Download HFMA CRCR EXAM/ACTUAL EXAM QUESTIONS WITH WELL DETAILED ANSWERS/GRADE A+ ASSURED 2025 G and more Exams Business Administration in PDF only on Docsity!
QUESTIONS WITH WELL DETAILED
ANSWERS/GRADE A+ ASSURED
2025 Grade A+ Exam study Guide
What are collection agency fees based on? - ANSA percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - ANSBirthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - ANSCase rates What customer service improvements might improve the patient accounts department? - ANSHolding staff accountable for customer service during performance reviews What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - ANSInform a Medicare beneficiary that Medicare may not pay for the order or service What type of account adjustment results from the patient's unwillingness to pay for a self-pay balance? - ANSBad debt adjustment What is the initial hospice benefit? - ANSTwo 90-day periods and an unlimited number of subsequent periods When does a hospital add ambulance charges to the Medicare inpatient claim? - ANSIf the patient requires ambulance transportation to a skilled nursing facility How should a provider resolve a late-charge credit posted after an account is billed? - ANSPost a late-charge adjustment to the account an increase in the dollars aged greater than 90 days from date of service indicate what about accounts - ANSThey are not being processed in a timely manner What is an advantage of a preregistration program? - ANSIt reduces processing times at the time of service What are the two statutory exclusions from hospice coverage? - ANSMedically unnecessary services and custodial care What core financial activities are resolved within patient access? - ANSScheduling, insurance verification, discharge processing, and payment of point-of-service receipts What statement applies to the scheduled outpatient? - ANSThe services do not involve an overnight stay How is a mis-posted contractual allowance resolved? - ANSComparing the contract reimbursement rates with the contract on the admittance advice to identify the correct amount What type of patient status is used to evaluate the patient's need for inpatient care? - ANSObservation Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has received what? - ANSMedically necessary inpatient hospital services for at least 3 consecutive days before the skilled nursing care admission When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - ANSWhen the patient is the insured What are non-emergency patients who come for service without prior notification to the provider called? - ANSUnscheduled patients If the insurance verification response reports that a subscriber has a single policy, what is the status of the subscriber's spouse? - ANSNeither enrolled not entitled to benefits Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act, establishes what? - ANSDisclosure rules for consumer credit sales and consumer loans
QUESTIONS WITH WELL DETAILED
ANSWERS/GRADE A+ ASSURED
2025 Grade A+ Exam study Guide
What is a principal diagnosis? - ANSPrimary reason for the patient's admission Collecting patient liability dollars after service leads to what? - ANSLower accounts receivable levels What is the daily out-of-pocket amount for each lifetime reserve day used? - ANS50% of the current deductible amount What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as an RHC services? - ANSInpatient care What code indicates the disposition of the patient at the conclusion of service? - ANSPatient discharge status code What are hospitals required to do for Medicare credit balance accounts? - ANSThey result in lost reimbursement and additional cost to collect When an undue delay of payment results from a dispute between the patient and the third party payer, who is responsible for payment? - ANSPatient Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include: - ANSA valid CPT or HCPCS code With advances in internet security and encryption, revenue-cycle processes are expanding to allow patients to do what? - ANSAccess their information and perform functions on-line What date is required on all CMS 1500 claim forms? - ANSonset date of current illness What does scheduling allow provider staff to do - ANSReview appropriateness of the service request What code is used to report the provider's most common semiprivate room rate? - ANSCondition code Regulations and requirements for coding accountable care organizations, which allows providers to begin creating these organizations, were finalized in: - ANS What is a primary responsibility of the Recover Audit Contractor? - ANSTo correctly identify proper payments for Medicare Part A & B claims How must providers handle credit balances? - ANSComply with state statutes concerning reporting credit balance Insurance verification results in what? - ANSThe accurate identification of the patient's eligibility and benefits What form is used to bill Medicare for rural health clinics? - ANSCMS 1500 What activities are completed when a scheduled pre-registered patient arrives for service? - ANSRegistering the patient and directing the patient to the service area In addition to being supported by information found in the patient's chart, a CMS 1500 claim must be coded using what? - ANSHCPCS (Healthcare Common Procedure Coding system) What results from a denied claim? - ANSThe provider incurs rework and appeal costs Why does the financial counselor need pricing for services? - ANSTo calculate the patient's financial responsibility What type of provider bills third-party payers using CMS 1500 form - ANSHospital-based mammography centers How are disputes with nongovernmental payers resolved? - ANSAppeal conditions specified in the individual payer's contract
