CRCR Final Exam Questions with Answers 2023 Already Graded A+

CRCR Final Exam Questions with Answers 2023 Already Graded A+. Are there rules for how a debt collector communicates with debtor? - ANSWER-Yes, eg no profane language, can't contact before 8 AM Is a newborn a scheduled or unscheduled pt - ANSWER-unscheduled What are the three types of pt access incoming to a HCO? - ANSWER-scheduled, unscheduled, recurring What is LCD - ANSWER-local coverage determinants, in absence of NCD, LCD dtermines whether -Care will pay for an item or service What is NCD - ANSWER-national coverage determinants:' nationwide determination of whether Medicare will pay for an item or service What % of pts should be pre-registered of all scheduled pts? - ANSWER-98% What is the code for HIPAA transaction set for HC eligibility and benefit responses - ANSWER-270 outgoing 271 response What are some payer data elements needed to process payment? - ANSWER-policy type, covered persons, mail address, cvr type (HMO), deductible What is an PPO - ANSWER-closest to indemnity plan, only preferred doctors in network get contracted prices What is an EPO - ANSWER-exclusive provider - limits services to only EP What is POS - ANSWER-point of service - if doc makes referral out, plan will pay, if pt requests out of service, pt pays What is CDHP - ANSWER-consumer directed healthplan, often with a HSA What is the % discount model in MCO - ANSWER-a % is discounted What is the DRG model in MCO - ANSWER-pymt based on predetermined fixed amount What is the APG model in MCO - ANSWER-divides outpt services into 600 procedural groups, each APG assigned a relative payment weight What is a case rate - ANSWER-pt's condition forms basis for payment for all services What is stop loss - ANSWER-plan covers 80% of charges to 100%, stop loss is plan covers 50% of charges $120k What are some managed care requirments? - ANSWER-pre-certification/preauthorization, referral (PCP-specialist), notification - providers notify payer pt is requesting service, days approval, continued stay review, site of service limitations (eg only colonosco as outpt) What are some concerns with EMTALA - ANSWER-sign posted on walls, no prior authorization, women in active labor must be assisted thru delivery, on-call MD must respond, no dumping, no transfer (unless cannot provide service), must do mental health screening, must keep pt log What is the referring MD - ANSWER-the one to referred to another MD What is the attending MD - ANSWER-One who wrote order for service What is the consulting MD - ANSWER-who consults with another MD How long does Medicare Part A cover inpat services? - ANSWER-60 days, then 30 coinsurance, then pt can use 60 days of lifetime reserve HICN - ANSWER-healthcare insurance claim # issued by SSN to those elgible for SSN How often does Medicare update co-insurance amounts for Part B? - ANSWER-yearly done by OPPS, outpt prospective pymnt system How are payments under -Care A paid? what system? - ANSWER-based on DRGs (more than more ACOs), reasonable cost at CAHs, rehab hosp, psych, ped, lg term care hosp