CRCR Exam UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS
What are collection agency fees based on? - CORRECT ANSWER A percentage of dollars
collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule?
- CORRECT ANSWER Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated between the
payer and some or all providers? - CORRECT ANSWER Case rates
What customer service improvements might improve the patient accounts department? - CORRECT
ANSWER Holding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - CORRECT
ANSWER Inform 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? - CORRECT ANSWER Bad debt adjustment
What is the initial hospice benefit? - CORRECT ANSWER Two 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - CORRECT
ANSWER If 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? - CORRECT
ANSWER Post 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
- CORRECT ANSWER They are not being processed in a timely manner
,What is an advantage of a preregistration program? - CORRECT ANSWER It reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? - CORRECT ANSWER
Medically unnecessary services and custodial care
What core financial activities are resolved within patient access? - CORRECT ANSWER
Scheduling, insurance verification, discharge processing, and payment of point-of-service
receipts
What statement applies to the scheduled outpatient? - CORRECT ANSWER The services do
not involve an overnight stay
How is a mis-posted contractual allowance resolved? - CORRECT ANSWER Comparing 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? - CORRECT
ANSWER Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary
has received what? - CORRECT ANSWER Medically 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$? - CORRECT
ANSWER When the patient is the insured
What are non-emergency patients who come for service without prior notification to the provider
called? - CORRECT ANSWER Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what is the status of
the subscriber's spouse? - CORRECT ANSWER Neither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act,
establishes what? - CORRECT ANSWER Disclosure rules for consumer credit sales and
consumer loans
,What is a principal diagnosis? - CORRECT ANSWER Primary reason for the patient's
admission
Collecting patient liability dollars after service leads to what? - CORRECT ANSWER Lower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - CORRECT ANSWER
50% 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? - CORRECT ANSWER Inpatient care
What code indicates the disposition of the patient at the conclusion of service? - CORRECT
ANSWER Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - CORRECT ANSWER
They 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? - CORRECT ANSWER Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: - CORRECT ANSWER A valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are expanding to allow
patients to do what? - CORRECT ANSWER Access their information and perform functions
on-line
What date is required on all CMS 1500 claim forms? - CORRECT ANSWER onset date of
current illness
What does scheduling allow provider staff to do - CORRECT ANSWER Review
appropriateness of the service request
, What code is used to report the provider's most common semiprivate room rate? - CORRECT
ANSWER Condition code
Regulations and requirements for coding accountable care organizations, which allows providers to
begin creating these organizations, were finalized in: - CORRECT ANSWER 2012
What is a primary responsibility of the Recover Audit Contractor? - CORRECT ANSWER To
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - CORRECT ANSWER Comply with state
statutes concerning reporting credit balance
Insurance verification results in what? - CORRECT ANSWER The accurate identification of
the patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - CORRECT ANSWER CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for service? -
CORRECT ANSWER Registering 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? - CORRECT ANSWER HCPCS (Healthcare Common Procedure Coding
system)
What results from a denied claim? - CORRECT ANSWER The provider incurs rework and
appeal costs
Why does the financial counselor need pricing for services? - CORRECT ANSWER To
calculate the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - CORRECT ANSWER
Hospital-based mammography centers
QUESTIONS AND CORRECT ANSWERS
What are collection agency fees based on? - CORRECT ANSWER A percentage of dollars
collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule?
- CORRECT ANSWER Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated between the
payer and some or all providers? - CORRECT ANSWER Case rates
What customer service improvements might improve the patient accounts department? - CORRECT
ANSWER Holding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - CORRECT
ANSWER Inform 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? - CORRECT ANSWER Bad debt adjustment
What is the initial hospice benefit? - CORRECT ANSWER Two 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - CORRECT
ANSWER If 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? - CORRECT
ANSWER Post 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
- CORRECT ANSWER They are not being processed in a timely manner
,What is an advantage of a preregistration program? - CORRECT ANSWER It reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? - CORRECT ANSWER
Medically unnecessary services and custodial care
What core financial activities are resolved within patient access? - CORRECT ANSWER
Scheduling, insurance verification, discharge processing, and payment of point-of-service
receipts
What statement applies to the scheduled outpatient? - CORRECT ANSWER The services do
not involve an overnight stay
How is a mis-posted contractual allowance resolved? - CORRECT ANSWER Comparing 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? - CORRECT
ANSWER Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary
has received what? - CORRECT ANSWER Medically 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$? - CORRECT
ANSWER When the patient is the insured
What are non-emergency patients who come for service without prior notification to the provider
called? - CORRECT ANSWER Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what is the status of
the subscriber's spouse? - CORRECT ANSWER Neither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act,
establishes what? - CORRECT ANSWER Disclosure rules for consumer credit sales and
consumer loans
,What is a principal diagnosis? - CORRECT ANSWER Primary reason for the patient's
admission
Collecting patient liability dollars after service leads to what? - CORRECT ANSWER Lower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - CORRECT ANSWER
50% 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? - CORRECT ANSWER Inpatient care
What code indicates the disposition of the patient at the conclusion of service? - CORRECT
ANSWER Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - CORRECT ANSWER
They 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? - CORRECT ANSWER Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: - CORRECT ANSWER A valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are expanding to allow
patients to do what? - CORRECT ANSWER Access their information and perform functions
on-line
What date is required on all CMS 1500 claim forms? - CORRECT ANSWER onset date of
current illness
What does scheduling allow provider staff to do - CORRECT ANSWER Review
appropriateness of the service request
, What code is used to report the provider's most common semiprivate room rate? - CORRECT
ANSWER Condition code
Regulations and requirements for coding accountable care organizations, which allows providers to
begin creating these organizations, were finalized in: - CORRECT ANSWER 2012
What is a primary responsibility of the Recover Audit Contractor? - CORRECT ANSWER To
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - CORRECT ANSWER Comply with state
statutes concerning reporting credit balance
Insurance verification results in what? - CORRECT ANSWER The accurate identification of
the patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - CORRECT ANSWER CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for service? -
CORRECT ANSWER Registering 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? - CORRECT ANSWER HCPCS (Healthcare Common Procedure Coding
system)
What results from a denied claim? - CORRECT ANSWER The provider incurs rework and
appeal costs
Why does the financial counselor need pricing for services? - CORRECT ANSWER To
calculate the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - CORRECT ANSWER
Hospital-based mammography centers
