CRCR Certification Exam Prep
Study online at https://quizlet.com/_hmr9tz
1. Which option is Health Plan Contracting
NOT a continuum
of care provider?
2. ABC Hospital has The hospital should distribute a RFP to solicit vendor capabilities, evaluate vendor's
experienced a expertise to provide outsourcing services, visit vendor locations, perform vendor
16% increase in reference checks, talk with vendor clients, and interview vendor employees to
new patients over assess experience level. This sets up an evaluation process, the same as any other
the past 6 purchased service would be evaluated.
months. The hos-
pital is under-
staffed in its
insurance claim
and payment
processing de-
partment and
cannot handle
this increase in
work load. It is
considering hir-
ing an outsourc-
ing vendor to as-
sist. What are the
steps that the
hospital needs to
take to establish
and ensure a suc-
cessful vendor re-
lationship?
3. True or False True
- Patient service
, CRCR Certification Exam Prep
Study online at https://quizlet.com/_hmr9tz
costs are calculat-
ed in the pre-ser-
vice process for
scheduled pa-
tients.
4. What is the in- By meeting established benchmarks for quality and efficiency, participating orga-
tended outcome nizations may receive a share of the savings generated by reducing duplicative
of collaborations services, improving productivity, minimizing paperwork, and other cost efficiencies.
made through an
ACO delivery sys-
tem?
5. Which option is Assisted Living Services
NOT a depart-
ment that sup-
ports and collab-
orates with the
revenue cycle?
6. Annually, the OIG Standard Unique Employer Identifier
publishes a work
plan of compli-
ance issues and
objectives that
will be focused on
throughout the
following year.
Identify which
option is NOT a
work plan task
, CRCR Certification Exam Prep
Study online at https://quizlet.com/_hmr9tz
mentioned in this
course.
7. What is the pur- To ensure accuracy of he health plan information.
pose of insurance
verification?
8. What are the Eligibility criteria, application process, application assistance, list of all providers -
required compo- regardless of network status
nents of financial
assistance policy
(FAP)?
9. Federally-aided, Medicaid
state-operated
program to Medicaid is for low-income individuals or families. Eligibility for Medicaid benefits
provide health expanded effective January 1, 2014 through a provision of the Patient Protection
and long-term and Affordable Care Act (PPACA), as states were provided additional funding if
care coverage. benefits were extended to individuals under 65 years of age with incomes up to
133% of the federal poverty level.
10. What are claim Rules developed to verify the accuracy and completeness of claims based on each
edits? 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.
11. What are the var- By Agreement (consensus), By Judicial Process, By Statute
ious lien types?
12. 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),
Study online at https://quizlet.com/_hmr9tz
1. Which option is Health Plan Contracting
NOT a continuum
of care provider?
2. ABC Hospital has The hospital should distribute a RFP to solicit vendor capabilities, evaluate vendor's
experienced a expertise to provide outsourcing services, visit vendor locations, perform vendor
16% increase in reference checks, talk with vendor clients, and interview vendor employees to
new patients over assess experience level. This sets up an evaluation process, the same as any other
the past 6 purchased service would be evaluated.
months. The hos-
pital is under-
staffed in its
insurance claim
and payment
processing de-
partment and
cannot handle
this increase in
work load. It is
considering hir-
ing an outsourc-
ing vendor to as-
sist. What are the
steps that the
hospital needs to
take to establish
and ensure a suc-
cessful vendor re-
lationship?
3. True or False True
- Patient service
, CRCR Certification Exam Prep
Study online at https://quizlet.com/_hmr9tz
costs are calculat-
ed in the pre-ser-
vice process for
scheduled pa-
tients.
4. What is the in- By meeting established benchmarks for quality and efficiency, participating orga-
tended outcome nizations may receive a share of the savings generated by reducing duplicative
of collaborations services, improving productivity, minimizing paperwork, and other cost efficiencies.
made through an
ACO delivery sys-
tem?
5. Which option is Assisted Living Services
NOT a depart-
ment that sup-
ports and collab-
orates with the
revenue cycle?
6. Annually, the OIG Standard Unique Employer Identifier
publishes a work
plan of compli-
ance issues and
objectives that
will be focused on
throughout the
following year.
Identify which
option is NOT a
work plan task
, CRCR Certification Exam Prep
Study online at https://quizlet.com/_hmr9tz
mentioned in this
course.
7. What is the pur- To ensure accuracy of he health plan information.
pose of insurance
verification?
8. What are the Eligibility criteria, application process, application assistance, list of all providers -
required compo- regardless of network status
nents of financial
assistance policy
(FAP)?
9. Federally-aided, Medicaid
state-operated
program to Medicaid is for low-income individuals or families. Eligibility for Medicaid benefits
provide health expanded effective January 1, 2014 through a provision of the Patient Protection
and long-term and Affordable Care Act (PPACA), as states were provided additional funding if
care coverage. benefits were extended to individuals under 65 years of age with incomes up to
133% of the federal poverty level.
10. What are claim Rules developed to verify the accuracy and completeness of claims based on each
edits? 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.
11. What are the var- By Agreement (consensus), By Judicial Process, By Statute
ious lien types?
12. 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),
