CRSC CERTIFICATION
Which of the following are the main governing bodies affecting heaathcare change (select one)
CMS and CLIA
CMS AND ECOA
CMS AND OIG
OIG AND TJC
Which of the following is an operating division of HHS (select all that apply)
Food and Drug Administration (FDA)
Department of veteran affairs (VA)
Administration for Community (ACL)
Adminsitration for children and families (ACF
Administration for healthy living for Seniors (AHLS)
What are other manes for Medicare and Medicaid programs respectively (select 1)
Part A and Part B
CMS and OIG
Title XVIII and Title XIX
HIPPA and ECOA
What is the CMS program to monitor and improve utilization and quality of care for medicare beneficiaries (select 1)
Quality Improvement Organization QIO
Health Insurance marketplace (HIM)
American Hospital Association (AHA)
State Childrens Health Insurance Program SCHIP
Which of the following is true of the patient care Partnership (select all that apply)
It replaces the "patient's bill of rights"
It was adopted by the AHA
Outlines what a provider can expect
It is a plain language brocure
Addresses patient expectations from admission to dismissal only
Whiche of the following is not a typical goal for reengineering patient access (select one)
Place the focus on customer service to improve the initial patient impression
Identify ways to decrease wait times
Free up staff time for training on new technology and regulations
Preregister patients whenever pssible
Which of the following is not gathered during preregistration or preadmission (select one)
History of chief complaint
Patient demographics
Financial information
Socioeconomic information
What is the term for diagnostic medical testing before surgical or invasive procedures to determine hospitalization/surgical suitability (select one)
Therapeutic medical screening
Preadmission testing
Preadmission screening
Diagnostic medical screening
Which of the following is not true of precertification and preauthorization (select one)
The key success factor is implementing a strong customer service philosophy and forming a feeling of partnership between the patient and provider
It means getting authorization from an insurance company review organization approving the medical necessity of the service
It involves getting authorization to treat and authorization for an average length of stay/number of services for the patient's condition
Failure to preauthorize can result in total denial of claims with related increases in appeals, time spent by billing staff in rework and lost revenue
Which of the following is not a suggested practice before seeing a patient in the office (select one)
Gathering information (new vs. Established patient, purpose of appointment, name of referring physician/PCP, insurance information, etc)
Mailing the Notice of Privacy Practices
Pulling charts and preparing fee tickets
Obtaining referrals for visits
Which of the following is not a recommended question to answer during insurance verification (select one)
Is precertification required? Has it been obtained?
What is the deductible amount and has any portion of it been met
What is the address and telephone number of the claims office
Has the policy holder ever been late with a premium payment
What information is needed to calculate the patient's estimated responsibility for a hospital stay (select all that apply)
ALOS for the diagnosis
Average cost per day by type of service
Average cost per day by type of service
Admitting physician's estimated length of stay
The hospital's flat rate procedures/drg/contractural payer allowance
The daily room charge by type
Patient third-party insurance plan benefit levels
What are some anticipated outcomes of a deposit collection program when combined wiht preregistration and insurance verification (select the correct word in parentheses so that each item is an anticipated outcome)
Hospital collections - increased
Hospital collections - reduced
Amount due at discharge-increased
Amount due at discharge-reduced
Overall accounts receivable p increased
Overall accounts receivable - reduced
Financial risk and bad debt - increased
Financial risk and bad debt - reduced
Possibility of public relations issues - increased
Possibility of public relations issues - decreased
What are the five collection control points - facility setting
Which of the following is not true of the requirements to notify beneficiaries when they are an outpatient receiving observation services and not an inpatient (select one)
The requirement is part of the NOTICE Act and MOON is the standardized notice used
The requirement is for both written and oral notification
The notification must be provided within 24 hours to patients who are in observation status for more than 12 hours
If the beneficiary/representative does not sign the form, the following are required: staff member name, signature, and title, certification that the notification was presented with date and time, and an annotation in the additional information section of the form
Which of the following is not true of the ABN (select one)
The ABN must contain a brief description of the service, the estimated cost, and the reason the service is not expected to be covered
A signed ABN supports Medicare's rule that a beneficiary is not protected from financial liability if that person had or should have had knowledge that a service was noncovered.