QUESTIONS WITH WELL DETAILED
ANSWERS/GRADE A+ ASSURED
2025 Grade A+ Exam study Guide
What will comprehensive patient access processing accomplish? - ANSMinimize the need for follow-up on insurance accounts Through what document does a hospital establish compliance standards? - ANSCode of conduct How does utilization review staff use correct insurance information? - ANSTo obtain approval for inpatient days and coordinate services When is it not appropriate to use observation status? - ANSAs a substitute for an inpatient admission What is a serious consequence of misidentifying a patient in the MPI? - ANSThe services will be documented in the wrong record When a patient reports directly to a clinical department for service, what will the clinical department staff do? - ANSRedirect the patient to the patient access department for registration What process can be used to shorten claim turnaround time? - ANSSend high-dollar hard- copy claims with required attachments by overnight mail or registered mail How are patient reminder calls used? - ANSTo make sure the patient follows the prep instructions and arrives at the scheduled time for service If a patient declares a straight bankruptcy, what must the provider do? - ANSWrite off the account to the contractual adjustment account According to the Department of Health and Human Services guidelines, what is NOT considered income? - ANSSale of property, house, or car The situation where neither the patient nor spouse is employed is described to the patient using: - ANSA condition code What option is an alternative to valid long-term payment plans? - ANSBank loans What is an advantage of using a collection agency to collect delinquent patient accounts? - ANSCollection agencies collect accounts faster than hospital does What statement DOES NOT apply to revenue codes? - ANSrevenue codes identify the payer When a patient's illness results in an unusually high amount of medical bills not covered by insurance or other patient pay resources, what type of account is created - ANScatastrophic charity What happens when a patient receives non-emergent services from and out-of-network provider? - ANSPatient payment responsibility is higher Every patient who is new to the healthcare provider must be offered what? - ANSA printed copy of the provider's privacy notice How may a collection agency demonstrate its performance? - ANSCalculate the rate of recovery What is true of the information the provider supplies to indicate that an authorization for service has been received from the patient's primary payer? - ANSIt is posted on the remittance advice by the payer What standard claim forms are currently used by the healthcare industry to submit claims to third-party payers? - ANSThe UB-04 and the CMS 1500
QUESTIONS WITH WELL DETAILED
ANSWERS/GRADE A+ ASSURED
2025 Grade A+ Exam study Guide
Unless the patient encounter is an emergency, what is the efficient and effective procedure for obtaining information? - ANSObtain the required demographic and insurance information before services are rendered what protocol was developed through the Patient Friendly Billing Project? - ANSProvide information using language that is easily understood by the average reader What technique is acceptable way to complete the MSP screening for a facility situation? - ANSAsk if the patient's current services was accident related What is a valid reason for a payer to delay a claim? - ANSFailure to complete authorization requirements IF outpatient diagnostic services are provided within three days of the admission of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these charges - ANSThey must be combined with the inpatient bill and paid under the MS-DRG system What do large adjustments require? - ANSManager-level approval What items are valid identifiers to establish a patient's identification? - ANSPhoto identification, date of birth, and social security number What must a provider do to qualify an account as a Medicare bad debts? - ANSPursue the account for 120 days and then refer it to an outside collection agency What restriction does a managed care plan place on locations that must be used if the plan is to pay for the services provided? - ANSSite-of-service limitation What is an example of an outcome of the Patient Friendly Billing Project? - ANSRedesigned patient billing statements using patient-friendly language What statement describes the APC (Ambulatory payment classification) system? - ANSAPC rates are calculated on a national basis and are wage-adjusted by geographic region What is a benefit of insurance verification? - ANSPre-certification or pre-authorization requirements are confirmed What is an effective tool to help staff collect payments at the time of service? - ANSDevelop scripts for the