CRCR STUDY GUIDE REVIEW 2025 FALL
EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS GRADED A +
Through what document does a hospital establish compliance standards? -CORRECT->>Code of
Conduct
What is the purpose of the OIG work plan? -CORRECT->>Communicate Issues that will be
reviewed during the year for compliance with Medicare Regulations
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window
rule? -CORRECT->>Diagnostic services and related charges provided on Wednesday, Thursday
and Friday before admission.
What does a modifier allow a provider to do? -CORRECT->>Report a specific circumstance that
affected a procedure or service without changing the code or its definition
If outpatient diagnostic services are provided within three days of the admission of a Medicare
beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to
these charges? -CORRECT->>They must be combined with the inpatient bill and paid under the
MS-DRG (diagnosis related group) system.
If outpatient diagnostic services are provided within three days of the admission of a Medicare
beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to
these
,charges? -CORRECT->>It reviews Medicare payments for beneficiaries who have other
insurance and assesses the effectiveness of procedures in preventing inappropriate Medicare
payments for beneficiaries with other insurance coverage.
What is a recurring or series registration? -CORRECT->>One registration record is created for
multiple days of service.
What are nonemergency patients who come for service without prior notification to the provider
called?
-CORRECT->>Unscheduled Patients
Which of the following statements apply to the observation patient type? -CORRECT->>It is
used to evaluate the need for an inpatient admission.
Which services are hospice programs required to provide on an around-the-clock basis? -
CORRECT->> Physician, nursing and pharmacy
What is the purpose of the initial step in the outpatient testing scheduling process? -CORRECT-
>>Identify the correct patient on the providers database or add the patient to the database
Scheduler instructions are used to prompt the scheduler to do what? -CORRECT->>Complete
the scheduling process correctly based on service requested.
The time needed to prepare the patient before service is the difference between the patient's
arrival time and which of the following? -CORRECT->>Procedure time
Medicare guidelines require that when a test is ordered for which as LCD (local coverage
determination) or NCD (national coverage determination) exist, the information provided on the
order must include which of the following? -CORRECT->>Documentation of the medical
necessity of the test.
What is an advantage of a preregistration program? -CORRECT->>It reduces processing times
at the time of service
, What data are required to establish a new MPI (master patient index) entry? -CORRECT->>The
patients full legal name, date of birth and sex
Which HIPAA transition set provides electronic processing of insurance verification requests
and responses? -CORRECT->>The 270-271 Set
A mother and father both cover their 16-year-old child as a dependent on their health insurance
plans, which both follow the birthday rule. The mothers date of birth is January 19, 1968; the
father's date of birth is July 19, 1967. Whose plan is the primary payer? -CORRECT->>The
Mothers Plan
What is a co-payment? -CORRECT->>The fixed amount that is due for a specific service
A patient's annual out-of-pocket limitation is $3000, excluding the deductible. To date this
calendar year, the patient has satisfied the $500 deductible and has paid $2300 in coinsurance to
various providers. For the balance of the calendar year, what is the maximum amount of
coinsurance the patient will owe? -CORRECT->>$3000 - $2300 = $700
What type of plan allows the subscriber to pay lower premium costs in return for a higher
deductible? -CORRECT->>Consumer Directed Health Plan
What is a characteristic of a managed care contracting methodology? -CORRECT-
>>Prospectively set rates for inpatient and outpatient services.
Which provision protects the patient from Medical expenses that exceed a preset level? -
CORRECT->>Stop Loss
What document must a primary care physician send to an HMO (health maintenance
organization) patient to authorize a visit to a specialist for additional testing or care? -
CORRECT->>Referral
What activities are completed when a scheduled, pre-registered patient arrives for service? -
CORRECT->> Activating the record, obtaining signatures, and finalizing financial issues.
EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS GRADED A +
Through what document does a hospital establish compliance standards? -CORRECT->>Code of
Conduct
What is the purpose of the OIG work plan? -CORRECT->>Communicate Issues that will be
reviewed during the year for compliance with Medicare Regulations
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window
rule? -CORRECT->>Diagnostic services and related charges provided on Wednesday, Thursday
and Friday before admission.
What does a modifier allow a provider to do? -CORRECT->>Report a specific circumstance that
affected a procedure or service without changing the code or its definition
If outpatient diagnostic services are provided within three days of the admission of a Medicare
beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to
these charges? -CORRECT->>They must be combined with the inpatient bill and paid under the
MS-DRG (diagnosis related group) system.
If outpatient diagnostic services are provided within three days of the admission of a Medicare
beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to
these
,charges? -CORRECT->>It reviews Medicare payments for beneficiaries who have other
insurance and assesses the effectiveness of procedures in preventing inappropriate Medicare
payments for beneficiaries with other insurance coverage.
What is a recurring or series registration? -CORRECT->>One registration record is created for
multiple days of service.
What are nonemergency patients who come for service without prior notification to the provider
called?
-CORRECT->>Unscheduled Patients
Which of the following statements apply to the observation patient type? -CORRECT->>It is
used to evaluate the need for an inpatient admission.
Which services are hospice programs required to provide on an around-the-clock basis? -
CORRECT->> Physician, nursing and pharmacy
What is the purpose of the initial step in the outpatient testing scheduling process? -CORRECT-
>>Identify the correct patient on the providers database or add the patient to the database
Scheduler instructions are used to prompt the scheduler to do what? -CORRECT->>Complete
the scheduling process correctly based on service requested.
The time needed to prepare the patient before service is the difference between the patient's
arrival time and which of the following? -CORRECT->>Procedure time
Medicare guidelines require that when a test is ordered for which as LCD (local coverage
determination) or NCD (national coverage determination) exist, the information provided on the
order must include which of the following? -CORRECT->>Documentation of the medical
necessity of the test.
What is an advantage of a preregistration program? -CORRECT->>It reduces processing times
at the time of service
, What data are required to establish a new MPI (master patient index) entry? -CORRECT->>The
patients full legal name, date of birth and sex
Which HIPAA transition set provides electronic processing of insurance verification requests
and responses? -CORRECT->>The 270-271 Set
A mother and father both cover their 16-year-old child as a dependent on their health insurance
plans, which both follow the birthday rule. The mothers date of birth is January 19, 1968; the
father's date of birth is July 19, 1967. Whose plan is the primary payer? -CORRECT->>The
Mothers Plan
What is a co-payment? -CORRECT->>The fixed amount that is due for a specific service
A patient's annual out-of-pocket limitation is $3000, excluding the deductible. To date this
calendar year, the patient has satisfied the $500 deductible and has paid $2300 in coinsurance to
various providers. For the balance of the calendar year, what is the maximum amount of
coinsurance the patient will owe? -CORRECT->>$3000 - $2300 = $700
What type of plan allows the subscriber to pay lower premium costs in return for a higher
deductible? -CORRECT->>Consumer Directed Health Plan
What is a characteristic of a managed care contracting methodology? -CORRECT-
>>Prospectively set rates for inpatient and outpatient services.
Which provision protects the patient from Medical expenses that exceed a preset level? -
CORRECT->>Stop Loss
What document must a primary care physician send to an HMO (health maintenance
organization) patient to authorize a visit to a specialist for additional testing or care? -
CORRECT->>Referral
What activities are completed when a scheduled, pre-registered patient arrives for service? -
CORRECT->> Activating the record, obtaining signatures, and finalizing financial issues.
