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...

CHFP Module 1 Certification Test

Definition of cost - correct answer Can be the amount paid for the service. It can also be the amount paid for salaries or to other vendors Direct Cost - correct answer Are the costs that can be traced directly to a department, product, or service (Salaries, Employee benefits, medications, supplies, aging and equipment maintenance contract Direct cost in a health Plan - correct answer Would be the actual claims payments made by the plan on behalf of its members indirect costs - correct ...

HFMA 2 Questions and Correct Solutions 2024 Describe the paper and electronic claims flow process. - Answer -1. Electronic Claim Submission= EDI claims forwarded to either directly or via EDI clearing house/ vendor. 2. Claims Verification= Clearinghouse specifications and insurance company requirements used to validate transmitted claims. 3. Rejected Claims = Claims not meeting requirements returned via clearinghouse error report. 4. Accepted claims= sent to insurance company for provider...

HFMA CRCR 2024 chapter 2 Correctly Answered HMO A health plan that provides comprehensive healthcare services, within a designated population, on a pre-payment basis.(2.5 Health Plans) PPO A health plan that provides comprehensive healthcare services, within a designated population, on a pre-payment basis.(2.5 Health Plans) CDHP Subscriber agrees to a high initial deductible, in return for lower premiums.(2.5 Health Plans) POS Members can refer themselves outside the plan and still ge...

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

HFMA CRCR Exam Topics Questions and Correct Solutions 2024 Revenue Cycle - Answer -All of the major processing steps required to process a patient account from the request for service through closing the account with a zero balance and purging it from the system. Pre-Service - Answer -1. Patient is scheduled and registered for s

HFMA CRCR Glossary with Correct Solutions 2024 835 Record - Answer -A standard electronic message between a health plan and provider sending remittance data on a claim to the provider. 837 Record - Answer -A standard electronic message between a provider and a health plan sending data on a claim to the health plan. AAR - Answer -After-hours activity report ABN - Answer -Advanced Beneficiary Notice ACC - Answer -Ambulatory care center Access - Answer -Ability to receive hospital, physici...

HFMA CRCR Questions and Correct Solutions 2024 Through what document does a hospital establish compliance standards? - Answer -code of conduct What is the purpose OIG work plant? - Answer -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? - Answer -Non-diagnostic service provided on Tuesday through Friday What does a modifier allow a provider to do? - Answer -Report a sp...

HFMA Study Guide Correctly Answered 2024 Through what document does a hospital establish compliance standards? - Answer -Code of Conduct What is the purpose of the OIG work plan? - Answer -Communicate issues that will be reviewed during the year for compliance with Medicare regulations If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? - Answer -Diagnostic services and related charges provided on the Wednesday, Thursday and Friday before ...

HFMA terms With Correct Solutions 2024 provider - general - Answer -A party rendering medical care such as a physician or hopsital facilities provider - Answer -Includes hospitals, skilled nursing facilities, assisted living facilities, home health agencies, and ambulatory centers professional provider - Answer -includes physicians, pharmacists, nurses, therapists, and allied health professionals primary care - Answer -primary care physicians are usually trained in family practice, general...