2024 HFMA CRCR Study Guide A+ Rated Guide | Questions and Answers (Solved)
- Through what document does a hospital establish compliance standards?-
Answer: Code of Conduct
- What is the purpose of the OIG work plan?
Answer: Communicate issues that will be reviewed during the year for compliance
with Medicare regulations
- If a Medicare patient is admitted on Friday, what services fall within the three-
day DRG window rule?
Answer: Diagnostic services and related charges provided on the Wednesday,
Thursday and Friday before admission
- What does a modifier allow a provider to do?
Answer: Report a specific circumstance that affected a procedure or service without changing the code or its definition
- If outpatient diagnostic services are provided within three days of the ad-
mission of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these charges?
Answer: They must be combined with the inpatient bill and paid under the MS-DRG
(diagnosis-related group) system
- Why is the OIG (Office of Inspector General) pursuing the Medicare Secondary
Payer (MSP) initiative?
Answer: It reviews Medicare payments for beneficiaries who have other insurance
and assesses the effectiveness of procedures in pre- venting inappropriate Medicare payments for beneficiaries with other insurance coverage
- What is a recurring or series registration?
Answer: One registration record is created for multiple days of service
- What are non-emergency patients who come for service without prior noti fication
to the provider called?
Answer: Unscheduled patients
- Which of the following statements apply to the observation patient type?
Answer: It is used to evaluate the need for an inpatient admission
- / 2
- Which services are hospice programs required to provide on an around-the-
clock basis?
Answer: Physician, nursing, and pharmacy
- What is the purpose of the initial step in the outpatient testing scheduling
process?Answer: Identify the correct patient in the provider's database or add the patient to the database
- Scheduler instructions are used to prompt the scheduler to do what?
Answer: - Complete the scheduling process correctly based on service requested
- The time needed to prepare the patient before service is the difference between
the patient's arrival time and which of the following?
Answer: Schedule time
- Medicare guidelines require that when a test is ordered for which an
LCD (local coverage determination) or NCD (national coverage determination) exists, the information provided on the order must include which of the following?
Answer: Documentation of the medical necessity for the test
- What is an advantage of a preregistration program?
Answer: It reduces processing times at the time of service
- What data are required to establish a new MPI (master patient index) entry?
Answer: The patient's full legal name, date of birth, and sex
- Which HIPAA transaction set provides electronic processing of insurance
verification requests and responses?
Answer: The 270-271 set
- A mother and father both cover their 16-year-old child as a dependent on their
health insurance plans, which both follow the birthday rule. The mother's date of birth is January 19, 1968; the father's date of birth is July 19, 1967. Whose plan is the primary payer?
Answer: The mother's plan
- Which of the following statements is true about third-party payments?
Answer: The payments are received by the provider from the payer responsible for reimbursing the provider for the patient's covered services
- / 2