process of requesting payments What is a benefit of electronic claims processing? - ANSProviders can electronically view patient's eligibility What does Medicare Part D provide coverage for? - ANSPrescription drugs What are some core elements of a board-approved financial policy - ANSCharity care, payment methods, and installment payment guidelines What circumstance would result in an incorrect nightly room charge? - ANSIf the patient's discharge, ordered for tomorrow, has not been charted What is NOT a typical charge master problem that can result in a denial? - ANSDoes not include required modifiers Access - ANSAn individual's ability to obtain medical services on a timely and financially acceptable level Administrative Services Only (ASO) - ANSUsually contracted administrative services to a self-insured health plan
QUESTIONS WITH WELL DETAILED
ANSWERS/GRADE A+ ASSURED
2025 Grade A+ Exam study Guide
Third-part administrator (TPA) - ANSProvides services to employers or insurance companies for utilization review, claims payment and benefit design Third-party reimbursement - ANSA general term used for the healthcare benefit payments - used to identify that for benefit plans there are three parties in the transaction Usual, customary, and reasonable (UCR) - ANSHealth insurance plan reimbursement methodology that limits payment to the lower billed charges, the provider's customary charge, or the prevailing charge for the service in the community Utilization review - ANSReview conducted by professional healthcare personnel of the appropriateness of, quality of, and need for healthcare services provided to patients Charge - ANSThe dollar amount a provider sets for services rendered before negotiating any discounts. The charge can be different from the amount paid Cost - ANSThe definition of cost varies by party incurring the expense Price - ANSthe total amount a provider expects to be paid by payers and patients for healthcare services Care purchaser - ANSIndividual or entity that contributes to the purchase of healthcare services Payer - ANSAn organization that negotiates or sets rates for provider services, collects revenue through premium payments or tax dollars, processes provider claims for service, and pays provider claims using collected premium or tax revenues Provider - ANSAn entity, organization, or individual that furnishes a healthcare service Out of pocket payment - ANSThe portion of the total payment for medical services and treatment for which the patient is responsible, including copayments, coinsurance, and deductibles Price transparency - ANSIn health care, readily available information on the price of healthcare services that, together, with other information helps define the value of those services and enables patients and other care purchasers to identify, compare, and choose providers that offer the desired level of value Value - ANSThe quality of a healthcare service in relation to the total price paid for the service by care purchasers What areas does the code of conduct typically focus on? - ANSHuman resources. Privacy/confidentiality. Quality of care. Billing/coding. Conflicts of interest. Laws/regulations FERA - ANSFraud Enforcement and Recovery act ESRD - ANSEnd-stage renal disease. The patient has permanent kidney failure, is covered by a GHP, and has not yet completed the 30-month coordination period What is the purpose of a compliance program? - ANSMitigate potential fraud and abuse in the industry-specific key risk areas What is important about an effective corporate compliance program? - ANSA program that embodies many elements to create a program that is transparent, clearly articulated and emphasized at all employee levels as a seriously held personal and organizational responsibility, one that relies on full communication inside and outside the organization
QUESTIONS WITH WELL DETAILED
ANSWERS/GRADE A+ ASSURED
2025 Grade A+ Exam study Guide
What is a CCO - ANSChief compliance officer - they typically report directly to the board of directors/trustees as well as the chief executive officer, and has limited responsibilities for other operational aspects of the organization What are the situations where another payer may be completely responsible for payment? - ANSWork-related accidents, black lung program services, patient is enrolled in Medicare Advantage, Federal grant programs Under Medicare rules, certain outpatient services that are provided within three days of the admission date, by hospitals or by entities owned or controlled by hospitals, must be billed as part of an inpatient stay. - ANSTRUE The OIG has issued compliance guidance/model compliance plans for all of the following entities: - ANShospices. physician practices. ambulance providers Providers who are found to be in violation of CMS regulations are subject to: - ANSCorporate integrity agreements What MSP situation requires LGHP - ANSDisability The disadvantages of outsourcing include all of the following EXCEPT: a) The impact of customer service or patient relations b) The impact of loss of direct control of accounts receivable services c) Increased costs due to vendor ineffectiveness d) Reduced internal staffing costs and a reliance on outsourced staff - ANSD