1|Page
CRCR CERTIFICATION EXAM PREP WITH
QUESTIONS AND DETAILED ANSWERS THE LATEST
UPDATED EXAM BANK INCLUDING EXPERT
VERIFIED SOLUTIONS FOR A SURE PASS
Which option is NOT a continuum of care provider?
Health Plan Contracting
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?
The hospital should 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, and interview vendor employees
to assess experience level. This sets up an evaluation process, the same as any
other purchased service would be evaluated.
True or False - Patient service costs are calculated in the pre-service process for
scheduled patients.
True
What is the intended outcome of collaborations made through an ACO delivery
system?
,2|Page
By meeting established benchmarks for quality and efficiency, participating
organizations may receive a share of the savings generated by reducing duplicative
services, improving productivity, minimizing paperwork, and other cost
efficiencies.
Which option is NOT a department that supports and collaborates with the revenue
cycle?
Assisted Living Services
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.
Standard Unique Employer Identifier
What is the purpose of insurance verification?
To ensure accuracy of he health plan information.
What are the required components of financial assistance policy (FAP)?
Eligibility criteria, application process, application assistance, list of all providers -
regardless of network status
,3|Page
Federally-aided, state-operated program to provide health and long-term care
coverage.
Medicaid
Medicaid is for low-income individuals or families. Eligibility for Medicaid
benefits expanded effective January 1, 2014 through a provision of the Patient
Protection and Affordable Care Act (PPACA), as states were provided additional
funding if benefits were extended to individuals under 65 years of age with
incomes up to 133% of the federal poverty level.
What are claim edits?
Rules developed to verify the accuracy and completeness of claims based on each
health plan's policies.
Data sources for these claim edits (rules) are Medicare and Medicaid bulletins and
manuals, individual health plan manuals and contracts, and other documents
routinely provided by health plans. The claim editing process lets providers
identify and resolve claim issues to ensure clean claim submission to the health
plan.
What are the various lien types?
By Agreement (consensus), By Judicial Process, By Statute
Explain the By Agreement (Consensus) lien type.
, 4|Page
A creditor can protect his/her security interest (which lasts until the full balance is
paid) by filing a financing statement under the Uniform Commercial Code (UCC),
usually at the Secretary of State’s Office.
The financing statement generally includes the following information:
- Names and addresses of the agreeing parties
- A description of the collateral (the property to which the lien attaches)
Signatures of all agreeing parties
When personal property is used as collateral, the agreement is called a security
interest.
When the secured property is real estate, the agreement is called a mortgage.
Explain the By Judicial Process lien type.
A judicial lien results from a creditor's efforts to collect the debt. When a creditor
is unable to collect a debt using reasonable "pressuring" techniques (which are
regulated by the Fair Debt Collection Practices Act), the creditor must resort to
legally prescribed collection procedures.
Explain the By Statute lien type.
CRCR CERTIFICATION EXAM PREP WITH
QUESTIONS AND DETAILED ANSWERS THE LATEST
UPDATED EXAM BANK INCLUDING EXPERT
VERIFIED SOLUTIONS FOR A SURE PASS
Which option is NOT a continuum of care provider?
Health Plan Contracting
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?
The hospital should 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, and interview vendor employees
to assess experience level. This sets up an evaluation process, the same as any
other purchased service would be evaluated.
True or False - Patient service costs are calculated in the pre-service process for
scheduled patients.
True
What is the intended outcome of collaborations made through an ACO delivery
system?
,2|Page
By meeting established benchmarks for quality and efficiency, participating
organizations may receive a share of the savings generated by reducing duplicative
services, improving productivity, minimizing paperwork, and other cost
efficiencies.
Which option is NOT a department that supports and collaborates with the revenue
cycle?
Assisted Living Services
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.
Standard Unique Employer Identifier
What is the purpose of insurance verification?
To ensure accuracy of he health plan information.
What are the required components of financial assistance policy (FAP)?
Eligibility criteria, application process, application assistance, list of all providers -
regardless of network status
,3|Page
Federally-aided, state-operated program to provide health and long-term care
coverage.
Medicaid
Medicaid is for low-income individuals or families. Eligibility for Medicaid
benefits expanded effective January 1, 2014 through a provision of the Patient
Protection and Affordable Care Act (PPACA), as states were provided additional
funding if benefits were extended to individuals under 65 years of age with
incomes up to 133% of the federal poverty level.
What are claim edits?
Rules developed to verify the accuracy and completeness of claims based on each
health plan's policies.
Data sources for these claim edits (rules) are Medicare and Medicaid bulletins and
manuals, individual health plan manuals and contracts, and other documents
routinely provided by health plans. The claim editing process lets providers
identify and resolve claim issues to ensure clean claim submission to the health
plan.
What are the various lien types?
By Agreement (consensus), By Judicial Process, By Statute
Explain the By Agreement (Consensus) lien type.
, 4|Page
A creditor can protect his/her security interest (which lasts until the full balance is
paid) by filing a financing statement under the Uniform Commercial Code (UCC),
usually at the Secretary of State’s Office.
The financing statement generally includes the following information:
- Names and addresses of the agreeing parties
- A description of the collateral (the property to which the lien attaches)
Signatures of all agreeing parties
When personal property is used as collateral, the agreement is called a security
interest.
When the secured property is real estate, the agreement is called a mortgage.
Explain the By Judicial Process lien type.
A judicial lien results from a creditor's efforts to collect the debt. When a creditor
is unable to collect a debt using reasonable "pressuring" techniques (which are
regulated by the Fair Debt Collection Practices Act), the creditor must resort to
legally prescribed collection procedures.
Explain the By Statute lien type.
