Rev Cycle 4

Question 1

In the pre-service stage, the requested service is screened for medical necessity, health

plan coverage and benefits are verified and:

• Billing authorization is signed by the patient
• The patient signs the consents for treatment
• The patient signs a statement attesting an understanding and acceptance of payment

policies

• Pre-authorization are obtained

Answer 1

Pre-authorization are obtained

Question 2

Improving the overall patient experience requires revenue cycle leadership and staff to

simultaneously be:

• Clear on policies and consistent in applying the policies
• Careful in screening patient demands
• Monitoring the costs and charges the patient incurs
• Inquisitive, responsive and flexible

Answer 2

Clear on policies and consistent in applying the policies

Question 3

Hospitals need which of the following information sets to assess a patient’s financial

status:

• Income, expenses, debt
• Patient and guarantor’s income, expenses and assets
• Income, expenses and capacity to take on more debt
• Assets liquidity, Income, expenses, credit worthiness

Answer 3

Patient and guarantor’s income, expenses and assets

Question 4

cycle activities I the Time of Service stage DO

NOT INCLUDE:

• Pre-registration record is activated, consents are signed, and co-payment is collected
• Positive patient identification is completed, and patient is given an armband
• Final bill is presented for payment
• Preprocessed patients may report to a designated “express arrival” desk

Answer 4

Final bill is presented for payment

Question 5

The Electronic Remittance Advice (ERA) data set is :

• Used for Electronic Funds Transfers between hospitals and a bank
• A standardized form that provides 3rd party payment details to

providers

• Required for annual Medicare quality reporting forms
• Safeguards the Electronic claims process

Answer 5

A standardized form that provides 3rd party payment details to

providers

Question 6

Appropriate training for patient financial counseling staff must cover all of the following

EXCEPT:

• Patient financial communications best practices specific to staff role
• Financial assistance policies
• Documenting the conversation in the medical records
• Available patient financing options

Answer 6

Documenting the conversation in the medical records

Question 7

All of the following information should be reviewed as part of schedule finalization

EXCEPT:

• The results of any and all test
• The service to be provided
• The arrival time and procedure time
• The patient’s preparation instructions

Answer 7

The results of any and all test

Question 8

Indemnity plans usually reimburse:

• Only for contracted Services
• A claim up to 80% of the charges
• A certain percentage of the charges after the patient meets the

policy’s annual deductible

• A patient for out-of-pocket charges

Answer 8

A certain percentage of the charges after the patient meets the
policy’s annual deductible

Question 9

Because 501(r) regulations focus on identifying potential eligible financial assistants

patients hospitals must:

• Capture their experience with such patients to properly budget
• Hold financial conversations with patients as soon as possible
• Build the necessary processes to handle the potentially lengthy payment schedule
• Expedite payment processing of normal accounts receivable to protect cash flow

Answer 9

Hold financial conversations with patients as soon as possible

Question 10

Which option is a benefit of pre-registering a patient for services

• The patient arrival process is expedited, reducing wait times and

delays

• The verification of insurance after completion of the services
• Service departments have the ability to override schedules and block time to reduce

testing volume

• The patient receiving multiple calls from the provider

Answer 10

The patient arrival process is expedited, reducing wait times and
delays

Question 11

HIPPA had adopted Employer Identification Numbers (EIN) to be used in standard

transactions to identify the employer of an individual described in a transaction EIN’s are

assigned by

• The Social Security Administration
• The US department of the Treasury
• The United States department of labor

Answer 11

The Internal Revenue Service

Question 12

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

• Transfer from ICU to the Medical/Surgical floor is not reflected in the

registration system.

• Pharmacy orders to the ICU have not been entered into the pharmacy system
• Condition has not been discussed during the shift change report meeting
• Discharge for the next day has not been charted

Answer 12

Transfer from ICU to the Medical/Surgical floor is not reflected in the
registration system.

Question 13

With any remaining open balances, after insurance payments have been posted, the

account financial liability is

• Written off as bad debt
• Potentially transferred to the patient
• Sold to a collection agency
• Treated as the cost of doing business

Answer 13

Potentially transferred to the patient

Question 14

When there is a request for service the scheduling staff member must confirm the patient’s

unique identification information to:

• Verify the patient’s insurance coverage if the patient is a returning customer
• Ensure that she/he accesses the correct information in the historical

database

• Confirm that physician orders have been received
• Check if any patient balance due

Answer 14

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

Question 15

Identifying the patient, in the MPI, creating the registration record, completing medical

necessity screening, determining insurance eligibility and benefits resolving managed

care, requirements and completing financial education/resolution are all

• The data collection steps for scheduling and pre-registering a patient
• Registration steps that must be completed before any medical services are provided
• The steps mandated for billing Medicare Part A
• The process of closing an account