The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: a) Medical necessity review by an independent physician's panel b) Judicial review by a federal district court c) Redetermination by the company that handles claims for Medicare d) Review by the Medicare Appeals Council (Appeals Council) - ANSB Business ethics, or organizational ethics represent: a) The principles and standards by which organizations operate b) Regulations that must be followed by law c) Definitions of appropriate customer service d) The code of acceptable conduct - ANSA A portion of the accounts receivable inventory which has NOT qualified for billing includes: a) Charitable pledges b) Accounts created during pre-registration but not activated c) Accounts coded but held within the suspense period d) Accounts assigned to a pre-collection agency - ANSA Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare established guideline(s) used to determine:
QUESTIONS WITH WELL DETAILED
ANSWERS/GRADE A+ ASSURED
2025 Grade A+ Exam study Guide
regulations - ANSC Case Management requires that a case manager be assigned a) To patients of any physician requesting case management b) To a select patient group c) To every patient d) To specific cases designated by third party contractual agreement - ANSB Pricing transparency is defined as readily available information on the price of healthcare services, that together with other information, help define the value of those services and enable consumers to a) Identify, compare, and choose providers that offer the desired level of value b) Customize health care with a personally chosen mix of providers c) Negotiate the cost of health plan premiums d) Verify the cost of individual clinicians - ANSA Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a monthly fee is known as a a) MSO b) HMO c) PPO d) GPO - ANSB In a Chapter 7 Straight Bankruptcy filing a) The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt b) The court liquidates the debtor's nonexempt property, pays creditors, and begins to pay off the largest claims first. All claims are paid some portion of the amount owed c) The court vacates all claims against a debtor with the understanding that the debtor may not apply for credit without court supervision d) The court establishes a creditor payment schedule with the longest outstanding claims paid first - ANSA The core financial activities resolved within patient access include: a) Scheduling, pre-registration, insurance verification and managed care processing b) Scheduling, insurance verification, clinical discharge processing and payment posting of point of service receipts
QUESTIONS WITH WELL DETAILED
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c) Scheduling, registration, charge entry and managed care processing d) Scheduling, pre-registration, registration, medical necessity screening and patient refunds - ANSA Which of the following is NOT contained in a collection agency agreement? a) A clear understanding that the provider retains ownership of any outsourced activities b) Specific language as to who will pay legal fees, if needed c) An annual renewal clause d) A mutual hold-harmless clause - ANSD Maintaining routine contact with the health plan or liability payer, making sure all required information is provided and all needed approvals are obtained is the responsibility of: a) Patient Accounts b) Managed Care Contract Staff c) HIM staff d) Case Management - ANSD What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? a) Revenue codes b) Correct Part A and B procedural codes c) The CMS 1500 Part B attachment d) Medical necessity documentation - ANSA Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implement procedures for identifying and processing accounts: a) Monitor compliance b) Have the account triaged for any partial payment possibilities c) Assist in arranging for a commercial bank loan d) Obtain the patients income tax statements from the prior 2 years - ANSA For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: a) Are optional b) Should take place between the patient or guarantor and properly trained provider representatives c) May take place between the patient and discharge planning d) Are focused on verifying required third-party payer information - ANSB The purpose of a financial report is to:
QUESTIONS WITH WELL DETAILED
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c) The portion of the bill outside of the patient's self-pay d) Transports deemed medically necessary by the attending paramedic-ambulance crew - ANSC An individual enrolled in Medicare who is dissatisfied with the government's claim determination is entitled to reconsideration of the decision. This type of appeal is known as a) A beneficiary appeal b) A Medicare supplemental review c) A payment review d) A Medicare determination appeal - ANSA The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physicians to do all of the following EXCEPT: a) Drive significant improvements in the areas of quality and the patient experience b) Embrace new reimbursement models c) Improve outcomes d) Obtain higher compensation for physicians - ANSD Duplicate payments occur: a) When providers re-bill claims based on nonpayment from the initial bill submission b) When service departments do not process charges with the organization's suspense days c) When the payer's coordination of benefits is not captured correctly at the time of patient registration d) When there are other healthcare claims in process and the anticipated deductibles and co-insurance amounts still show open but will be met by the in-process claims - ANSa The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can a) Purchase qualified health benefit plans regardless of insured's health status b) Obtain price estimates for medical services c) Negotiate the price of medical services with providers d) Meet federal mandates for insurance coverage and obtain the corresponding tax deduction - ANSA The most common resolution methods for credit balances include all of the following EXCEPT:
