CRCR LATEST EXAMS TEST PAPER QUESTIONS
AND ANSWERS SURE A+
✔✔What are non-emergency patients who come for service without prior notification to
the provider called? - ✔✔Unscheduled patients
✔✔If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse? - ✔✔Neither enrolled not entitled to
benefits
✔✔Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
Lending Act, establishes what? - ✔✔Disclosure rules for consumer credit sales and
consumer loans
✔✔What is a principal diagnosis? - ✔✔Primary reason for the patient's admission
✔✔Collecting patient liability dollars after service leads to what? - ✔✔Lower accounts
receivable levels
✔✔What is the daily out-of-pocket amount for each lifetime reserve day used? - ✔✔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? - ✔✔Inpatient care
✔✔What code indicates the disposition of the patient at the conclusion of service? -
✔✔Patient discharge status code
✔✔What are hospitals required to do for Medicare credit balance accounts? - ✔✔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? - ✔✔Patient
✔✔Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - ✔✔A valid CPT or HCPCS code
✔✔With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - ✔✔Access their information and perform
functions on-line
✔✔What date is required on all CMS 1500 claim forms? - ✔✔onset date of current
illness
✔✔What does scheduling allow provider staff to do - ✔✔Review appropriateness of the
service request
✔✔What code is used to report the provider's most common semiprivate room rate? -
✔✔Condition code
✔✔Regulations and requirements for coding accountable care organizations, which
allows providers to begin creating these organizations, were finalized in: - ✔✔2012
✔✔What is a primary responsibility of the Recover Audit Contractor? - ✔✔To correctly
identify proper payments for Medicare Part A & B claims
✔✔How must providers handle credit balances? - ✔✔Comply with state statutes
concerning reporting credit balance
✔✔Insurance verification results in what? - ✔✔The accurate identification of the
patient's eligibility and benefits
✔✔What form is used to bill Medicare for rural health clinics? - ✔✔CMS 1500
,✔✔What activities are completed when a scheduled pre-registered patient arrives for
service? - ✔✔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? - ✔✔HCPCS (Healthcare Common Procedure
Coding system)
✔✔What results from a denied claim? - ✔✔The provider incurs rework and appeal costs
✔✔Why does the financial counselor need pricing for services? - ✔✔To calculate the
patient's financial responsibility
✔✔What type of provider bills third-party payers using CMS 1500 form - ✔✔Hospital-
based mammography centers
✔✔How are disputes with nongovernmental payers resolved? - ✔✔Appeal conditions
specified in the individual payer's contract
✔✔The important message from Medicare provides beneficiaries with information
concerning what? - ✔✔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? - ✔✔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? - ✔✔Submit interim bills to the Medicare
program.
✔✔90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for
liability claims after what happens? - ✔✔120 days passes, but the claim then be
withdrawn from the liability carrier
✔✔What data are required to establish a new MPI entry? - ✔✔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?
- ✔✔Determine the correct payer and notify the incorrect payer of the processing error
✔✔What do EMTALA regulations require on-call physicians to do? - ✔✔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? - ✔✔They must be balanced
✔✔What will cause a CMS 1500 claim to be rejected? - ✔✔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? - ✔✔The cost of the test
✔✔how are HCPCS codes and the appropriate modifiers used? - ✔✔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? - ✔✔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? - ✔✔Patient arrival
processing is expedited, reducing wait times and delays
✔✔What is a characteristic of a managed contracting methodology? - ✔✔Prospectively
set rates for inpatient and outpatient services
✔✔What do the MSP disability rules require? - ✔✔That the patient's spouse's employer
must have less than 20 employees in the group health plan
✔✔what organization originated the concept of insuring prepaid health care services? -
✔✔Blue Cross and blue Shield
✔✔What is true about screening a beneficiary for possible MSP situations? - ✔✔It is
acceptable to complete the screening form after the patient has completed the
registration process and been sent to the service department
✔✔If the patient cannot agree to payment arrangements, what is the next option? -
✔✔Warn the patient that unpaid accounts are placed with collection agencies for further
processing
✔✔In services lines such as cardiology or orthopedics, what does the case-rate
payment methodology allow providers to do? - ✔✔Receive a fixed for specific
procedures
✔✔What will comprehensive patient access processing accomplish? - ✔✔Minimize the
need for follow-up on insurance accounts
