CRCR EXAM PREP, MULTIPLE CHOICE, CERTIFIED
REVENUE CYCLE REPRESENTATIVE, MATERIALS FROM
HFMA EXPECTED QUESTIONS WITH VERIFIED
ANSWERS
Question 1.
How are HBP (Hospital-Based Physician) claims billed?
ANSWER
FORMAT: CMS 1500/837-P
If physicians are paid salary/percentage methods, hospital bill patients.
Fee-For-Service (FFS) HBPs bill their patients directly
Question 2.
When do R&B (Room and Bed/Board) charges get posted?
ANSWER
From the midnight census, based on the room and accommodation/LOC associated w/ the
room that the patient occupies at midnight
Question 3.
What happens if all benefits are exhausted for Medicare Part A?
ANSWER
If the pt has Medicare Part B, part B can be billed for svcs covered in the OP environment.
Question 4.
What are Net Days in A/R?
ANSWER
How fast receivables are collected
Other name: A/R days
,Question 5.
What are the Core Elements of a Chargemaster?
ANSWER
- CDM # (assigned to a given line item)
- Department # (revenue generating area) - Billing/Charge Description (appears on claim)
- Charge Amount (assigned to chargemaster line item)
- CPT/HCPCS
- Modifiers
- Revenue codes
- General Ledger (GL) Number
Question 6.
A mother sees a charge on her hospital bill for a circumcision for a newborn girl. This is an example of
falsifying medical records to boost reimbursement. True or False
ANSWER
False.
Question 7.
What are the different types of liens?
ANSWER
- Agreement (Consensus)
- Judicial Process
- Statute
Question 8.
How should claim lines be coded if more than one Level 2 Modifiers need to be reported for 1 single
code?
ANSWER
HCPCS code need to be repeated on another line with the appropriate Level 2 Modifier.
Ex. Code 26010 (drainage of finger abscess; simple) done on the left thumb and second finger
would be code:
26010FA
26010F1
,Question 9.
What are the 5 major groups in KPIs?
ANSWER
1. Patient Access
2. Pre-Billing
3. Claims
4. Account Resolution
5. Financial Management
Question 10.
What is the Correct Coding Initiative (CCI)?
ANSWER
The CCI ensures that the most comprehensive groups of codes, rather than the component
parts, are billed.
Question 11.
Which option is a federally-aided, state-operated program to provide health and long-term care
coverage?
A. Medicare
B. Medicaid
C. Self-Insured Plans
D. Liability
ANSWER
B. Medicaid
Question 12.
What is ICD-10-CM?
ANSWER
Diagnostic-classification system consisting of >68,000 DX codes
- Principle
- Secondary
- Presenting
- Complications
- Co-mobidifites
, Question 13.
Which of the following statements represent common reasons for inpatient claim denials:
A. Failure to obtain a required pre-authorizations; failure to complete a continued stay authorization
and services provided which were not medical necessary.
B. Providing an inappropriate level of care as supported by the documentation provided with the claim
C. An omitted HCPCS code
D. The APC payment was incorrectly calculated by the provider
ANSWER
A. Failure to obtain a required pre-authorizations; failure to complete a continued stay
authorization and services provided which were not medical necessary.
Question 14.
What is Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)?
ANSWER
Survey asks recently discharged adult patients 32 QUESTIONS about aspects of their hospital
experience that they're uniquely suited to address.
Contains:
- 21 items = asks "how often" or whether patients experienced a critical aspect of hospital care.
- 4 items = direct patients to relevant questions
- 5 items = adjust for the mix of patients across hospitals
- 2 items = support Congressionally-mandated reports.
Question 15.
What is a Stop-Loss Provision?
ANSWER
Provision found in health plan contracts that provides protection for medical expenses that
exceed certain levels
Question 16.
Can an Observation status be used for pts waiting for nursing home placement or as a convenience of
the pt, family, physician or hospital?
ANSWER
NO
REVENUE CYCLE REPRESENTATIVE, MATERIALS FROM
HFMA EXPECTED QUESTIONS WITH VERIFIED
ANSWERS
Question 1.
How are HBP (Hospital-Based Physician) claims billed?
ANSWER
FORMAT: CMS 1500/837-P
If physicians are paid salary/percentage methods, hospital bill patients.
Fee-For-Service (FFS) HBPs bill their patients directly
Question 2.
When do R&B (Room and Bed/Board) charges get posted?
ANSWER
From the midnight census, based on the room and accommodation/LOC associated w/ the
room that the patient occupies at midnight
Question 3.
What happens if all benefits are exhausted for Medicare Part A?
ANSWER
If the pt has Medicare Part B, part B can be billed for svcs covered in the OP environment.
Question 4.
What are Net Days in A/R?
ANSWER
How fast receivables are collected
Other name: A/R days
,Question 5.
What are the Core Elements of a Chargemaster?
ANSWER
- CDM # (assigned to a given line item)
- Department # (revenue generating area) - Billing/Charge Description (appears on claim)
- Charge Amount (assigned to chargemaster line item)
- CPT/HCPCS
- Modifiers
- Revenue codes
- General Ledger (GL) Number
Question 6.
A mother sees a charge on her hospital bill for a circumcision for a newborn girl. This is an example of
falsifying medical records to boost reimbursement. True or False
ANSWER
False.
Question 7.
What are the different types of liens?
ANSWER
- Agreement (Consensus)
- Judicial Process
- Statute
Question 8.
How should claim lines be coded if more than one Level 2 Modifiers need to be reported for 1 single
code?
ANSWER
HCPCS code need to be repeated on another line with the appropriate Level 2 Modifier.
Ex. Code 26010 (drainage of finger abscess; simple) done on the left thumb and second finger
would be code:
26010FA
26010F1
,Question 9.
What are the 5 major groups in KPIs?
ANSWER
1. Patient Access
2. Pre-Billing
3. Claims
4. Account Resolution
5. Financial Management
Question 10.
What is the Correct Coding Initiative (CCI)?
ANSWER
The CCI ensures that the most comprehensive groups of codes, rather than the component
parts, are billed.
Question 11.
Which option is a federally-aided, state-operated program to provide health and long-term care
coverage?
A. Medicare
B. Medicaid
C. Self-Insured Plans
D. Liability
ANSWER
B. Medicaid
Question 12.
What is ICD-10-CM?
ANSWER
Diagnostic-classification system consisting of >68,000 DX codes
- Principle
- Secondary
- Presenting
- Complications
- Co-mobidifites
, Question 13.
Which of the following statements represent common reasons for inpatient claim denials:
A. Failure to obtain a required pre-authorizations; failure to complete a continued stay authorization
and services provided which were not medical necessary.
B. Providing an inappropriate level of care as supported by the documentation provided with the claim
C. An omitted HCPCS code
D. The APC payment was incorrectly calculated by the provider
ANSWER
A. Failure to obtain a required pre-authorizations; failure to complete a continued stay
authorization and services provided which were not medical necessary.
Question 14.
What is Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)?
ANSWER
Survey asks recently discharged adult patients 32 QUESTIONS about aspects of their hospital
experience that they're uniquely suited to address.
Contains:
- 21 items = asks "how often" or whether patients experienced a critical aspect of hospital care.
- 4 items = direct patients to relevant questions
- 5 items = adjust for the mix of patients across hospitals
- 2 items = support Congressionally-mandated reports.
Question 15.
What is a Stop-Loss Provision?
ANSWER
Provision found in health plan contracts that provides protection for medical expenses that
exceed certain levels
Question 16.
Can an Observation status be used for pts waiting for nursing home placement or as a convenience of
the pt, family, physician or hospital?
ANSWER
NO