QUESTIONS WITH WELL DETAILED
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2025 Grade A+ Exam study Guide
a) Designate the overpayment for charity care b) Submit the corrected claim to the payer incorporating credits c) Either send a refund or complete a takeback form as directed by the payer d) Determine the correct primary payer and notify incorrect payer of overpayment - ANSA EFT (electronic funds transfer) is a) An electronic claim submission b) The record of payments in the hospital's accounting system c) An electronic confirmation that a payment is due d) An electronic transfer of funds from payer to payee - ANSD Revenue cycle activities occurring at the point-of-service include all of the following EXCEPT: a) The monitoring of charges b) The provision of case management and discharge planning services c) Providing charges to the third-party payer as they are incurred d) The generation of charges - ANSC Medicare beneficiaries remain in the same "benefit period" a) Up to hospitalization discharge b) Until the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days c) Each calendar year d) Up to 60 days - ANSB Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and a) Provide evidence of financial status b) Provide a method of measuring the collection and control of A/R c) Establish productivity targets d) Make allowance for accurate revenue forecasting - ANSB Recognizing that health coverage is complicated and not all patients are able to navigate this terrain, HFMA best practices specify that a) The patient accounts staff have someone assigned to research coverage on behalf of patients b) Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions c) Patient coverage education may need to be provided by the
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a) The Center for Medicare and Medicaid Services (CMS) b) Each state's Medicaid plan c) Medicare d) The Medicare Administrative Contractor (MAC) at the end of the hospice cap period - ANSD With the advent of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to a) Reschedule the visit for non-payment of a prior balance b) Strictly limit charity care and bad-debt c) Collect patient's self-pay and deductibles in the first encounter d) Assist patients in understanding their insurance coverage and their financial obligation - ANSD A nightly room charge will be incorrect if the patient's a) Discharge for the next day has not been charted b) Condition has not been discussed during the shift change report meeting c) Pharmacy orders to the ICU have not been entered in the pharmacy system d) Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system - ANSD Which of the following is required for participation in Medicaid? a) Meet income and assets requirements b) Meet a minimum yearly premium c) Be free of chronic conditions d) Obtain a health insurance policy - ANSA HFMA best practices call for patient financial discussions to be reinforced a) By issuing a new invoice to the patient b) By copying the provider's attorney on a written statement of conversation c) By obtaining some type of collateral d) By changing policies to programs - ANSB A Medicare Part A benefit period begins: a) With admission as an inpatient b) The first day in which an individual has not been a hospital inpatient not in a skilled nursing facility for the previous 60 days c) Upon the day the coverage premium is paid d) Immediately once authorization for treatment is provided by the health plan - ANSA If further treatment can only be provided in a hospital setting, the patient's condition
QUESTIONS WITH WELL DETAILED
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cannot be evaluated and/or treated within 24 hours, or if there is not an anticipation of improvement in the patient's condition with 24 hours, the patient a) Will remain in observation for up to 72 hours after which the patient is admitted as an inpatient b) Will be admitted as an inpatient c) Will be discharged and if needed, designated to a priority one outpatient status d) Will have his/her case reviewed by the attending physician, a consulting physician and the primary care physician and a future course of care will then be determined - ANSB It is important to have high registration quality standards because a) Incomplete registrations will trigger exclusion from Medicare participation b) Incomplete registrations will raise satisfaction scores for the hospital c) Inaccurate registration may cause discharge before