Certified Revenue Cycle Representative
- CRCR (2021) Questions and Answers
1. A 68 year old patient, a Medicare beneficiary, was in a car accident. A medical insurance
claim was filed with the auto insurance carrier. Six months later this claim remains
unpaid. How can the provider pursue payment from Medicare? - ANS-The provider
must first bill the auto insurer; however, after a period of 120 days, if the claim
remains unpaid, the provider may cancel the liability claim and bill Medicare.
2. ABC Hospital has experienced a 16% increase in new patients over the past 6 months.
The hospital is understaffed in its insurance claim and payment processing department
and cannot handle this increase in work load. It is considering hiring an outsourcing
vendor to assist. What are the steps that the hospital needs to take to establish and
ensure a successful vendor relationship? - ANS-**A. Distribute a RFP to solicit vendor
capabilities, evaluate vendor's expertise to provide outsourcing services, visit
vendor locations, perform vendor reference checks, talk with vendor clients,
interview vendor employees to assess experience level.
B. Evaluate vendor's expertise in providing outsourcing services, visit vendor locations,
interview vendor employees to assess expertise level.
3. Accurate identification of the patient is the first step in the scheduling process. Identifiers
used in various combination to achieve accurate patient identification include? -
ANS-Full legal name, date of birth, sex and social security number
4. Agency fees are: - ANS-A. Paid by patients.
**B. The cost to the provider for collection agency monies offset by the return on
baddebt accounts.
C. Only reported annually to the provider.
D. Waived for accounts aged greater than one year from date of service.
5. 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. - ANS-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
6. Based on what you have just read, which activity is not considered when initiating
self-pay follow-up and account resolution activities? - ANS-A. Poverty Guidelines
B. Financial Profile
C. Presumptive Financial Assistance Determination
**D. Patient Open Balance Billing
, 7. Case management and discharge planning services are a post-service activty -
ANS-True
**False
8. Case managers are involved from admission with the discharge planning process. The
purpose of discharge planning is: - ANS-To estimate how long the patient will be in
the hospital, identify the expected outcome of the hospitalization and initiate any
special requirements for services at or after the time of discharge.
9. Collection agency reports should be provided: - ANS-A. Whenever staff have the time to
generate them.
B. Whenever an account is cancelled.
**C. In at least two formats regarding accounts assigned on a routine basis.
D. As needed to prove recovery rates.
10. Collection results are: - ANS-A. Always guaranteed by the collection agency.
**B. Accurately calculated to demonstrate the actual recovery percentage rate.
C. Calculated using agency's private formula.
D. Never reported except during contract negotiations.
11. Consents are signed as part of the post-services process. - ANS-True
**False
12. Corporate compliance programs play an important role in protecting the integrity of
operations and ensuring compliance with federal and state requirements. The code of
conduct is: - ANS-All of the above
13. Credit balances may be created by any of the following activities except: - ANS-Credits
to pharmacy charges posted before the claim final bills
14. DRG's are a system of classifying inpatients on the basis of diagnoses, procedures, and
co-morbidities for purposes of payment to hospitals. Each DRG includes: - ANS-A
relative weight which is multiplied by the established base payment rate to
calculate the reimbursement for a specific DRG. For exceptionally costly cases
over a set dollar amount, an outlier payment is added to the calculated payment.
15. Each hospital covered by the 501(r) regulations is required to develop a financial
assistance policy. Which of the following elements is NOT a required element of the
policy? - ANS-The notice that individuals eligible for financial assistance under this
policy may be charged more that the amount generally billed (AGB) to insured
patients.
16. Each type of service has unique billing rules which come into play during the provision of
service. For the skilled nursing facility, care is covered if which of the following factors
are present: - ANS-The patient required skilled services on a daily basis and those
services can only be provided on an inpatient basis in a SNF.