Answer 15

The data collection steps for scheduling and pre-registering a patient

Question 16

the following

• The accurate identification of the patient’s eligibility and benefits
• The consistent formatting of the patient’s name and identification number
• The resolution of managed care and billing requirements
• The identification of physician fee schedule amounts and the NPI (national provider

identifier) numbers

Answer 16

The accurate identification of the patient’s eligibility and benefits

Question 17

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

• HCPCs codes
• ICD-10 Procedural codes
• CPT codes
• Revenue codes

Answer 17

Revenue codes

Question 18

The importance of Medical records being maintained by HIM is that the patient records:

• Are evidence used in assessing the quality of care
• Are the primary source for clinical data required for reimbursement

by health plans and liability payers

• Are the strongest evidence and defense in the event of a Medicare Audit
• Are the evidence cited in quality review

Answer 18

Are the primary source for clinical data required for reimbursement

by health plans and liability payers

Question 19

Medicare patients are NOT required to produce a physician order to receive which of

these services

• Diagnostic Mammography, flu vaccine, or B-12 shots
• Diagnostic Mammography, flu vaccine, or pneumonia vaccine
• Screening Mammography, flu vaccine or pneumonia vaccine
• Screening Mammography, flu vaccine or B-12 shots

Answer 19

Screening Mammography, flu vaccine or pneumonia vaccine

Question 20

Patients should be informed that costs presented in a price estimate may

• Vary from estimates, depending on the actual services performed
• Be guaranteed if the patient satisfies all patient financial responsibilities at the time

of registration

• Be lower as price estimates use the highest market price
• Only determine the percentage of the total that the patient is responsible for and not

the actual cost

Answer 20

Vary from estimates, depending on the actual services performed

Question 21

the health plan for

• All pre-admission emergency transports
• Transport deemed medically necessary by the attending paramedic-ambulance crew
• 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

• The portion of the bill outside of the patient’s self-pay

Answer 21

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

Question 22

In Chapter 7 straight bankruptcy filling

• The court establishes a creditor payment schedule with the longest outstanding claims

paid first

• The court liquidates the debtor’s nonexempt property, pays creditors,

and discharges the debtor from the debt

• The court vacates all claims against a debtor with the understanding that the debtor

may not apply for credit without court supervision

• The court liquidates the debtor’s nonexempt property, pays creditors, and begins to

pay off the largest claims first. All claims are paid some portions of the amount owed.

Answer 22

The court liquidates the debtor’s nonexempt property, pays creditors,
and discharges the debtor from the debt

Question 23

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

• Utilization review
• Case management
• Census management
• Patient through-put

Answer 23

Case management

Question 24

Which of the following is required for participation in Medicaid

• Obtain a supplemental health insurance policy
• Meet income and assets requirements
• Meet a minimum yearly premium
• Be free of chronic conditions

Answer 24

Meet income and assets requirements

Question 25

When primary payment is received, the actual reimbursement

• Is compared to the expected reimbursement
• Is recorded by Patient Accounting and the patient’s account is the closed
• Is compared to the expected reimbursement, the remaining

contractual adjustments are posted, and secondary claims are

submitted

• Trigger that the secondary claims can then be prepared.

Answer 25

Is compared to the expected reimbursement, the remaining
contractual adjustments are posted, and secondary claims are
submitted

Question 26

Days in A/R is calculated based on the value of

• Total cash received to date
• The time it takes to collect anticipated revenue
• The total accounts receivable on a specific date
• Total anticipated revenue minus expenses

Answer 26

The total accounts receivable on a specific date

Question 27

All of the following are forms of hospital payment contracting EXCEPT

• Per diem payment
• Bundled Payment
• Fixed Contracting
• Contracted Rebating

Answer 27

Contracted Rebating

Question 28

The standard claim form used for billing by hospitals, nursing facilities, and other in-patient

services is called the

• UB-04
• 1500
• COST REPORT
• REMITTANCE NOTICE

Answer 28

UB-04

Question 29

To maximize the value derived from customer complaints, all consumer complaints should be

• Responded to within two business days
• Tracked and shared to improve the customer experience
• Handled by a specially trained “service recovery” team
• Brought immediately to management’s attention

Answer 29

Responded to within two business days

Question 30

assessment of healthcare providers and systems) initiative

was launched to

• Gather national date on overall trust in the nation’s health care system
• Create a national database on physician quality
• Provide a standardized method for evaluating patient’s perspective on

hospital care. ?

• Provide data for building shared savings reimbursement for quality procedures.

Answer 30

Provide a standardized method for evaluating patient’s perspective on

hospital care. ?

Question 31

Health Plan Contracting Departments do all of the following EXCEPT

• Establish a global reimbursement rate to use with all third-party payer
• Review all managed care contracts for accuracy for loading contract terms into the

patient accounting system

• Review payment schemes to ensure that the health plan and provider understand how

reimbursements must be calculated

• Review contracts to ensure the appeals process for denied claims is clearly specified

Answer 31

Establish a global reimbursement rate to use with all third-party payer