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HFMA: Healthcare Financial Management
Association Exam Questions and Verified Answers Through what document does a hospital establish compliance standards?
Correct answer: Code of Conduct
What is the purpose of the OIG work plan?
Correct 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?
Correct answer: Diagnostic services and related charges
provided on the Wednesday, Thursday and Friday before admission
What does a modifier allow a provider to do?
Correct 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 admission of a Medicare beneficiary to an IPPS (Inpatient
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Prospective Payment System) hospital, what must happen to these charges?
Correct 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?
Correct answer: It reviews Medicare payments for beneficiaries
who have other insurance and assesses the effectiveness of procedures in preventing inappropriate Medicare payments for beneficiaries with other insurance coverage
What is a recurring or series registration?
Correct answer: One registration record is created for multiple
days of service
What are non-emergency patients who come for service without prior notification to the provider called?
Correct answer: Unscheduled patients
Which of the following statements apply to the observation patient type?
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Correct answer: It is used to evaluate the need for an inpatient
admission
Which services are hospice programs required to provide on an around-the-clock basis?
Correct answer: Physician, nursing, and pharmacy
What is the purpose of the initial step in the outpatient testing scheduling process?
Correct 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?
Correct 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?
Correct answer: Schedule time
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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?
Correct answer: Documentation of the medical necessity for the
test
What is an advantage of a preregistration program?
Correct answer: It reduces processing times at the time of
service
What data are required to establish a new MPI (master patient index) entry?
Correct 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?