17. EMTALA prohibits inquiries about health plan or liability payer information if the inquiry
will delay examination or treatment. What other requirements apply to the Emergency
Department registration work? - ANS-ALL of the above
18. Examples of managed care plans include: - ANS-All of the above
Historically, revenue cycle has delt with contractual adjustments, bad debt and charity
deductions from gross revenue. Although deductions continue to exist, the definition of
net revenue has been modified through the implementation of ASC 606. Developed by
- CRCR (2021) Questions and Answers
1. A 68 year old patient, a Medicare beneficiary, was in a car accident. A medical insurance
claim was filed with the auto insurance carrier. Six months later this claim remains
unpaid. How can the provider pursue payment from Medicare? - ANS-The provider
must first bill the auto insurer; however, after a period of 120 days, if the claim
remains unpaid, the provider may cancel the liability claim and bill Medicare.
2. ABC Hospital has experienced a 16% increase in new patients over the past 6 months.
The hospital is understaffed in its insurance claim and payment processing department
and cannot handle this increase in work load. It is considering hiring an outsourcing
vendor to assist. What are the steps that the hospital needs to take to establish and
ensure a successful vendor relationship? - ANS-**A. Distribute a RFP to solicit vendor
capabilities, evaluate vendor's expertise to provide outsourcing services, visit
vendor locations, perform vendor reference checks, talk with vendor clients,
interview vendor employees to assess experience level.
B. Evaluate vendor's expertise in providing outsourcing services, visit vendor locations,
interview vendor employees to assess expertise level.
3. Accurate identification of the patient is the first step in the scheduling process. Identifiers
used in various combination to achieve accurate patient identification include? -
ANS-Full legal name, date of birth, sex and social security number
4. Agency fees are: - ANS-A. Paid by patients.
**B. The cost to the provider for collection agency monies offset by the return on
baddebt accounts.
C. Only reported annually to the provider.
D. Waived for accounts aged greater than one year from date of service.
5. 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. - ANS-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
6. Based on what you have just read, which activity is not considered when initiating
self-pay follow-up and account resolution activities? - ANS-A. Poverty Guidelines
B. Financial Profile
C. Presumptive Financial Assistance Determination
**D. Patient Open Balance Billing
, 7. Case management and discharge planning services are a post-service activty -
ANS-True
**False
8. Case managers are involved from admission with the discharge planning process. The
purpose of discharge planning is: - ANS-To estimate how long the patient will be in
the hospital, identify the expected outcome of the hospitalization and initiate any
special requirements for services at or after the time of discharge.
9. Collection agency reports should be provided: - ANS-A. Whenever staff have the time to
generate them.
B. Whenever an account is cancelled.
**C. In at least two formats regarding accounts assigned on a routine basis.
D. As needed to prove recovery rates.
10. Collection results are: - ANS-A. Always guaranteed by the collection agency.
**B. Accurately calculated to demonstrate the actual recovery percentage rate.
C. Calculated using agency's private formula.
D. Never reported except during contract negotiations.
11. Consents are signed as part of the post-services process. - ANS-True
**False
12. Corporate compliance programs play an important role in protecting the integrity of
operations and ensuring compliance with federal and state requirements. The code of
conduct is: - ANS-All of the above
13. Credit balances may be created by any of the following activities except: - ANS-Credits
to pharmacy charges posted before the claim final bills
14. DRG's are a system of classifying inpatients on the basis of diagnoses, procedures, and
co-morbidities for purposes of payment to hospitals. Each DRG includes: - ANS-A
relative weight which is multiplied by the established base payment rate to
calculate the reimbursement for a specific DRG. For exceptionally costly cases
over a set dollar amount, an outlier payment is added to the calculated payment.
15. Each hospital covered by the 501(r) regulations is required to develop a financial
assistance policy. Which of the following elements is NOT a required element of the
policy? - ANS-The notice that individuals eligible for financial assistance under this
policy may be charged more that the amount generally billed (AGB) to insured
patients.
16. Each type of service has unique billing rules which come into play during the provision of
service. For the skilled nursing facility, care is covered if which of the following factors
are present: - ANS-The patient required skilled services on a daily basis and those
services can only be provided on an inpatient basis in a SNF.
17. EMTALA prohibits inquiries about health plan or liability payer information if the inquiry
will delay examination or treatment. What other requirements apply to the Emergency
Department registration work? - ANS-ALL of the above
18. Examples of managed care plans include: - ANS-All of the above
Historically, revenue cycle has delt with contractual adjustments, bad debt and charity
deductions from gross revenue. Although deductions continue to exist, the definition of
net revenue has been modified through the implementation of ASC 606. Developed by