full treatment is obtained d) Inaccurate or incomplete patient data will delay payment or cause denials - ANSD Medicare will only pay for tests and services that a) Constitute appropriate treatment and are fairly priced b) Have solid documentation c) Can be demonstrated as necessary d) Medicare determines are "reasonable and necessary" - ANSD Room and bed charges are typically posted a) From case management reports generated for contracted payers b) Through the case management daily resource report c) At the end of each business day d) From the midnight census - ANSD The process of creating the pre=registration record ensures a) Ability to pursue extraordinary collection activities b) Early and productive communication with a third-party payer c) Accurate billing d) That access staff will have the compete and valid information needed to finalize any remaining pre-access activities - ANSC Once the EMTALA requirements are satisfied a) Third-party payer information should be collected from the patient and the payer should be notified of the ED visit b) The patient then assumes full liability for services unless a third- party is notified or the patient applies for financial assistance with the first 48 hours
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service, will be a) Denied by Medicare b) The provider's responsibility but can be deemed charity care c) Fully paid with interest d) The full responsibility of the patient. - ANSA This concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits a) Third-party invoicing b) Account resolution c) Claims processing d) Billing - ANSC The ACO investment model will test the use of pre-paid shared savings to a) Raise quality ratings in designated hospitals. b) Encourage new ACOs to form in rural and underserved areas c) Attract physicians to participate in the ACO payment system d) Invest in treatment protocols that reduce costs to Medicare - ANSB Chapter 13 Bankruptcy, debtor rehabilitation, is a court proceeding a) That establishes a payment priority order to creditors' claims b) That classifies the debtor as eligible for government financial assistance for housing, medical treatment and food as debts are paid c) That creates a clear court-supervised payment accountability plan going forward d) That reorganizes a debtor's holdings and instructs creditors to look to the debtor's future earnings for payment - ANSD HFMA's patient financial communication best practices specify that patients should be told about the types of services provided and a) A satisfaction survey regarding clinical service providers b) The price of service to their covering health plan c) The service providers that typically participate in the service, e.g., radiologists, pathologists, etc. d) An expiration of why a specific service is not provided - ANSC The important Message from Medicare provides beneficiaries information concerning their a) Understanding of billing issues and the deductibles and/or co-insurance due for the current visit b) Right to refuse to use lifetime reserve days for the current stay c) Right to appeal a discharge decision if the patient disagrees with the plan
QUESTIONS WITH WELL DETAILED
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d) Obligation to reimburse the hospital for any services not covered by the Medicare program - ANSC All of the following are potential causes of credit balances EXCEPT a) Duplicate payments b) Primary and secondary payers both paying as primary c) Inaccurate upfront collections based on incorrect liability estimates d) A patient's choice to build up a credit against future medical bills - ANSD Medicare Part B has an annual deductible, and the beneficiary is responsible for a) A co-insurance payment for all Part B covered services b) Physicians office fees c) Tests outside of an inpatient setting d) Prescriptions - ANSA The importance of medical records being maintained by HIM is that the patient records a) Are the primary source for clinical data required for reimbursement by health plans and liability payers b) Are the strongest evidence and defense in the event of a Medicare audit c) Are evidence used in assessing the quality of care d) Are the evidence cited in quality review - ANSA A decision on whether a patient should be admitted as an inpatient or become an outpatient observation patient requires medical judgments based on all of the following EXCEPT a) The patient's home care coverage b) Current medical needs c) The likelihood of an adverse event occurring to the patient d) The patient's medical history - ANSA Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish a) Provider and physician reimbursement for specific diagnoses and tests b) Prospective Medicare patient financial responsibilities for a given diagnosis c) Reasonable and customary prices for services in a given area d) What services or healthcare items are covered under Medicare - ANSD What are some core elements if a board-approved financial assistance policy? a) Payment requirements, staffing hours, and admission policies b) Case management, payment methods, and discharge policies c) Deposit requirements, pre-registration calling hours, and charity care policy d) Eligibility, application process, and nonpayment collection