AND ANSWERS SURE A+
✔✔What are non-emergency patients who come for service without prior notification to
the provider called? - ✔✔Unscheduled patients
✔✔If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse? - ✔✔Neither enrolled not entitled to
benefits
✔✔Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
Lending Act, establishes what? - ✔✔Disclosure rules for consumer credit sales and
consumer loans
✔✔What is a principal diagnosis? - ✔✔Primary reason for the patient's admission
✔✔Collecting patient liability dollars after service leads to what? - ✔✔Lower accounts
receivable levels
✔✔What is the daily out-of-pocket amount for each lifetime reserve day used? - ✔✔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? - ✔✔Inpatient care
✔✔What code indicates the disposition of the patient at the conclusion of service? -
✔✔Patient discharge status code
✔✔What are hospitals required to do for Medicare credit balance accounts? - ✔✔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? - ✔✔Patient
✔✔Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - ✔✔A valid CPT or HCPCS code
✔✔With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - ✔✔Access their information and perform
functions on-line
✔✔What date is required on all CMS 1500 claim forms? - ✔✔onset date of current
illness
✔✔What does scheduling allow provider staff to do - ✔✔Review appropriateness of the
service request
✔✔What code is used to report the provider's most common semiprivate room rate? -
✔✔Condition code
✔✔Regulations and requirements for coding accountable care organizations, which
allows providers to begin creating these organizations, were finalized in: - ✔✔2012
✔✔What is a primary responsibility of the Recover Audit Contractor? - ✔✔To correctly
identify proper payments for Medicare Part A & B claims
✔✔How must providers handle credit balances? - ✔✔Comply with state statutes
concerning reporting credit balance
✔✔Insurance verification results in what? - ✔✔The accurate identification of the
patient's eligibility and benefits
✔✔What form is used to bill Medicare for rural health clinics? - ✔✔CMS 1500
,✔✔What activities are completed when a scheduled pre-registered patient arrives for
service? - ✔✔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? - ✔✔HCPCS (Healthcare Common Procedure
Coding system)
✔✔What results from a denied claim? - ✔✔The provider incurs rework and appeal costs
✔✔Why does the financial counselor need pricing for services? - ✔✔To calculate the
patient's financial responsibility
✔✔What type of provider bills third-party payers using CMS 1500 form - ✔✔Hospital-
based mammography centers
✔✔How are disputes with nongovernmental payers resolved? - ✔✔Appeal conditions
specified in the individual payer's contract
✔✔The important message from Medicare provides beneficiaries with information
concerning what? - ✔✔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? - ✔✔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? - ✔✔Submit interim bills to the Medicare
program.
✔✔90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for
liability claims after what happens? - ✔✔120 days passes, but the claim then be
withdrawn from the liability carrier
✔✔What data are required to establish a new MPI entry? - ✔✔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?
- ✔✔Determine the correct payer and notify the incorrect payer of the processing error
✔✔What do EMTALA regulations require on-call physicians to do? - ✔✔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? - ✔✔They must be balanced
✔✔What will cause a CMS 1500 claim to be rejected? - ✔✔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? - ✔✔The cost of the test
✔✔how are HCPCS codes and the appropriate modifiers used? - ✔✔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? - ✔✔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? - ✔✔Patient arrival
processing is expedited, reducing wait times and delays
✔✔What is a characteristic of a managed contracting methodology? - ✔✔Prospectively
set rates for inpatient and outpatient services
✔✔What do the MSP disability rules require? - ✔✔That the patient's spouse's employer
must have less than 20 employees in the group health plan
✔✔what organization originated the concept of insuring prepaid health care services? -
✔✔Blue Cross and blue Shield
✔✔What is true about screening a beneficiary for possible MSP situations? - ✔✔It is
acceptable to complete the screening form after the patient has completed the
registration process and been sent to the service department
✔✔If the patient cannot agree to payment arrangements, what is the next option? -
✔✔Warn the patient that unpaid accounts are placed with collection agencies for further
processing
✔✔In services lines such as cardiology or orthopedics, what does the case-rate
payment methodology allow providers to do? - ✔✔Receive a fixed for specific
procedures
✔✔What will comprehensive patient access processing accomplish? - ✔✔Minimize the
need for follow-up on insurance accounts
