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HFMA STUDY
crcr
| Question | Answer |
|---|---|
| True or False: The following statement represents an advantage of outsourcing: Limits internal staffing requirements | TRUE |
| Which evaluation criteria demonstrates reputation expectations: | The employment of staff who have documented experience working in financial areas of health care. |
| Which concept is NOT a contracted payment model? | Stop-Loss Provision |
| True or False: The following statement represents an advantage of outsourcing: Impact on direct control of accounts receivable | FALSE |
| Collection results are: | Accurately calculated to demonstrate the actual recovery percentage rate. |
| Sending the bill electronically to the health plan in a time-of-service activity. | FALSE |
| What is the intended outcome of collaborations made through an ACO delivery system? | To ensure appropriateness of care, elimination of duplicate services, and prevention of medical errors for a population of patients. |
| Annually, the OIG publishes a work plan of compliance issues and objectives that will be focused on throughout the following year. Identify which option is NOT a work plan task mentioned in this course. | Standard Unique Employer Identifier |
| Which statement is NOT a unique billing rule specific to providers? | A patient may be balance billed for whatever amount the non-contracting physician charges above the health plan’s reimbursement amount. |
| True or False: The following statement represents an advantage of outsourcing: Impact on customer service | FALSE |
| True or False: The following statement represents an advantage of outsourcing: Vendor absorbs some financial risk based on “efficiency” factor | TRUE |
| Which of the following are essential elements of an effective compliance program? | Established compliance standards and procedures. .Oversight of personnel by high-level personnel. Reasonable methods to achieve compliance with standards, including monitoring systems and hotlines. |
| True or False: Consents are signed as part of the post-service process | FALSE |
| What do business/organizational ethics represent? | Principles and standards by which organizations operate |
| The patient account is monitored for payment is a time-of-service activity. | FALSE |
| Case management and discharge planning services are a post-service activity. | FALSE |
| In what manner do case managers assist revenue cycle staff? | Providing assistance with written appeals to health plans related to utilization and other care issues. |
| Which of the following statements does not apply to billing during the COVID-19 public health emergency ? | Telemedicine claims are not payable if the patient conducts the telemedicine visit from home. |
| Which of these statements describes the new methodology for the determination of net patient service revenue ? | Net patient service revenue is defined as the total incurred charges, less the explicit price concession, less any applicable implicit price concession(s) as applied to the specific portfolio of accounts. |
| What happens during the post-service stage? | Final coding of all services, preparation and submission of claims, payment processing and balance billing and resolution. |
| True or False: The following statement represents an advantage of outsourcing: Capitalizes on the economies of scale | TRUE |
| Which option is NOT a continuum of care provider? | Health Plan Contracting |
| In order to promote the use of correct coding methods on a national basis and prevent payment errors due to improper coding, CMS developed what? | The Correct Coding Initiative (CCI) |
| The patient is scheduled and registered for service is a time-of-service activity. | FALSE |
| Patient relations include: | The ability to sensitively deal with patients or individuals while managing collection efficiency. |
| What are KPIs? | Key performance indicators, which set standards for accounts receivable (A/R) and provide a method of measuring the collection and control of A/R. |
| True or False: The following statement represents an advantage of outsourcing: Ineffective vendor results in increased costs | FALSE |
| It is considering hiring an outsourcing vendor to assist. What are the steps that the hospital needs to take to establish and ensure a successful vendor relationship? | Distribute a RFP to solicit vendor capabilities, evaluate vendor’s expertise to provide outsourcing services, visit vendor locations, perform vendor reference checks, talk with vendor clients, interview vendor employees to assess experience level. |
| Agency fees are: | The cost to the provider for collection agency monies offset by the return on baddebt accounts. |
| Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle initiative? | Process Compliance |
| Which option is NOT a HFMA best practice? | Coordinate the resolution of bad debt accounts with a law firm |
| What are claim edits? | Rules developed to verify the accuracy and completeness of claims based on each health plan's policies |
