HFMA Study guides, Class notes & Summaries

CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023 Steps used to control costs of managed care include: Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage HMO Conventional PPO and POS H...

CSBI – HFMA QUESTIONS ANSWERED 100% CORRECT, SCORED A+ What has changed for Healthcare Analytics? 1 - Increased computing power and storage, decrease in cost; 2 - increased abundance of data in healthcare; 3 - increase in individuals having strong competencies Big Data Refers to the Growth in available data, massive continually increasing volume of live and stored data for analysis; and the increase in tools available for highly sophisticated ways to combine and analyze data to yie...

HFMA CRCR EXAM QUESTIONS WITH 100% CORRECT ANSWERS 2024 What are collection agency fees based on? - ANSWERS A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - ANSWERS Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - ANSWERS Case rates What customer service improvements might improve the patient accounts departmen...

HFMA CRCR EXAM LATEST EXAM 170+ QUESTIONS AND CORRECT ANSWERS(VERIFIED ANSWERS) Pre-Service activities 1. Requested service is screened for med necessity, health coverage/benefits verified, preauthorization obtained and estimate to patient oop costs generated within guidelines of NSA and state regulations. 2. Patient notified of financial responsibility including copayment and health plan deductibles, eligibility of financial assistance assessed. 3. Patient is scheduled 4. Encounte...

HFMA CRCR exam 2023/2024 with 100% correct answers updated Through what document does a hospital establish compliance standards? - ANSWERS code of conduct What is the purpose OIG work plant? - ANSWERS Identify Acceptable compliance programs in various provider setting If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? - ANSWERS Non-diagnostic service provided on Tuesday through Friday What does a modifier allow a provider to do? - ANS...

HFMA CRCR EXAM QUESTIONS WITH 100% CORRECT ANSWERS 2024 What are collection agency fees based on? - ANSWERS A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - ANSWERS Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - ANSWERS Case rates What customer service improvements might improve the patient accounts departmen...

HFMA CRCR EXAM LATEST EXAM 170+ QUESTIONS AND CORRECT ANSWERS(VERIFIED ANSWERS) Pre-Service activities 1. Requested service is screened for med necessity, health coverage/benefits verified, preauthorization obtained and estimate to patient oop costs generated within guidelines of NSA and state regulations. 2. Patient notified of financial responsibility including copayment and health plan deductibles, eligibility of financial assistance assessed. 3. Patient is scheduled 4. Encounte...

HFMA CRCR exam 2023/2024 with 100% correct answers updated Through what document does a hospital establish compliance standards? - ANSWERS code of conduct What is the purpose OIG work plant? - ANSWERS Identify Acceptable compliance programs in various provider setting If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? - ANSWERS Non-diagnostic service provided on Tuesday through Friday What does a modifier allow a provider to do? - ANS...

HFMA CRCR exam 2023/2024 with 100% correct answers updated Through what document does a hospital establish compliance standards? - ANSWERS code of conduct What is the purpose OIG work plant? - ANSWERS Identify Acceptable compliance programs in various provider setting If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? - ANSWERS Non-diagnostic service provided on Tuesday through Friday What does a modifier allow a provider to do? - ANS...

HFMA CRCR EXAM LATEST EXAM 170+ QUESTIONS AND CORRECT ANSWERS(VERIFIED ANSWERS) Pre-Service activities 1. Requested service is screened for med necessity, health coverage/benefits verified, preauthorization obtained and estimate to patient oop costs generated within guidelines of NSA and state regulations. 2. Patient notified of financial responsibility including copayment and health plan deductibles, eligibility of financial assistance assessed. 3. Patient is scheduled 4. Encounte...

HFMA CRCR EXAM QUESTIONS WITH 100% CORRECT ANSWERS 2024 What are collection agency fees based on? - ANSWERS A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - ANSWERS Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - ANSWERS Case rates What customer service improvements might improve the patient accounts departmen...