CRCR Exam Prep, Multiple Choice, Certified Revenue
Cycle Representative, Materials from HFMA UPDATED
ACTUAL QUESTIONS WITH CORRECT ANSWERS
Question 1.
In what situation(s) should a provider NOT use a modifier?
ANSWER
- CPT already indicates 2-4 lesions
- CPT indicates multiple extremities
Question 2.
What are other names for Three-Day Payment Window?
ANSWER
ALL OF THE ABOVE
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
Question 3.
What happens during the post-service stage?
ANSWER
Final coding, preparation and submission of claims, payment processing, balance billing and
resolution.
Question 4.
What are the below tasks part of?
- Educate patients
- Coordinate to avoid duplicate patient contacts
- Be consistent in key aspects of account resolution
- Follow best practices for communication
ANSWER
Best practices created by the Medical Debt Task Force
,Question 5.
Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle initiative?
ANSWER
Process Compliance
Question 6.
Which option is NOT a continuum of care provider?
A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility
ANSWER
B. Health Plan Contracting
Question 7.
What is "implied certification"?
ANSWER
When it is implied that a provider met all compliance standards before submitting a claim
Question 8.
Which of the following are essential elements of an effective compliance program?
A. Established compliance standards and procedures.
B. Designation of a compliance officer employed within the Billing Department.
C. Oversight of personnel by high-level personnel.
D. Automatic dismissal of any employee excluded from participation in a federal healthcare program.
E. Reasonable methods to achieve compliance with standards, including monitoring systems and
hotlines.
ANSWER
A. Established compliance standards and procedures.
C. Oversight of personnel by high-level personnel.
E. Reasonable methods to achieve compliance with standards, including monitoring systems
and hotlines.
,Question 9.
When was Health Information Technology for Economic and Clinical Health (HITECH) Act signed into
law?
ANSWER
FEB 17, 2009
Question 10.
When did HITECH Act become effective?
ANSWER
2013
Question 11.
Annually, the OIG publishes a work plan of compliance issues and objectives that will be focused on
throughout the following year. Identify which option is NOT a work plan task mentioned in this course.
A. Payments to Physicians for Co-Surgery Procedures
B. Denials and Appeals in Medicare Part D C. Medicare Hospital Payments for Claims Involving the
Acute- and Post-Acute-Care Transfer Policies
D. Standard Unique Employer Identifier
ANSWER
D. Standard Unique Employer Identifier
Question 12.
What Plan are the tasks below a part of?
- Medicare Payments Made Outside of the Hospice Benefit
- Denials and Appeals in Medicare Part C and Part D
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits
ANSWER
The 2020 OIG Work Plan
, Question 13.
When was the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act signed
into law?
ANSWER
JUNE 25 2010
Question 14.
What is the Medicare DRG Three-Day Payment Window?
ANSWER
All Diagnostic services provided to a Medicare patient by a hospital on the Date of the patient's
Inpatient admission or during the 3 calendar days (or in the case of a non-IPPS hospital: 1
calendar day) immediately BEFORE the Date of Admission are REQUIRED to be included on the
bill for the IP stay (unless there is no Part A coverage)
Question 15.
Do Outpatient Non-Diagnostic Services qualify for separate payments if provided with the Three-Day
Payment Window?
ANSWER
No
Question 16.
What is modifier 59?
ANSWER
Used to identify CPTs OTHER THAN E&M services, NOT normally reported together, but are
appropriate under the circumstances.
Documentation must support a different session, different procedure or surgery, different site
or organ system, separate.
Question 17.
What is condition code 51?
ANSWER
Code noted on the separate UB-04 OP claim, thus indicating the charge is unrelated to the
admission.
Cycle Representative, Materials from HFMA UPDATED
ACTUAL QUESTIONS WITH CORRECT ANSWERS
Question 1.
In what situation(s) should a provider NOT use a modifier?
ANSWER
- CPT already indicates 2-4 lesions
- CPT indicates multiple extremities
Question 2.
What are other names for Three-Day Payment Window?
ANSWER
ALL OF THE ABOVE
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
Question 3.
What happens during the post-service stage?
ANSWER
Final coding, preparation and submission of claims, payment processing, balance billing and
resolution.
Question 4.
What are the below tasks part of?
- Educate patients
- Coordinate to avoid duplicate patient contacts
- Be consistent in key aspects of account resolution
- Follow best practices for communication
ANSWER
Best practices created by the Medical Debt Task Force
,Question 5.
Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle initiative?
ANSWER
Process Compliance
Question 6.
Which option is NOT a continuum of care provider?
A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility
ANSWER
B. Health Plan Contracting
Question 7.
What is "implied certification"?
ANSWER
When it is implied that a provider met all compliance standards before submitting a claim
Question 8.
Which of the following are essential elements of an effective compliance program?
A. Established compliance standards and procedures.
B. Designation of a compliance officer employed within the Billing Department.
C. Oversight of personnel by high-level personnel.
D. Automatic dismissal of any employee excluded from participation in a federal healthcare program.
E. Reasonable methods to achieve compliance with standards, including monitoring systems and
hotlines.
ANSWER
A. Established compliance standards and procedures.
C. Oversight of personnel by high-level personnel.
E. Reasonable methods to achieve compliance with standards, including monitoring systems
and hotlines.
,Question 9.
When was Health Information Technology for Economic and Clinical Health (HITECH) Act signed into
law?
ANSWER
FEB 17, 2009
Question 10.
When did HITECH Act become effective?
ANSWER
2013
Question 11.
Annually, the OIG publishes a work plan of compliance issues and objectives that will be focused on
throughout the following year. Identify which option is NOT a work plan task mentioned in this course.
A. Payments to Physicians for Co-Surgery Procedures
B. Denials and Appeals in Medicare Part D C. Medicare Hospital Payments for Claims Involving the
Acute- and Post-Acute-Care Transfer Policies
D. Standard Unique Employer Identifier
ANSWER
D. Standard Unique Employer Identifier
Question 12.
What Plan are the tasks below a part of?
- Medicare Payments Made Outside of the Hospice Benefit
- Denials and Appeals in Medicare Part C and Part D
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits
ANSWER
The 2020 OIG Work Plan
, Question 13.
When was the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act signed
into law?
ANSWER
JUNE 25 2010
Question 14.
What is the Medicare DRG Three-Day Payment Window?
ANSWER
All Diagnostic services provided to a Medicare patient by a hospital on the Date of the patient's
Inpatient admission or during the 3 calendar days (or in the case of a non-IPPS hospital: 1
calendar day) immediately BEFORE the Date of Admission are REQUIRED to be included on the
bill for the IP stay (unless there is no Part A coverage)
Question 15.
Do Outpatient Non-Diagnostic Services qualify for separate payments if provided with the Three-Day
Payment Window?
ANSWER
No
Question 16.
What is modifier 59?
ANSWER
Used to identify CPTs OTHER THAN E&M services, NOT normally reported together, but are
appropriate under the circumstances.
Documentation must support a different session, different procedure or surgery, different site
or organ system, separate.
Question 17.
What is condition code 51?
ANSWER
Code noted on the separate UB-04 OP claim, thus indicating the charge is unrelated to the
admission.
