CMSM CMSM Healthcare Finance and Revenue Cycle Management 3

Question 1

Which US law requires healthcare organizations to provide financial assistance policies and limits on charges for uninsured patients to maintain nonprofit hospital tax-exempt status?

Accepted Answer

ACA Section 501(r)

Answer

ACA Section 501(r) requires nonprofit hospitals to establish charity care and financial assistance programs as a condition of maintaining their tax-exempt status.

Question 2

What is the significance of a 'clean claim' in the billing process?

Accepted Answer

A claim submitted without errors that can be processed without additional information

Answer

A clean claim contains all required data elements without deficiencies, allowing the payer to process and adjudicate it without requesting additional information.

Question 3

Under Medicare's Prospective Payment System (PPS) for inpatient care, payments are determined primarily by which classification system?

Accepted Answer

Diagnosis-Related Groups (DRGs)

Answer

Medicare's inpatient PPS uses Diagnosis-Related Groups (DRGs) to classify hospital stays into payment categories based on diagnosis, procedures, and patient characteristics.

Question 4

A CMSM is tasked with improving cash flow. Which strategy directly accelerates payment collection?

Accepted Answer

Implementing automated eligibility checks and electronic remittance posting

Answer

Automated eligibility verification reduces front-end errors and electronic remittance posting speeds reconciliation, directly shortening the revenue cycle and improving cash flow.

Question 5

What is the Stark Law primarily designed to prevent in US healthcare settings?

Accepted Answer

Physician self-referral to entities in which they have a financial relationship

Answer

The Stark Law (Physician Self-Referral Law) prohibits physicians from referring Medicare/Medicaid patients to entities with which the physician or an immediate family member has a financial relationship.

CMSM - Certified Medical Services Manager Practice Test

CMSM - Certified Medical Services Manager Practice Test

CMSM CMSM Healthcare Finance and Revenue Cycle Management 3