CRCR 2027 CORE MAIN ANSWERS AND QUESTIONS
SET A+
✔✔What happens when a patient receives non-emergent services from and out-of-
network provider? - ✔✔Patient payment responsibility is higher
✔✔Every patient who is new to the healthcare provider must be offered what? - ✔✔A
printed copy of the provider's privacy notice
✔✔How may a collection agency demonstrate its performance? - ✔✔Calculate the rate
of recovery
✔✔What is true of the information the provider supplies to indicate that an authorization
for service has been received from the patient's primary payer? - ✔✔It is posted on the
remittance advice by the payer
✔✔What standard claim forms are currently used by the healthcare industry to submit
claims to third-party payers? - ✔✔The UB-04 and the CMS 1500
✔✔Unless the patient encounter is an emergency, what is the efficient and effective
procedure for obtaining information? - ✔✔Obtain the required demographic and
insurance information before services are rendered
✔✔what protocol was developed through the Patient Friendly Billing Project? -
✔✔Provide information using language that is easily understood by the average reader
✔✔What technique is acceptable way to complete the MSP screening for a facility
situation? - ✔✔Ask if the patient's current services was accident related
✔✔What is a valid reason for a payer to delay a claim? - ✔✔Failure to complete
authorization requirements
, ✔✔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 - ✔✔They must be combined with the inpatient bill
and paid under the MS-DRG system
✔✔What do large adjustments require? - ✔✔Manager-level approval
✔✔What items are valid identifiers to establish a patient's identification? - ✔✔Photo
identification, date of birth, and social security number
✔✔What must a provider do to qualify an account as a Medicare bad debts? -
✔✔Pursue the account for 120 days and then refer it to an outside collection agency
✔✔What restriction does a managed care plan place on locations that must be used if
the plan is to pay for the services provided? - ✔✔Site-of-service limitation
✔✔What is an example of an outcome of the Patient Friendly Billing Project? -
✔✔Redesigned patient billing statements using patient-friendly language
✔✔What statement describes the APC (Ambulatory payment classification) system? -
✔✔APC rates are calculated on a national basis and are wage-adjusted by geographic
region
✔✔What is a benefit of insurance verification? - ✔✔Pre-certification or pre-authorization
requirements are confirmed
✔✔What is an effective tool to help staff collect payments at the time of service? -
✔✔Develop scripts for the process of requesting payments
✔✔What is a benefit of electronic claims processing? - ✔✔Providers can electronically
view patient's eligibility
✔✔What does Medicare Part D provide coverage for? - ✔✔Prescription drugs
✔✔What are some core elements of a board-approved financial policy - ✔✔Charity
care, payment methods, and installment payment guidelines
✔✔What circumstance would result in an incorrect nightly room charge? - ✔✔If the
patient's discharge, ordered for tomorrow, has not been charted
✔✔What is NOT a typical charge master problem that can result in a denial? - ✔✔Does
not include required modifiers
SET A+
✔✔What happens when a patient receives non-emergent services from and out-of-
network provider? - ✔✔Patient payment responsibility is higher
✔✔Every patient who is new to the healthcare provider must be offered what? - ✔✔A
printed copy of the provider's privacy notice
✔✔How may a collection agency demonstrate its performance? - ✔✔Calculate the rate
of recovery
✔✔What is true of the information the provider supplies to indicate that an authorization
for service has been received from the patient's primary payer? - ✔✔It is posted on the
remittance advice by the payer
✔✔What standard claim forms are currently used by the healthcare industry to submit
claims to third-party payers? - ✔✔The UB-04 and the CMS 1500
✔✔Unless the patient encounter is an emergency, what is the efficient and effective
procedure for obtaining information? - ✔✔Obtain the required demographic and
insurance information before services are rendered
✔✔what protocol was developed through the Patient Friendly Billing Project? -
✔✔Provide information using language that is easily understood by the average reader
✔✔What technique is acceptable way to complete the MSP screening for a facility
situation? - ✔✔Ask if the patient's current services was accident related
✔✔What is a valid reason for a payer to delay a claim? - ✔✔Failure to complete
authorization requirements
, ✔✔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 - ✔✔They must be combined with the inpatient bill
and paid under the MS-DRG system
✔✔What do large adjustments require? - ✔✔Manager-level approval
✔✔What items are valid identifiers to establish a patient's identification? - ✔✔Photo
identification, date of birth, and social security number
✔✔What must a provider do to qualify an account as a Medicare bad debts? -
✔✔Pursue the account for 120 days and then refer it to an outside collection agency
✔✔What restriction does a managed care plan place on locations that must be used if
the plan is to pay for the services provided? - ✔✔Site-of-service limitation
✔✔What is an example of an outcome of the Patient Friendly Billing Project? -
✔✔Redesigned patient billing statements using patient-friendly language
✔✔What statement describes the APC (Ambulatory payment classification) system? -
✔✔APC rates are calculated on a national basis and are wage-adjusted by geographic
region
✔✔What is a benefit of insurance verification? - ✔✔Pre-certification or pre-authorization
requirements are confirmed
✔✔What is an effective tool to help staff collect payments at the time of service? -
✔✔Develop scripts for the process of requesting payments
✔✔What is a benefit of electronic claims processing? - ✔✔Providers can electronically
view patient's eligibility
✔✔What does Medicare Part D provide coverage for? - ✔✔Prescription drugs
✔✔What are some core elements of a board-approved financial policy - ✔✔Charity
care, payment methods, and installment payment guidelines
✔✔What circumstance would result in an incorrect nightly room charge? - ✔✔If the
patient's discharge, ordered for tomorrow, has not been charted
✔✔What is NOT a typical charge master problem that can result in a denial? - ✔✔Does
not include required modifiers
