CRCR Certification Exam Questions And Answers Verified 100% Correct

CRCR Certification Exam Questions And Answers Verified 100% Correct Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish - ANSWER What services or healthcare items are covered under Medicare Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with - ANSWER -The Provider Reimbursement Review Board Concurrent review and discharge planning - ANSWER -Occurs during service Duplicate payments occur: - ANSWER -When providers re-bill claims based on nonpayment from the initial bill submission An individual enrolled in Medicare who is dissatisfied with the government's claim determination is entitled to reconsideration of the decision. This type of appeal is known as - ANSWER -A beneficiary appeal Insurance verification results in which of the following - ANSWER -The accurate identification of the patient's eligibility and benefits The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: - ANSWER -Judicial review by a federal district court Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the providermay not ask about a patient's insurance information if it would delay what? - ANSWER -Medical screening and stabilizing treatment Ambulance services are billed directly to the health plan for - ANSWER -Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility Key performance indicators (KPIs) set standards for accounts receivables (A/R) and - ANSWER -Provide a method of measuring the collection and control of A/R he patient discharge process begins when - ANSWER -The physician writes the discharge orders The nightly room charge will be incorrect if the patient's - ANSWER -Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system. The soft cost of a dissatisfied customer is - ANSWER -The customer passing on info about their negative experience to potential pts or through social media channels An advantage of a pre-registration program is - ANSWER -The opportunity to reduce the corporate compliance failures within the registration process It is important to have high registration quality standards because - ANSWER Inaccurate or incomplete patient data will delay payment or cause denials Telemed seeks to improve a patient's health by - ANSWER -Permitting 2-way real time interactive communication between the patient and the clinical professional Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a monthly fee is known as a - ANSWER -HMO Identifying the patient, in the MPI, creating the registration record, completing medical necessity screening, determining insurance eligibility and benefits resolving managed care, requirements and completing financial education/resolution are all - ANSWER -The data collection steps for scheduling and pre-registering a patient Medicare Part B has an annual deductible, and the beneficiary is responsible for - ANSWER -A co-insurance payment for all Part B covered services The standard claim form used for billing by hospitals, nursing facilities, and other inpatient - ANSWER -UB-04 Charges are the basis for - ANSWER -Separation of fiscal responsibilities between the patient and the health plan All of the following are forms of hospital payment contracting EXCEPT - ANSWER -Contracted Rebating The most common resolution methods for credit balances include all of the following EXCEPT: - ANSWER -Designate the overpayment for charity care Ambulance services are billed directly to the health plan for - ANSWER -The portion of the bill outside of the patient's self-pay A claim for reimbursement submitted to a third-party payer that has all the information and documentation required for the payer to make a decision on it is known as - ANSWER -A clean claim The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to - ANSWER -Medicare and Medicaid payments The Correct Coding Initiative Program consists of - ANSWER -Edits that are implemented within providers' claim processing systems To provide a patient with information that is meaningful to them, all of the following factors must be included EXCEPT - ANSWER -The actual physician reimbursement Which department supports/collaborates with the revenue cycle? - ANSWER Information Technology Medicare Part B has an annual deductible and the beneficiary is responsible for - ANSWER -a co-insurance payment for all Part B covered services The two types of claims denial appeals are - ANSWER -Beneficiary and Provider Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) - ANSWER -Registration staff members routinely contact managed care plans for prior authorizations before the patient is seen by the on duty physician Rural Health Clinics (RHC) personnel can provide services in all of the following locations, EXCEPT - ANSWER -Providing inpatient services in the RHC The patient discharge process begins when - ANSWER -The physician writes the discharge order