CRCR EXAM MULTIPLE CHOICE, CRCR EXAM PREP,
CERTIFIED REVENUE CYCLE REPRESENTATIVE - CRCR
What are collection agency fees based on? - Precise Answer ✔✔A percentage of dollars
collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what
other rule? - Precise Answer ✔✔Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated between
the payer and some or all providers? - Precise Answer ✔✔Case rates
What customer service improvements might improve the patient accounts department? -
Precise Answer ✔✔Holding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - Precise 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? - Precise Answer ✔✔Bad debt adjustment
What is the initial hospice benefit? - Precise Answer ✔✔Two 90-day periods and an unlimited
number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - Precise 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? - Precise
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 - Precise Answer ✔✔They are not being processed in a timely manner
What is an advantage of a preregistration program? - Precise Answer ✔✔It reduces processing
times at the time of service
What are the two statutory exclusions from hospice coverage? - Precise Answer ✔✔Medically
unnecessary services and custodial care
What core financial activities are resolved within patient access? - Precise Answer
✔✔Scheduling, insurance verification, discharge processing, and payment of point-of-service
receipts
What statement applies to the scheduled outpatient? - Precise Answer ✔✔The services do not
involve an overnight stay
,How is a mis-posted contractual allowance resolved? - Precise 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? - Precise
Answer ✔✔Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - Precise 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$? - Precise Answer
✔✔When the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - Precise 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? - Precise 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? - Precise Answer ✔✔Disclosure rules for consumer credit sales and consumer
loans
What is a principal diagnosis? - Precise Answer ✔✔Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - Precise Answer ✔✔Lower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - Precise 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? - Precise Answer ✔✔Inpatient care
What code indicates the disposition of the patient at the conclusion of service? - Precise Answer
✔✔Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - Precise 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? - Precise 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: - Precise 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? - Precise Answer ✔✔Access their information and perform functions
on-line
What date is required on all CMS 1500 claim forms? - Precise Answer ✔✔onset date of current
illness
What does scheduling allow provider staff to do - Precise Answer ✔✔Review appropriateness of
the service request
What code is used to report the provider's most common semiprivate room rate? - Precise
Answer ✔✔Condition code
Regulations and requirements for coding accountable care organizations, which allows providers
to begin creating these organizations, were finalized in: - Precise Answer ✔✔2012
What is a primary responsibility of the Recover Audit Contractor? - Precise Answer ✔✔To
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - Precise Answer ✔✔Comply with state statutes
concerning reporting credit balance
Insurance verification results in what? - Precise Answer ✔✔The accurate identification of the
patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - Precise Answer ✔✔CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for service? -
Precise 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? - Precise Answer ✔✔HCPCS (Healthcare Common Procedure Coding
system)
What results from a denied claim? - Precise Answer ✔✔The provider incurs rework and appeal
costs
Why does the financial counselor need pricing for services? - Precise Answer ✔✔To calculate
the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - Precise Answer
✔✔Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? - Precise Answer ✔✔Appeal
conditions specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information concerning what?
, - Precise Answer ✔✔Right to appeal a discharge decision if the patient disagrees with the
services
Why do managed care plans have agreements with hospitals, physicians, and other healthcare
providers to offer a range of services to plan members? - Precise Answer ✔✔To improve access
to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days, what
is the SNF permitted to do? - Precise Answer ✔✔Submit interim bills to the Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims
after what happens? - Precise Answer ✔✔120 days passes, but the claim then be withdrawn
from the liability carrier
What data are required to establish a new MPI entry? - Precise Answer ✔✔The patient's full
legal name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as primary? - Precise
Answer ✔✔Determine the correct payer and notify the incorrect payer of the processing error
What do EMTALA regulations require on-call physicians to do? - Precise Answer ✔✔Personally
appear in the emergency department and attend to the patient within a reasonable time
At the end of each shift, what must happen to cash, checks, and credit card transaction
documents? - Precise Answer ✔✔They must be balanced
What will cause a CMS 1500 claim to be rejected? - Precise Answer ✔✔The provider is billing
with a future date of service
Under Medicare regulations, which of the following is not included on a valid physician's order
for services? - Precise Answer ✔✔The cost of the test
how are HCPCS codes and the appropriate modifiers used? - Precise Answer ✔✔To report the
level 1, 2, or 3 code that correctly describes the service provided
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window
rule? - Precise Answer ✔✔Diagnostic and clinically-related non-diagnostic charges provided on
the Tuesday, Wednesday, Thursday, and Friday before admission
What is a benefit of pre-registering patient's for service? - Precise Answer ✔✔Patient arrival
processing is expedited, reducing wait times and delays
What is a characteristic of a managed contracting methodology? - Precise Answer
✔✔Prospectively set rates for inpatient and outpatient services
What do the MSP disability rules require? - Precise Answer ✔✔That the patient's spouse's
employer must have less than 20 employees in the group health plan
