CRCR Study Questions with All Correct & 100% Verified
Answers|2025/2026 Latest Version| Already Graded A+
code of conduct ✔Correct Answer--hospital establish compliance standards
Purpose of OIG work plan? ✔Correct Answer--communicate issues that will be reviewed during the
year for compliance with Medicare regulations
Medicare pt. admitted on Friday, what services fall within the three day window rule? ✔Correct
Answer--Dx services and related charges provided on the W,R, and F before adm.
What does modifier allow a provider to do? ✔Correct Answer--Report a specific circumstance that
affected a procedure or service without changing the code or its definition
Out pt. dx services provided within 3 days of adm. of a medicare benef. to an IPPS hospt, what must
happen to these charges ✔Correct Answer--combined with the in pt. bill and paid under the MS-
DRG system
Why is OIG pursuing the medicare Secondary Payer ✔Correct Answer--reviews medicare payments
for beneficiaries who have other insurance and assesses the effect. of procedures in preventing
inappro. medcare payments for benef. with other ins. coverage
Recurring or series registration? ✔Correct Answer--one reg. record is created for multi days of
service
Nonemergency pt. who comes for service w/out prior notif. to the provider called? ✔Correct
Answer--unscheduled pt.
stmnts apply to observ. pt. type ✔Correct Answer--used to evaluate the need for an in pt. adm.
which services are hospice programs required to provide on an around the clock basis ✔Correct
Answer--physician, nursing, pharmacy
purpose of initial step in put pt. testing scheduling process ✔Correct Answer--identifying the
correct pt. in the providers database or add the pt. to the database
scheduler instructions are used to prompt the scheduler to do what? ✔Correct Answer--complete
the scheduling process correctly based on service requested
medicare guidelines require that when a test is ordered for which an LCD or NCD exists, the info
provided on the order must include which of the following? ✔Correct Answer--documentation of
the medical necessity for the test
advantage of pre reg. program? ✔Correct Answer--reduces processing times at the time of serivce
what data are required to est. a new MPI entry? ✔Correct Answer--pts. name, DOB, sex
Which HIPAA trans. set provides electronic processing of ins, verif requests and responses?
✔Correct Answer--the 270-271 set
, a mother and father both cover their 16 yo child as a dep. on their health ins, plans, which both
follow the bday rule. mothers dob is 1-19-68 and fathers dob is 7-19-67; whose plan is primary
✔Correct Answer--mothers
true about third party payers? ✔Correct Answer--payments received by the provider from the
payer respon. for reimbursing the provider for the pts. covered services
co-payment? ✔Correct Answer--fixed amt. that is due for a specific service
pts annual out of pocket limitation is 3000, excluding deduct. to date this cal. year the pt has satisfied
the 500 deduct. and has paid 2300 in co insurance to various providers. max amount of coinsurance
the pt will owe ✔Correct Answer--700
type of plan that allows the subscriber to pay lower premium costs in return for a higher deductible?
✔Correct Answer--consumer directed health plan
characteristic of a managed care contracted methodology ✔Correct Answer--prospectively set
rates for in pt. and out pt. services
which provision protects the pt. from medical expenses that exceed a pre set level ✔Correct
Answer--stop loss
what document must a primary care phys. send to an HMO pt. to authorize a visit to a specialist for
add. testing or care? ✔Correct Answer--referral
activities are completed when a scheduled, pre reg pt. arrives for service? ✔Correct Answer--
activating the record, obtaining signatures, and finalizing financial issues
under EMTALA reg., the provider may not ask about a pts. ins. info if it would delay what ✔Correct
Answer--medical screening and stabilizing treatment
collecting pt liability dollars after service leads to what ✔Correct Answer--increased efforts by pt
acct staff to resolve these balanaces
important message from medicare provides beneficiaries with info concerning what? ✔Correct
Answer--right to appeal a discharge decision if the pt disagrees with the plan
which of the following is a step in the discharge process? ✔Correct Answer--have case
management services complete the discharge plan
what curcumstances would result in an incorrect nightly room charge? ✔Correct Answer--if pt.
transfer from the ICU to medical/surgical floor is not reflected in the reg system
which stmnt describes the goal of fin counseling services ✔Correct Answer--help the pt.
understand insurance coverage, including what the pt will owe for the current services
hospital has an APC based contract for the payment of out pt. services. total anticipated charges for
the visit are 2,380. the approved apc payment rate is 780. Where will the patient benefit package be
applied? ✔Correct Answer--to the approved APC payment rate
Answers|2025/2026 Latest Version| Already Graded A+
code of conduct ✔Correct Answer--hospital establish compliance standards
Purpose of OIG work plan? ✔Correct Answer--communicate issues that will be reviewed during the
year for compliance with Medicare regulations
Medicare pt. admitted on Friday, what services fall within the three day window rule? ✔Correct
Answer--Dx services and related charges provided on the W,R, and F before adm.
