Rev Cycle 2

Question 1

An individual enrolled in Medicare who is dissatisfied with the government’s claim determination is entitled to reconsideration of the decision. This type of appeal is known as

A beneficiary appeal

A Medicare supplemental review

A payment review

A Medicare determination appeal

Answer 1

A beneficiary appeal

Question 2

The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physicians to do all of the following EXCEPT:

Drive significant improvements in the areas of quality and the patient experience

Embrace new reimbursement models

Improve outcomes

Obtain higher compensation for physicians

Answer 2

Obtain higher compensation for physicians

Question 3

Duplicate payments occur:

When providers re-bill claims based on nonpayment from the initial bill submission

When service departments do not process charges with the organization’s suspense days

When the payer’s coordination of benefits is not captured correctly at the time of patient registration

When there are other healthcare claims in process and the anticipated deductibles and co-insurance amounts still show open but will be met by the in-process claims

Answer 3

When providers re-bill claims based on nonpayment from the initial bill submission

Question 4

The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can

Purchase qualified health benefit plans regardless of insured’s health status

Obtain price estimates for medical services

Negotiate the price of medical services with providers

Meet federal mandates for insurance coverage and obtain the corresponding

Answer 4

Purchase qualified health benefit plans regardless of insured’s health status

Question 5

The most common resolution methods for credit balances include all of the following EXCEPT:

Designate the overpayment for charity care

Submit the corrected claim to the payer incorporating credits

Either send a refund or complete a takeback form as directed by the payer

Determine the correct primary payer and notify incorrect payer of overpayment

Answer 5

Designate the overpayment for charity care

Question 6

EFT (electronic funds transfer) is

An electronic claim submission

The record of payments in the hospital’s accounting system

An electronic confirmation that a payment is due

An electronic transfer of funds from payer to payee

Answer 6

An electronic transfer of funds from payer to payee

Question 7

Revenue cycle activities occurring at the point-of-service include all of the following EXCEPT:

The monitoring of charges

The provision of case management and discharge planning services

Providing charges to the third-party payer as they are incurred

The generation of charges

Answer 7

Providing charges to the third-party payer as they are incurred

Question 8

Medicare beneficiaries remain in the same “benefit period”

Up to hospitalization discharge

Until the beneficiary is “hospitalization and/or skilled nursing facility-free” for 60 consecutive days

Each calendar year

Up to 60 days

Answer 8

Until the beneficiary is “hospitalization and/or skilled nursing facility-free” for 60 consecutive days

Question 9

Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and

Provide evidence of financial status

Provide a method of measuring the collection and control of A/R

Establish productivity targets

Make allowance for accurate revenue forecasting

Answer 9

Provide a method of measuring the collection and control of A/R

Question 10

Recognizing that health coverage is complicated and not all patients are able to navigate this terrain, HFMA best practices specify that

The patient accounts staff have someone assigned to research coverage on behalf of patients

Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions

Patient coverage education may need to be provided by the health plan

A representative of the health plan be included in the patient financial responsibilities discussion

Answer 10

Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions

Question 11

When there is a request for service, the scheduling staff member must confirm the patient’s unique identification information to

Check if there is any patient balance due

Verify the patient’s insurance coverage if the patient is a returning customer

Confirm that physician orders have been received

Ensure that she/he accesses the correct information in the historical database

Answer 11

Ensure that she/he accesses the correct information in the historical database

Question 12

Once the price is estimated in the pre-service stage, a provider’s financial best practice is to

Explain to the patient their financial responsibility and to determine the plan for payment

Allow the patient time to compare prices with other providers

Lock-in the prices

Have another employee double check the price estimate

Answer 12

Explain to the patient their financial responsibility and to determine the plan for payment

Question 13

What type of account adjustment results from the patient’s unwillingness to pay a self-pay balance?

Charity adjustment

Bad debt adjustment

Contractual adjustment

Administrative adjustment

Answer 13

Bad debt adjustment

Question 14

All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT

Medically unnecessary

Not delivered in a Medicare licensed care setting

Offered in an outpatient setting

Services and procedures that are custodial in nature

Answer 14

Services and procedures that are custodial in nature

Question 15

All of the following are forms of hospital payment contracting EXCEPT

Contracted Rebating

Per Diem Payment

Fixed Contracting

Bundled Payment

Answer 15

Contracted Rebating

Question 16

Overall aggregate payments made to a hospice are subject to a computed “cap amount” calculated by:

The Center for Medicare and Medicaid Services (CMS)

Each state’s Medicaid plan

Medicare

The Medicare Administrative Contractor (MAC) at the end of the hospice cap period

Answer 16

The Medicare Administrative Contractor (MAC) at the end of the hospice cap period

Question 17

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

Reschedule the visit for non-payment of a prior balance

Strictly limit charity care and bad-debt

Collect patient’s self-pay and deductibles in the first encounter

Assist patients in understanding their insurance coverage and their financial obligati

Answer 17

Assist patients in understanding their insurance coverage and their financial obligation

Question 18

A nightly room charge will be incorrect if the patient’s

Discharge for the next day has not been charted

Condition has not been discussed during the shift change report meeting

Pharmacy orders to the ICU have not been entered in the pharmacy system

Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system

Answer 18

Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system

Question 19

Which of the following is required for participation in Medicaid?

Meet income and assets requirements

Meet a minimum yearly premium

Be free of chronic conditions

Obtain a health insurance policy

Answer 19

Meet income and assets requirements

Question 20

HFMA best practices call for patient financial discussions to be reinforced

By issuing a new invoice to the patient

By copying the provider’s attorney on a written statement of conversation

By obtaining some type of collateral

By changing policies to programs

Answer 20

By copying the provider’s attorney on a written statement of conversation

Question 21

A Medicare Part A benefit period begins

With admission as an inpatient

The first day in which an individual has not been a hospital inpatient not in a skilled nursing facility for the previous 60 days

Upon the day the coverage premium is paid

Immediately once authorization for treatment is provided by the health plan

Answer 21

With admission as an inpatient

Question 22

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

Will remain in observation for up to 72 hours after which the patient is admitted as an inpatient

Will be admitted as an inpatient

Will be discharged and if needed, designated to a priority one outpatient status

Will have his/her case reviewed by the attending physician, a consulting physician and the primary care physician and a future course of care will then be determined

Answer 22

Will be admitted as an inpatient

Question 23

It is important to have high registration quality standards because

Incomplete registrations will trigger exclusion from Medicare participation

Incomplete registrations will raise satisfaction scores for the hospital

Inaccurate registration may cause discharge before full treatment is obtained

Inaccurate or incomplete patient data will delay payment or cause denials

Answer 23

Inaccurate or incomplete patient data will delay payment or cause denials

Question 24

Medicare will only pay for tests and services that

Constitute appropriate treatment and are fairly priced

Have solid documentation

Can be demonstrated as necessary

Medicare determines are “reasonable and necessary”

Answer 24

From the midnight census