The ABN must be signed and faxed to Medicare no later than 24 hours after the service is performed
While it is usually inappropriate to use ABNs in the ER, it is also inappropriate to just write off all noncovered ER services as this could be construed as an inducement
Entities that issue ABNs sare know by CMS as "notifiers"
What is the name for ABN triggering event when there is a discontinuation in the services being provided (select one)
Initiation
Reduction
Cessation
Termination
Per CMS an ABN must be retained for three years from discharge or completion of care unless there is another state-specific requirement
True
False
What are some of the critical tasks performed by case management/utilization review (select all that apply)
Preventing unnecessary services or treatment
Evaluating an individual's safety and ability to live independently at home
Obtaining appropriate medical care
Arranging for transportation to and from Doctor appointments
What type of care would be provided in the following scenario - A woman is the primary caregiver for her husband, who has multiple sclerosis. The patient needs an alternate caregiver while his wife recovers from an injury
Respite care
Hospice care
SNF - skilled nursing facility
Home health
To qualify for SNF coverage, Medicare requires a person to have been a hospital inpatient for at least three consecutive days (not including the day of discharge)
True
False
A single general consent document is signed to cover all procedures and services being performed in any 24-hour period
True
False
In the ER, failure of a patient, who is aware of what is happening, to object to treatment is implied consent - in fact
True
False
What is the name for a policyholder's written authorization to have insurance benefits paid directly to the provider (select one)
Conditional payments
Provisional benefits
Assignment of benefits
Authorization of payments
In what situation is a person prevented from consenting to service (select all that apply)
The person is an emancipated minor
The person is uninsured
The person is intoxicated
The person is declared mentally incompetent by the courts
Should a correction be required to a medical record, an authorized person should use correction fluid to neatly obscure the error and continue the note
True
False
Which of the following is authorized to make entries in the patient's medical record (select all that apply)
Treating/attending physician
A physician extender
Licensed, registered nurse
A financial counselor
A student from an accredited health profession program (under the supervision of his or her clinical instructor)
Telephone orders from a referring physician may be edited for clarity by an individual authorized to receive verbal orders
True
False
What does the Acronym NCD stand for (select one)
National Coverage Determination
National coverage Department
New Coverage Determination
New coverage Direction
Which type of LCD/NCD provides potential coverage circumstances, but most likely does not provide specified diagnoses, signs, symptoms, or ICD-10 codes that will be covered or non-covered (select one)
Definitive LCD/NCD
Non-definitive LCD/NCD
Which of gthe following is not true of MSP laws (select one)
Until 2010, Medicare was the primary payor for nearly all Medicare covered services
Before becoming entitled to Medicare, beneficiaries receive an IEQ that askes about any other healthcare coverage that might be primary to Medicare
Medicare considers it a fraudulent or abusive practice to regularly submit claims that are the responsibility of another insurer under the MSP provision
The CWF is a CMS file that contains Medicare patient eligibilty and utilzation date from the IEQ and ongoing MSPQs
Which of the following is true of financial policies in patient access/front desk (select all that apply)
They should describe trhe provider's policies in general tersm only to allow for flexible legal interpretation
They should clearly state when charges are due and payable; provide discount information; define acceptable methods of payment; outline charity guidelines and application procedures; and explain how accounts may be sent to a collection agency
Patient access/front desk staff should not discuss thes policies with pateints; instead, they should refer patients to a desingnated billing staff member
An effecgtive policy for collecting at the time of service will improve cash flow and will reduce AR days, the cost of patient statements, bad debt, and follow-up time
Which of the following is true of a practice terminating a patient-physician relationship (select one)
The patient-physician relationship can be extended only for continued failure to pay
The patient must acknowledge in writing the terminatyion of the patient-physician relationship
A physician is legally obligated to provide medical care to a patient until the patient-physician relationship is properly ended
A physician is legally obligated to provide medical care to a patient until the patient establishes a relationship with a new provider
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