What does modifier allow a provider to do? ✔Correct Answer--Report a specific circumstance that
affected a procedure or service without changing the code or its definition
Out pt. dx services provided within 3 days of adm. of a medicare benef. to an IPPS hospt, what must
happen to these charges ✔Correct Answer--combined with the in pt. bill and paid under the MS-
DRG system
Why is OIG pursuing the medicare Secondary Payer ✔Correct Answer--reviews medicare payments
for beneficiaries who have other insurance and assesses the effect. of procedures in preventing
inappro. medcare payments for benef. with other ins. coverage
Recurring or series registration? ✔Correct Answer--one reg. record is created for multi days of
service
Nonemergency pt. who comes for service w/out prior notif. to the provider called? ✔Correct
Answer--unscheduled pt.
stmnts apply to observ. pt. type ✔Correct Answer--used to evaluate the need for an in pt. adm.
which services are hospice programs required to provide on an around the clock basis ✔Correct
Answer--physician, nursing, pharmacy
purpose of initial step in put pt. testing scheduling process ✔Correct Answer--identifying the
correct pt. in the providers database or add the pt. to the database
scheduler instructions are used to prompt the scheduler to do what? ✔Correct Answer--complete
the scheduling process correctly based on service requested
medicare guidelines require that when a test is ordered for which an LCD or NCD exists, the info
provided on the order must include which of the following? ✔Correct Answer--documentation of
the medical necessity for the test
advantage of pre reg. program? ✔Correct Answer--reduces processing times at the time of serivce
what data are required to est. a new MPI entry? ✔Correct Answer--pts. name, DOB, sex
Which HIPAA trans. set provides electronic processing of ins, verif requests and responses?
✔Correct Answer--the 270-271 set
, a mother and father both cover their 16 yo child as a dep. on their health ins, plans, which both
follow the bday rule. mothers dob is 1-19-68 and fathers dob is 7-19-67; whose plan is primary
✔Correct Answer--mothers
true about third party payers? ✔Correct Answer--payments received by the provider from the
payer respon. for reimbursing the provider for the pts. covered services
co-payment? ✔Correct Answer--fixed amt. that is due for a specific service
pts annual out of pocket limitation is 3000, excluding deduct. to date this cal. year the pt has satisfied
the 500 deduct. and has paid 2300 in co insurance to various providers. max amount of coinsurance
the pt will owe ✔Correct Answer--700
type of plan that allows the subscriber to pay lower premium costs in return for a higher deductible?
✔Correct Answer--consumer directed health plan
characteristic of a managed care contracted methodology ✔Correct Answer--prospectively set
rates for in pt. and out pt. services
which provision protects the pt. from medical expenses that exceed a pre set level ✔Correct
Answer--stop loss
what document must a primary care phys. send to an HMO pt. to authorize a visit to a specialist for
add. testing or care? ✔Correct Answer--referral
activities are completed when a scheduled, pre reg pt. arrives for service? ✔Correct Answer--
activating the record, obtaining signatures, and finalizing financial issues
under EMTALA reg., the provider may not ask about a pts. ins. info if it would delay what ✔Correct
Answer--medical screening and stabilizing treatment
collecting pt liability dollars after service leads to what ✔Correct Answer--increased efforts by pt
acct staff to resolve these balanaces
important message from medicare provides beneficiaries with info concerning what? ✔Correct
Answer--right to appeal a discharge decision if the pt disagrees with the plan
which of the following is a step in the discharge process? ✔Correct Answer--have case
management services complete the discharge plan
what curcumstances would result in an incorrect nightly room charge? ✔Correct Answer--if pt.
transfer from the ICU to medical/surgical floor is not reflected in the reg system
which stmnt describes the goal of fin counseling services ✔Correct Answer--help the pt.
understand insurance coverage, including what the pt will owe for the current services
hospital has an APC based contract for the payment of out pt. services. total anticipated charges for
the visit are 2,380. the approved apc payment rate is 780. Where will the patient benefit package be
applied? ✔Correct Answer--to the approved APC payment rate
