CRCR CRCR - Certified Revenue Cycle Representative Program Revenue Cycle Management Fundamentals Questions and Answers 4 — Questions and Answers
Question 1: Which federal act established the requirement for hospitals to provide emergency medical treatment regardless of ability to pay?
- HIPAA
- EMTALA (Correct answer)
- ACA
- COBRA
Correct answer: EMTALA
EMTALA (Emergency Medical Treatment and Labor Act) requires hospitals with emergency departments to provide stabilizing treatment to any patient regardless of insurance status or ability to pay.
Question 2: In revenue cycle management, what does 'clean claim' refer to?
- A claim submitted without any diagnosis codes
- A claim that passes all edits and requires no additional information before processing (Correct answer)
- A claim that has been paid in full with no adjustments
- A claim submitted directly to Medicare without a clearinghouse
Correct answer: A claim that passes all edits and requires no additional information before processing
A clean claim contains all required data elements, passes all payer edits, and can be processed without requesting additional information, leading to faster reimbursement.
Question 3: What is the primary purpose of a Remittance Advice (RA) in the revenue cycle?
- To notify a patient of their outstanding balance
- To explain why a claim was denied
- To communicate payment decisions and adjustments made to submitted claims (Correct answer)
- To authorize a patient's elective procedure
Correct answer: To communicate payment decisions and adjustments made to submitted claims
A Remittance Advice details how a payer processed each claim, including payment amounts, denial reasons, and contractual adjustments, and is used to post payments accurately.
Question 4: Which metric measures the average number of days it takes a provider to collect payment after services are rendered?
- Net Collection Rate
- Days in Accounts Receivable (AR) (Correct answer)
- Denial Rate
- Cost to Collect
Correct answer: Days in Accounts Receivable (AR)
Days in AR is a key performance indicator calculated by dividing total AR by average daily charges, indicating the efficiency of the billing and collections process.
Question 5: A patient's insurance requires a $500 deductible and 20% coinsurance after the deductible. The allowed amount for a service is $1,500. If the deductible has not been met, what is the patient's responsibility?
- $300
- $500
- $700 (Correct answer)
- $1,500
Correct answer: $700
The patient pays $500 for the deductible plus 20% of the remaining $1,000 ($200), totaling $700 in patient responsibility.
Question 6: What is the function of the National Correct Coding Initiative (NCCI) edits?
- To verify patient demographic information before claims submission
- To prevent improper payment of procedures that should not be reported together (Correct answer)
- To assign diagnosis codes to inpatient hospital stays
- To establish fee schedules for Medicare providers
Correct answer: To prevent improper payment of procedures that should not be reported together
NCCI edits are procedure-to-procedure edits developed by CMS that prevent unbundling—the improper billing of component procedures separately when a comprehensive code exists.
Question 7: Which organization accredits hospitals and other healthcare organizations and is recognized by CMS for Medicare certification surveys?
- AHIMA
- HFMA
- The Joint Commission (TJC) (Correct answer)
- AAPC
Correct answer: The Joint Commission (TJC)
The Joint Commission is a nonprofit accreditation body that CMS has granted deeming authority, meaning TJC-accredited hospitals are considered to meet Medicare's Conditions of Participation.
CRCR CRCR - Certified Revenue Cycle Representative Program Revenue Cycle Management Fundamentals Questions and Answers 4
Which federal act established the requirement for hospitals to provide emergency medical treatment regardless of ability to pay?