| The following statements describe best practices established by the Medical Debt Task Force. Select the True statements. | Educate patients Exercise moderate judgement when communicating with providers about scheduled services. Be consistent in key aspects of account resolution. Follow best practices for communication. |
| Patient service costs are calculated in the pre-service process for scheduled patients. | TRUE |
| The correct way to handle the retention and payment of agency fees is ? | Follow the contractual agreement between the agency and the provider as to how monies sent to the agency will be handled. |
| What is the objective of the HCAHPS initiative? | To provide a standardized method for evaluating patients' perspective on hospital care. |
| Collection agency reports should be provided: | In at least two formats regarding accounts assigned on a routine basis. |
| What is the first component of a pricing determination? | Verification of the patient’s insurance eligibility and benefits |
| The following statement represents an advantage of outsourcing: Access to qualified staff | TRUE |
| In what manner do case managers assist revenue cycle staff? | Providing assistance with written appeals to health plans related to utilization and other care issues. |
| Which of these statements describes the new methodology for the determination of net patient service revenue: | Net patient service revenue is defined as the total incurred charges, less the explicit price concession, less any applicable implicit price concession(s) as applied to the specific portfolio of accounts. |
| What happens during the post-service stage? | Final coding of all services, preparation and submission of claims, payment processing and balance billing and resolution. |
| A day begins at midnight and ends 24 hours later, this is called the midnight-to-midnight method. | Counting Inpatient Days |
| Applies to Rural Health Clinic; Hospice; Skilled Nursing Facility; Ambulance; and Hospital-Based Physicians | Provider Type Billing Rule |
| Providers typically submit a single claim for an inpatient or outpatient episode of care, or a series or recurring claim or repeat outpatient services for the same condition | Outpatient Series |
| Section 6404 of the Patient Protection and ACA states that claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service, will be denied by Medicare. | Time Limits for Billing |
| What is the sequential order for a Silent PPO scheme? | The patient's claims is sent to the listed primary insurance carrier The patient's insurance company (a silent PPO) runs the healthcare provider's tax ID number through a PPO discount database or provides a repricing company a copy of the claim After a |
| Credit balances may be created by any of the following activities except : | Credits to pharmacy charges posted before the claim final bills |
| Which of the following statements represent common reasons for inpatient claim denials : | Failure to obtain a required pre - authorization ; failure to complete continued stay authorization and services provided which were not medically necessary |
| A 68 year old patient Medicare beneficiary , was in a car accident . A medical insurance claim was filed with the auto insurance carrier . Six months later this claim remains unpaid . How can the provider pursue payment from Medicare ? | The provider must first bill the auto insurer ; however , after a period of 120 days if the claim remains unpaid , the provider may cancel the liability claim and bill Medicare |
| To comply with the requirements of Section 501 ( r ) for tax - exempt hospitals chartered as 510 ( c ) 3 providers the hospital must complet which of the following activities : | A community needs assessments |
| Which of the following medical debt collection practices are recommended as part of HFMA's Best Practices for medical accoun resolution : | Establish policies and ensure that they are followed . |
| Each hospital covered by the 501 ( r ) regulations is required to develop financial assistance policy . Which of the following elements is not required element of the policy ? | The notice that individuals eligible for financial assistance under this policy may charged more than the amount generally billed ( AGB ) to insured patients. |
| Which option is NOT a required component of a FAP? | Out-of-network providers |
| Truth in Lending Act - establishes disclosure rules for consumer credit sales and consumer loans. The most important section is Regulation Z, which tells creditors how to comply with the law. | Title I: |
| Restrictions on Garnishment- 25% of a worker’s disposable earnings per week, or The amount by which a worker’s weekly wage exceeds 30 times the federal minimum wage | Title III: |
| Fair Credit Reporting Act - affects those who “issue or use reports on consumers in connection with the approval of credit.” This Act protects consumers’ rights and has exact standards that limits the use of consumer credit reports. T | Title VI |
