment options and supportive financial assistance programs In resolving medical accounts, a law firm may be used as: - ansA substitute for a collection agency In order for Regulation Z to apply, a hospital must - ans In choosing a setting for patient financial discussions, organizations should first and foremost - ansRespect the patients privacy In Chapter 7 straight bankruptcy filling - ansThe court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt In a self-insured (or self-funded) plan, the costs of medical care are - ansBorne by the employer on a pay- as-you-go basis In a Chapter 7 Straight Bankruptcy filing - ansThe court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt Improving the overall patient experience requires revenue cycle leadership and staff to simultaneously be: - ansClear on policies and consistent in applying the policies If further treatment can only be provided in a hospital setting, the patient's condition cannot be evaluated and/or treated within 24 hours, or if there is not an anticipation of improvement in the patient's condition with 24 hours, the patient - ansWill be admitted as an inpatient Identifying the patient, in the MPI, creating the registration record, completing medical necessity screening, determining insurance eligibility and benefits resolving managed care, requirements and
ANSWERS LATEST VERSION VERIFIED RATIONALE
GRADED A+
Health Plan Contracting Departments do all of the following EXCEPT - ansEstablish a global reimbursement rate to use with all third-party payer Health Information Management (HIM) is responsible for - ansAll patient medical records he patient discharge process begins when - ansThe physician writes the discharge orders For scheduled patients, important revenue cycle activities In the Time of Service stage DO NOT INCLUDE:
- ansFinal bill is presented for payment For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: - ansShould take place between the patient or guarantor and properly trained provider representatives floor is not reflected in the registration system Examples of ethics violations that impact the revenue cycle include all of the following EXCEPT - ansSeeking payment options for patient self-pay Eliminating mail time and reducing data entry time, electronically monitoring the receipt of claims and online claim adjudication, more prompt payment are all benefits achieved by - ansThe electronic submission of claims using electronic transfers EFT (electronic funds transfer) is - ansAn electronic transfer of funds from payer to payee ED patients should be informed that their ability to pay - ansWill not interfere with treatment of any emergency medical conditions Each patient is assigned a unique number, commonly called the - ansMaster Patient Index (MPI) number During pre-registration, a search for the patients MPI number is initiated using which of the following data sets? - ansPatient's full legal name and date of birth or the patient's Social Security number Duplicate payments occur: - ansWhen providers re-bill claims based on nonpayment from the initial bill submission Departments that need to be included in charge master maintenance include all of the following EXCEPT
- ansQuality Assurance Days in A/R is calculated based on the value of: - ansThe time it takes to collect anticipated revenue Days in A/R is calculated based on the value of - ansThe total accounts receivable on a specific date Concurrent review and discharge planning - ansOccurs during service Components of financial education include informing the patient of the hospital's financial policies, assessing the patient's ability to pay and - ansReviewing payment alternatives with the patient so appropriate resolution of the health care financial obligation is achieved
ANSWERS LATEST VERSION VERIFIED RATIONALE
GRADED A+
Claims with dates of service received later than one calendar year beyond the date of service, will be - ansDenied by Medicare Checks received through mail, cash received through mail, and lock box are all examples of - ansControl points for cash posting Charges as the most appropriate measurement of utilization enables - ansAccuracy of expense and cost capture Charges are the basis for - ansSeparation of fiscal responsibilities between the patient and the health plan Chapter 13 Bankruptcy, debtor rehabilitation, is a court proceeding - ansThat reorganizes a debtor's holdings and instructs creditors to look to the debtor's future earnings for payment Chapter 13 Bankruptcy, debtor rehabilitation is a court proceeding - ansThat reorganizes a debtor's holdings and instructs creditors to look to the debtors' future earnings for payment Case Management requires that a case manager be assigned - ansTo a select patient group Business ethics, or organizational ethics represent: - ansThe principles and standards by which organizations operate Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implement - ansMonitor compliance Because case managers document the clinical reasons for treatment, they are - ansA good resource when developing written appeals of denials Because 501(r) regulations focus on identifying potential eligible financial assistants patients hospitals must: - ansHold financial conversations with patients as soon as possible assigned by - ansThe Internal Revenue Service Appropriate training for patient financial counseling staff must cover all of the following EXCEPT: - ansDocumenting the conversation in the medical records Applying the contracted payment amount to the amount of total charges yields - ansA pricing agreement Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with - ansThe Provider Reimbursement Review Board 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 - ansHMO 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 - ansHMO
ANSWERS LATEST VERSION VERIFIED RATIONALE
GRADED A+
Account Receivable (A/R) Aging reports - ansDivide accounts receivable into 30, 60, 90 ,120 days past due categories A typical routine patient financial discussion would include - ansExplaining the benefits identified through verifying the patients insurance A scheduled inpatient represents an opportunity for the provider to do which of the following? - ansComplete registration and insurance approval before service A recurring/series registration is characterized by - ansThe creation of one registration record for multiple days of service A portion of the accounts receivable inventory which has NOT qualified for billing includes - ansCharitable pledges A portion of the accounts receivable inventory which has NOT qualified for billing includes: - ansCharitable pledges A nightly room charge will be incorrect if the patient's - ansTransfer from ICU (intensive care unit) to the Medical/Surgical A Medicare Part A benefit period begins: - ansWith admission as an inpatient A large number of credit balances are not the result of overpayments but of - ansPosting errors in the patient accounting system A four digit number code established by the National Uniform Billing Committee (NUBC)that categorizes/classifies a line item in the charge master is known as - ansRevenue codes A decision on whether a patient should be admitted as an inpatient or become about patient observation patient requires medical judgments based on all of the following EXCEPT - ansThe patient's home care coverage A comprehensive "Compliance Program" is defined as - ansSystematic procedures to ensure that the provisions of regulations imposed by a government agency are being met A claim is denied for the following reasons, EXCEPT: - ansThe submitted claim does not have the physicians signature A claim for reimbursement submitted to a third-party payer that has all the information and documentation required for the payer to make a decision on it is known as - ansA clean claim A balance sheet is - ansA statement of assets, liabilities, and capital for an organization at a specified point in time "Hard-coded" is the term used to refer to - ansCodes for services, procedures, and drugs automatically assigned by the charge master
ANSWERS LATEST VERSION VERIFIED RATIONALE
GRADED A+
ANSWERS LATEST VERSION VERIFIED RATIONALE
GRADED A+
ANSWERS LATEST VERSION VERIFIED RATIONALE
GRADED A+
ANSWERS LATEST VERSION VERIFIED RATIONALE
GRADED A+
ANSWERS LATEST VERSION VERIFIED RATIONALE
GRADED A+
