Certified
Revenue
Cycle
Representative
Materials
from
HFMA
In
what
situation(s)
should
a
provider
NOT
use
a
modifier?
-
CPT
already
indicates
2-4
lesions
-
CPT
indicates
multiple
extremities
3
multiple
choice
options
What
are
other
names
for
Three-Day
Payment
Window?
ALL
OF
THE
ABOVE
72-hour
rule,
DRG
window,
Three-Day
Window,
1
day
window
or
24-hour
rule
3
multiple
choice
options
What
happens
during
the
post-service
stage?
Final
coding,
preparation
and
submission
of
claims,
payment
processing,
balance
billing
and
resolution.
3
multiple
choice
options
What
are
the
below
tasks
part
of?
-
Educate
patients
-
Coordinate
to
avoid
duplicate
patient
contacts
-
Be
consistent
in
key
aspects
of
account
resolution
-
Follow
best
practices
for
communication
Best
practices
created
by
the
Medical
Debt
Task
Force
3
multiple
choice
options
We
have
an
expert-written
solution
to
this
problem!
Which
option
is
NOT
a
main
HFMA
Healthcare
Dollars
&
Sense®
revenue
cycle
initiative?
Process
Compliance
3
multiple
choice
options
Which
option
is
NOT
a
continuum
of
care
provider? A.
Physician
B.
Health
Plan
Contracting
C.
Hospice
D.
Skilled
Nursing
Facility
B.
Health
Plan
Contracting
3
multiple
choice
options
What
is
"implied
certification"?
When
it
is
implied
that
a
provider
met
all
compliance
standards
before
submitting
a
claim
3
multiple
choice
options
Which
of
the
following
are
essential
elements
of
an
effective
compliance
program?
A.
Established
compliance
standards
and
procedures.
B.
Designation
of
a
compliance
officer
employed
within
the
Billing
Department.
C.
Oversight
of
personnel
by
high-level
personnel.
D.
Automatic
dismissal
of
any
employee
excluded
from
participation
in
a
federal
healthcare
program.
E.
Reasonable
methods
to
achieve
compliance
with
standards,
including
monitoring
systems
and
hotlines.
A.
Established
compliance
standards
and
procedures.
C.
Oversight
of
personnel
by
high-level
personnel.
E.
Reasonable
methods
to
achieve
compliance
with
standards,
including
monitoring
systems
and
hotlines.
3
multiple
choice
options
When
was
Health
Information
Technology
for
Economic
and
Clinical
Health
(HITECH)
Act
signed
into
law?
FEB
17,
2009
3
multiple
choice
options
When
did
HITECH
Act
become
effective?
2013
3
multiple
choice
options Annually,
the
OIG
publishes
a
work
plan
of
compliance
issues
and
objectives
that
will
be
focused
on
throughout
the
following
year.
Identify
which
option
is
NOT
a
work
plan
task
mentioned
in
this
course.
A.
Payments
to
Physicians
for
Co-Surgery
Procedures
B.
Denials
and
Appeals
in
Medicare
Part
D
C.
Medicare
Hospital
Payments
for
Claims
Involving
the
Acute-
and
Post-Acute-Care
Transfer
Policies
D.
Standard
Unique
Employer
Identifier
D.
Standard
Unique
Employer
Identifier
3
multiple
choice
options
What
Plan
are
the
tasks
below
a
part
of?
-
Medicare
Payments
Made
Outside
of
the
Hospice
Benefit
-
Denials
and
Appeals
in
Medicare
Part
C
and
Part
D
-
Medicare
Part
B
Payments
for
End-Stage
Renal
Disease
Dialysis
Services
-
Review
of
Home
Health
Claims
for
Services
With
5
to
10
Skilled
Visits
The
2020
OIG
Work
Plan
3
multiple
choice
options
When
was
the
Preservation
of
Access
to
Care
for
Medicare
Beneficiaries
and
Pension
Relief
Act
signed
into
law?
JUNE
25
2010
3
multiple
choice
options
What
is
the
Medicare
DRG
Three-Day
Payment
Window?
All
Diagnostic
services
provided
to
a
Medicare
patient
by
a
hospital
on
the
Date
of
the
patient's
Inpatient
admission
or
during
the
3
calendar
days
(or
in
the
case
of
a
non-IPPS
hospital:
1
calendar
day)
immediately
BEFORE
the
Date
of
Admission
are
REQUIRED
to
be
included
on
the
bill
for
the
IP
stay
(unless
there
is
no
Part
A
coverage)
3
multiple
choice
options
Do
Outpatient
Non-Diagnostic
Services
qualify
for
separate
payments
if
provided
with
the
Three-Day
Payment
Window?
No
What
is
modifier
59? Used
to
identify
CPTs
OTHER
THAN
E&M
services,
NOT
normally
reported
together,
but
are
appropriate
under
the
circumstances.
Documentation
must
support
a
different
session,
different
procedure
or
surgery,
different
site
or
organ
system,
separate.
3
multiple
choice
options
What
is
condition
code
51?
Code
noted
on
the
separate
UB-04
OP
claim,
thus
indicating
the
charge
is
unrelated
to
the
admission.
3
multiple
choice
options
What
kind
of
hospitals
are
the
following:
Cancer
treatment
facilities,
psychiatric,
IP
rehabilitation,
LTC
and
children's
hospitals
for
examples
Non-IPPS
hospitals
3
multiple
choice
options
What
are
the
3
types
of
medical
necessity
screenings
and
noncoverage
notifications
required
in
the
Medicare
program?
1.
Advanced
Beneficiary
Notice
of
Noncoverage
(ABN)
for
Part
B
services.
2.
SNF
ABN
for
Part
A
SNF
services.
3.
HINN
-
Hospital-Issued
Notice
of
Non-Coverage
(Part
A)
What
is
Medicare
Part
B
ABN?
Used
to
explain
to
a
Medicare
patient
that
the
ordered
test
or
services
probably
WILL
NOT
be
covered
by
the
Medicare
b/c
the
DX
info
provided
by
the
Dr.
does
NOT
support
the
need
for
these
services.
****May
also
be
used
for
voluntary
notifications,
in
place
of
the
Notice
of
Exclusion
for
Medicare
Benefits
(NEMB).
What
is
the
Two-Midnight
Rule?
Hospital
admissions
spanning
2
midnights
would
be
considered
appropriate
for
payment
under
the
IPPS
rule
3
multiple
choice
options
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