| Fair Debt Collection Practices Act (FDCPA) - Act of 1978 applies only to third-party collection agencies that collect consumer debt. As long as a hospital collects its own debts using its own name, it is not considered a debt collector under the Act. | Title VIII |
| Which option is NOT a bankruptcy type governed by the 1979 Bankruptcy Act? | Creditor priority |
| Which function within the revenue cycle is NOT a good candidate for outsourcing? | Health Care Patient Services |
| Patient service costs are calculated in the pre-service process for scheduled patients. | True |
| The patient is scheduled and registered for service is a time-of-service activity. | False -Pre-service: |
| The 2020 OIG Work Plan tasks include the following: | Medicare Payments Made Outside of the Hospice Benefit Denials and Appeals in Medicare Part C and Part D Medicare Part B Payments for End-Stage Renal Disease Dialysis Services Review of Home Health Claims for Services With 5 to 10 Skilled Visits |
| Ongoing OIG reviews may continue in some or all of the following areas as wel | Reconciliation of outlier payments. Outpatient and inpatient stays under Medicare’s two-midnight rule. Medicare costs associated with defective medical devices and credits for replacement medical devices. Oversight of provider-based status and comparis |
| Days in A/R is calculated based on | the value of the total accounts receivable on a specific date. |
| A/R day calculations | can also be done for specific payers to evaluate the collection efficiency and payment progress on third-party payers or self-pay patients. |
| Completing an analysis of A/R aging and KPIs can help identify issues and areas for improvement. | can help identify issues and areas for improvement. |
| n order to report a provider’s revenue accurately | it is important to calculate the difference between gross revenue and net revenue. |
| To determine gross revenue, | The charges for all the services that a patient has received is totaled. |
| To determine net revenue | financial services estimate the dollar amount of contractual, discount, or other allowances that will be applied against those revenues. |
| CMS has set a target of moving Medicare payments | from volume-based to value-based payments and increasing the types of alternative payment models which include value-based payments. |
| The Affordable Care Act or ACA, was designed to | to reform the healthcare system into a system that rewards greater value, improves the quality of care and increases efficiency in the delivery of services. |
| Ethical behavior, | which is considered to be actions that are the right thing to do, not just what is required by a law, regulation or rule, is very important in healthcare. |
| The concept of ethical standards | applies to actions that are hoped for and expected by each individual staff and management member within healthcare. |
| It is important for staff and management to | to uphold the business ethics of the provider and act as peer role models. |
| The Three-Day DRG Window Rule requires | certain outpatient services that are provided within three days of the admission date, by hospitals or by entities wholly owned or controlled by hospitals, to be billed as part of an inpatient stay. |
| The purpose of the ABN | is to inform a Medicare beneficiary “before he or she receives specified items or services that might otherwise be paid for” that Medicare certainly or probably will not pay for those items or services on that particular occasion. |
| The situations where Medicare acts as secondary payer include: | Working Aged Accident or Other Liability Disability End-Stage Renal Disease (ESRD) |
| Continuum of care providers within the healthcare system include: | Health Plans & Payers Physicians Skilled Nursing Facilities Durable Medical Equipment Hospice Assisted Living |
| The departments that support and collaborate with the revenue cycle include: | Information Technology - Clinical Services - Finance-provides analysis and reporting to ensure compliance. Health Plan Contracting |
| Healthcare Dollars & Sense® is the name given to three HFMA revenue cycle initiatives: | Patient Financial Communications Price Transparency Medical Account Resolution |
| Post-service segment | after the patient is discharged) - Account activities occur after the patient is discharged until the account reaches a zero balance. |
| Time-of-service segment | account review is completed for a scheduled patient prior to his/her arrival. Upon arrival, the patient is positively identified, the pre-registration record is activated, consents are signed, and co-payments or other agreed upon amounts are collected. |
| Pre-service segment | (for scheduled patients) - Scheduling and pre-access processing is completed. The patient is scheduled, pre-registered for service and the required data is collected. |
| There are three critical segments of the revenue cycle | Pre-service segment Time-of-service segment Post-service segment |
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