2024 HFMA CRCR Set Complete Questions & Answers (Solved) 100% Correct
- Define Revenue Cycle
Answer: REVENUE CYCLE ----- is the series of events and services provided prior
to, during, and after the course of treatment
- Departments that contribute to the Revenue Cycle.
Answer: Departments that con- tribute to the Revenue Cycle.
- Access
- Health information management/ Medical records
- Case-management
- Patient Care Services
- Patient Financial Services
- What led the creation of revenue management services?
Answer: The emphasis on the revenue cycle has resulted in the need to organize its components differently and created a new business unit known as revenue integrity or revenue management services.
- Benefit of Electronic transactions?
Answer: Electronic transactions." Transactions are associated with revenue capture and collection activities. The implementation of electronic data interchange (EDI) allows actions previously conducted by telephone/ manual methods to be performed electronically ( improves workflow).
- 5010 Transaction Set Function?
Answer: 5010 Transaction Set new transaction pro-
cessing system with new transaction standards. These standards will:
- Offer healthcare providers enhanced information.
- Require providers to provide payers with additional data to facilitate claim pay-
ments.
6. 6 Transactions associated with the revenue cycle include:
Answer: 6 Transactions associated with the revenue cycle include:
- Claim/Encounter (837-I, 837-P, 837-COB, 837-P COB, NCPD).
- Remittance (835).
- Claim Status Inquiry/Response (276/277). 1 / 4
- Eligibility Inquiry/Response (270/271).
- Healthcare Services Review (278) Pre-certification and Referrals.
- Acknowledgment (999)
- Which of the following would be a hard cost of customer dissatisfaction? Loss of
future revenue Negative word-of-mouth advertising Decisions of future patients to use another facility Decisions of current patients to use other facilities for future ancillary services
Answer: loss of future revenue
- Define hard cost and soft cost.
Answer:
- Hard Cost -the loss of future revenue
- Soft Cost- Negative word-of-mouth advertising that may influence others not to
use the hospital.
- Single greatest reason for an inability to bill and collect accounts receivable in a
timely manner?
Answer: Single greatest reason for an inability to bill and collect accounts
receivable in a timely manner:
Inadequate and incorrect information received from the admitting/patient access department
- When certain services are not covered, a Medicare patient should be issued
a/an to notify the patient that they may be responsible for payment.
Answer: ABN---Advance Beneficiary Notice of Non-Coverage (ABN)
- The COBRA benefit is provided to employees or their family members if they
lose coverage due to a number of reasons, such as the following: (list 4)
Answer: The COBRA benefit is provided to employees or their family members if
they lose coverage due to a number of reasons, such as the following:
Loss of employment Reduction in hours worked Divorce Death of the supporting spouse
- The time required for gathering information has the highest return when the
investment is made .Before the patient's arrival 2 / 4
After discharge When the first bill comes off After the account goes to collections
Answer: Before the patient's arrival
- What are the 4 things included in claims adjudication?
- Determination of benefits levels and coverage
- Coordination of benefits
- Subrogation of third-party liability claims
- Generation of appropriate explanation of benefit forms
Answer: Claims adjudication includes the following:
- What are the twin goals of financial counseling?
Answer:
The twin goals of financial counseling are:
That the provider understands upfront a patient's ability to pay, and That the patient understands his or her financial responsibility to the provider.
- Accounts receivable (A/R) personnel must become key participants in the POS
collection process.Is this statement true or false?
Answer: False
- Which of the following is true of deposits?
A deposit should be requested to secure payment when precise charge calculations are not practical.Deposit policies should be reviewed and approved by the CFO. 3 / 4
To facilitate calculation of deposits, credit references should be readily avail- able.To facilitate internal reporting, deposit payments should be held in the general fund.
Answer: A deposit should be requested to secure payment when precise charge
calculations are not practical.
- In , a provider arranges for patients to obtain loans through a
local bank.In-house financing A bank financing agreement Charity care Bad debt write-off Answer: In-house financing ------------------------------ a provider arranges for patients to obtain loans through a local bank.
- The outpatient system will assign multiple APCs to outpatients to account for all
of the following, EXCEPT the .Diversity of sites of ambulatory care services Wide variety of patient needs addressed in the outpatient setting Intensity of physician care required High percentage of costs associated with ancillary services
Answer: Intensity of physician care required
- Why is the role of Access or Registration staff critical to billing?
Answer: Since billing occurs after the patient leaves the hospital or physician office, it is imperative that the Access or Registration staff obtains the correct information at time of registration.
- The Access department's policies and procedures should address the what
topics:
- / 4