CERTIFIED REVENUE CYCLE REPRESENTATIVE - CRCR
What are collection agency fees based on? - Precise Answer ✔✔A percentage of dollars
collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what
other rule? - Precise Answer ✔✔Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated between
the payer and some or all providers? - Precise Answer ✔✔Case rates
What customer service improvements might improve the patient accounts department? -
Precise Answer ✔✔Holding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - Precise 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? - Precise Answer ✔✔Bad debt adjustment
What is the initial hospice benefit? - Precise Answer ✔✔Two 90-day periods and an unlimited
number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - Precise 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? - Precise
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 - Precise Answer ✔✔They are not being processed in a timely manner
What is an advantage of a preregistration program? - Precise Answer ✔✔It reduces processing
times at the time of service
What are the two statutory exclusions from hospice coverage? - Precise Answer ✔✔Medically
unnecessary services and custodial care
What core financial activities are resolved within patient access? - Precise Answer
✔✔Scheduling, insurance verification, discharge processing, and payment of point-of-service
receipts
What statement applies to the scheduled outpatient? - Precise Answer ✔✔The services do not
involve an overnight stay
,How is a mis-posted contractual allowance resolved? - Precise 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? - Precise
Answer ✔✔Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - Precise 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$? - Precise Answer
✔✔When the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - Precise 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? - Precise 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? - Precise Answer ✔✔Disclosure rules for consumer credit sales and consumer
loans
What is a principal diagnosis? - Precise Answer ✔✔Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - Precise Answer ✔✔Lower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - Precise 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? - Precise Answer ✔✔Inpatient care
What code indicates the disposition of the patient at the conclusion of service? - Precise Answer
✔✔Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - Precise 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? - Precise 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: - Precise 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? - Precise Answer ✔✔Access their information and perform functions
on-line
What date is required on all CMS 1500 claim forms? - Precise Answer ✔✔onset date of current
illness
What does scheduling allow provider staff to do - Precise Answer ✔✔Review appropriateness of
the service request
What code is used to report the provider's most common semiprivate room rate? - Precise
Answer ✔✔Condition code
Regulations and requirements for coding accountable care organizations, which allows providers
to begin creating these organizations, were finalized in: - Precise Answer ✔✔2012
What is a primary responsibility of the Recover Audit Contractor? - Precise Answer ✔✔To
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - Precise Answer ✔✔Comply with state statutes
concerning reporting credit balance
Insurance verification results in what? - Precise Answer ✔✔The accurate identification of the
patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - Precise Answer ✔✔CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for service? -
Precise 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? - Precise Answer ✔✔HCPCS (Healthcare Common Procedure Coding
system)
What results from a denied claim? - Precise Answer ✔✔The provider incurs rework and appeal
costs
Why does the financial counselor need pricing for services? - Precise Answer ✔✔To calculate
the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - Precise Answer
✔✔Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? - Precise Answer ✔✔Appeal
conditions specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information concerning what?
, - Precise Answer ✔✔Right to appeal a discharge decision if the patient disagrees with the
services
Why do managed care plans have agreements with hospitals, physicians, and other healthcare
providers to offer a range of services to plan members? - Precise Answer ✔✔To improve access
to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days, what
is the SNF permitted to do? - Precise Answer ✔✔Submit interim bills to the Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims
after what happens? - Precise Answer ✔✔120 days passes, but the claim then be withdrawn
from the liability carrier
What data are required to establish a new MPI entry? - Precise Answer ✔✔The patient's full
legal name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as primary? - Precise
Answer ✔✔Determine the correct payer and notify the incorrect payer of the processing error
What do EMTALA regulations require on-call physicians to do? - Precise Answer ✔✔Personally
appear in the emergency department and attend to the patient within a reasonable time
At the end of each shift, what must happen to cash, checks, and credit card transaction
documents? - Precise Answer ✔✔They must be balanced
What will cause a CMS 1500 claim to be rejected? - Precise Answer ✔✔The provider is billing
with a future date of service
Under Medicare regulations, which of the following is not included on a valid physician's order
for services? - Precise Answer ✔✔The cost of the test
how are HCPCS codes and the appropriate modifiers used? - Precise Answer ✔✔To report the
level 1, 2, or 3 code that correctly describes the service provided
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window
rule? - Precise Answer ✔✔Diagnostic and clinically-related non-diagnostic charges provided on
the Tuesday, Wednesday, Thursday, and Friday before admission
What is a benefit of pre-registering patient's for service? - Precise Answer ✔✔Patient arrival
processing is expedited, reducing wait times and delays
What is a characteristic of a managed contracting methodology? - Precise Answer
✔✔Prospectively set rates for inpatient and outpatient services
What do the MSP disability rules require? - Precise Answer ✔✔That the patient's spouse's
employer must have less than 20 employees in the group health plan
