CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representat
(2023) - Materials from HFMA
1. - CPT already indicates 2-4 lesions
- CPT indicates multiple extremities: In what situation(s) should a provider NOT
use a modifier?
2. ALL OF THE ABOVE
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule-
: What are other names for Three-Day Payment Window?
3. Final coding, preparation and submission of claims, payment processing,
balance billing and resolution.: What happens during the post-service stage?
4. Best practices created by the Medical Debt Task Force: 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
5. Process Compliance: Which option is NOT a main HFMA Healthcare Dollars &
Sense revenue cycle initiative?
6. B. Health Plan Contracting: Which option is NOT a continuum of care provider?
A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility
7. When it is implied that a provider met all compliance standards before
submitting a claim: What is "implied certification"?
8. A. Established compliance standards and procedures.
C. Oversight of personnel by high-level personnel.
E. Reasonable methods to achieve compliance with standards, including mon-
itoring systems and hotlines.: 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.
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representat
(2023) - Materials from HFMA
E. Reasonable methods to achieve compliance with standards, including monitoring
systems and hotlines.
9. FEB 17, 2009: When was Health Information Technology for Economic and Clin-
ical Health (HITECH) Act signed into law?
10. 2013: When did HITECH Act become effective?
11. D. Standard Unique Employer Identifier: 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
12. The 2020 OIG Work Plan: 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
13. JUNE 25 2010: When was the Preservation of Access to Care for Medicare
Beneficiaries and Pension Relief Act signed into law?
14. 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): What is the Medicare DRG Three-Day
Payment Window?
15. No: Do Outpatient Non-Diagnostic Services qualify for separate payments if
provided with the Three-Day Payment Window?
16. 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.: What is modifier 59?
17. Code noted on the separate UB-04 OP claim, thus indicating the charge is
unrelated to the admission.: What is condition code 51?
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representat
(2023) - Materials from HFMA
18. Non-IPPS hospitals: What kind of hospitals are the following:
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's hospitals
for examples
19. 1. Advanced Beneficiary Notice of Noncoverage (ABN) for Part B services.
2. SNF ABN for Part A SNF services.
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A): What are the 3
types of medical necessity screenings and noncoverage notifications required in the
Medicare program?
20. Used to explain to a Medicare patient that the ordered test or services
probably WILL NOT be covered by the Medicare b/c the DX info provided by
the Dr. does NOT support the need for these services.
****May also be used for voluntary notifications, in place of the Notice of
Exclusion for Medicare Benefits (NEMB).: What is Medicare Part B ABN?
21. Hospital admissions spanning 2 midnights would be considered appropri-
ate for payment under the IPPS rule: What is the Two-Midnight Rule?
22. - W/C
- Black Lung Program services
- Veterans Affairs (VA) services
- Federal grant programs
- Public Health Service programs (i.e Medicaid): What are some MSP claims that
require additional review by the OIG to ensure compliance?
23. - Working Aged (commercial insurance is Primary)
- Accident or other liability (car/tort)
- End-Stage Renal Disease (ESRD)
- Disability: What are some cases where Medicare is the Secondary Payer?
24. Occurrence Code 05 - ACCIDENT / NO MEDICAL OR LIABILITY COVER-
AGE: What code must be provided on UB-04 when billing Medicare as Primary for
accident or injury?
25. 120 days
After 120 days, the provider has the option to CX liability claim and bill
Medicare. Medicare will process the claim under IPPS rules and recover
payment from the liability health plan.: How long should a provider wait to bill
Medicare after billing liability insurance(s)?
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representat
(2023) - Materials from HFMA
26. The CCI ensures that the most comprehensive groups of codes, rather than
the component parts, are billed.: What is the Correct Coding Initiative (CCI)?
27. The edits are built in the OP code editor, check for mutually exclusive code
pairs. The unit-of-service edits determine the max allowed # of services for
each Healthcare Common Procedure Coding System (HCPCS) code.: What is
a CCI edit?
28. Modifiers, Exception, and modifiers used for OPPS (Outpatient Prospec-
tive Payment System): What are examples of Coding initiatives?
29. Beneficiary Notices Initiative (BNI) details the 9 different types of financial
liability notices required under both the traditional Medicare and Medicare
Advantage programs.: What is the Beneficiary Notices Initiative (BNI)?
30. 2-digit #s OR alpha character that are appended to a CPT/HCPCS code
to provide more info about the service without changing its definition or
code.: What are modifiers?
31. Yes: Can a service or procedure have both professional and technical compo-
nent?
32. 2 Levels: How many levels of modifiers are used for OPPS (Outpatient Prospec-
tive Payment System)?
33. - Provides info about PERFORMANCE of a procedure
- Apply to CPT Codes
- Has 2 numbers (ex. Modifier 59): What are Level 1 Modifiers?
34. - Provides info about an ANATOMICAL or about a procedure/service
- Apply to HCPCS Codes
- Has 2 Letters (ex. Modifier XU, XE)
- Has 2 Letter + 1 Number: What are Level 2 Modifiers?
35. When Medicare is the Primary or Secondary payer (append to CPTs).: -
When does Level 2 Modifiers apply to Medicare?
36. Add specificity to the reporting of CPTs performed on eyelids, fingers, toes,
and arteries.: Why should providers use Level 2 anatomical modifiers?
37. 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: How should claim lines be coded if more than one Level 2 Modifiers need
to be reported for 1 single code?
(2023) - Materials from HFMA
1. - CPT already indicates 2-4 lesions
- CPT indicates multiple extremities: In what situation(s) should a provider NOT
use a modifier?
2. ALL OF THE ABOVE
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule-
: What are other names for Three-Day Payment Window?
3. Final coding, preparation and submission of claims, payment processing,
balance billing and resolution.: What happens during the post-service stage?
4. Best practices created by the Medical Debt Task Force: 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
5. Process Compliance: Which option is NOT a main HFMA Healthcare Dollars &
Sense revenue cycle initiative?
6. B. Health Plan Contracting: Which option is NOT a continuum of care provider?
A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility
7. When it is implied that a provider met all compliance standards before
submitting a claim: What is "implied certification"?
8. A. Established compliance standards and procedures.
C. Oversight of personnel by high-level personnel.
E. Reasonable methods to achieve compliance with standards, including mon-
itoring systems and hotlines.: 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.
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representat
(2023) - Materials from HFMA
E. Reasonable methods to achieve compliance with standards, including monitoring
systems and hotlines.
9. FEB 17, 2009: When was Health Information Technology for Economic and Clin-
ical Health (HITECH) Act signed into law?
10. 2013: When did HITECH Act become effective?
11. D. Standard Unique Employer Identifier: 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
12. The 2020 OIG Work Plan: 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
13. JUNE 25 2010: When was the Preservation of Access to Care for Medicare
Beneficiaries and Pension Relief Act signed into law?
14. 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): What is the Medicare DRG Three-Day
Payment Window?
15. No: Do Outpatient Non-Diagnostic Services qualify for separate payments if
provided with the Three-Day Payment Window?
16. 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.: What is modifier 59?
17. Code noted on the separate UB-04 OP claim, thus indicating the charge is
unrelated to the admission.: What is condition code 51?
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representat
(2023) - Materials from HFMA
18. Non-IPPS hospitals: What kind of hospitals are the following:
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's hospitals
for examples
19. 1. Advanced Beneficiary Notice of Noncoverage (ABN) for Part B services.
2. SNF ABN for Part A SNF services.
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A): What are the 3
types of medical necessity screenings and noncoverage notifications required in the
Medicare program?
20. Used to explain to a Medicare patient that the ordered test or services
probably WILL NOT be covered by the Medicare b/c the DX info provided by
the Dr. does NOT support the need for these services.
****May also be used for voluntary notifications, in place of the Notice of
Exclusion for Medicare Benefits (NEMB).: What is Medicare Part B ABN?
21. Hospital admissions spanning 2 midnights would be considered appropri-
ate for payment under the IPPS rule: What is the Two-Midnight Rule?
22. - W/C
- Black Lung Program services
- Veterans Affairs (VA) services
- Federal grant programs
- Public Health Service programs (i.e Medicaid): What are some MSP claims that
require additional review by the OIG to ensure compliance?
23. - Working Aged (commercial insurance is Primary)
- Accident or other liability (car/tort)
- End-Stage Renal Disease (ESRD)
- Disability: What are some cases where Medicare is the Secondary Payer?
24. Occurrence Code 05 - ACCIDENT / NO MEDICAL OR LIABILITY COVER-
AGE: What code must be provided on UB-04 when billing Medicare as Primary for
accident or injury?
25. 120 days
After 120 days, the provider has the option to CX liability claim and bill
Medicare. Medicare will process the claim under IPPS rules and recover
payment from the liability health plan.: How long should a provider wait to bill
Medicare after billing liability insurance(s)?
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representat
(2023) - Materials from HFMA
26. The CCI ensures that the most comprehensive groups of codes, rather than
the component parts, are billed.: What is the Correct Coding Initiative (CCI)?
27. The edits are built in the OP code editor, check for mutually exclusive code
pairs. The unit-of-service edits determine the max allowed # of services for
each Healthcare Common Procedure Coding System (HCPCS) code.: What is
a CCI edit?
28. Modifiers, Exception, and modifiers used for OPPS (Outpatient Prospec-
tive Payment System): What are examples of Coding initiatives?
29. Beneficiary Notices Initiative (BNI) details the 9 different types of financial
liability notices required under both the traditional Medicare and Medicare
Advantage programs.: What is the Beneficiary Notices Initiative (BNI)?
30. 2-digit #s OR alpha character that are appended to a CPT/HCPCS code
to provide more info about the service without changing its definition or
code.: What are modifiers?
31. Yes: Can a service or procedure have both professional and technical compo-
nent?
32. 2 Levels: How many levels of modifiers are used for OPPS (Outpatient Prospec-
tive Payment System)?
33. - Provides info about PERFORMANCE of a procedure
- Apply to CPT Codes
- Has 2 numbers (ex. Modifier 59): What are Level 1 Modifiers?
34. - Provides info about an ANATOMICAL or about a procedure/service
- Apply to HCPCS Codes
- Has 2 Letters (ex. Modifier XU, XE)
- Has 2 Letter + 1 Number: What are Level 2 Modifiers?
35. When Medicare is the Primary or Secondary payer (append to CPTs).: -
When does Level 2 Modifiers apply to Medicare?
36. Add specificity to the reporting of CPTs performed on eyelids, fingers, toes,
and arteries.: Why should providers use Level 2 anatomical modifiers?
37. 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: How should claim lines be coded if more than one Level 2 Modifiers need
to be reported for 1 single code?
