CRCR PAPER ACTUAL ANSWERS AND QUESTIONS
SET A+
✔✔When there is a request for service, the scheduling staff member must confirm the
patient's unique identification information to - ✔✔Ensure that she/he accesses the
correct information in the historical database
✔✔Maintaining routine contact with the health plan or liability payer, making sure all
required information is provided and all needed approvals are obtained is the
responsibility of: - ✔✔Case Management
✔✔Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and
- ✔✔Provide a method of measuring the collection and control of A/R
✔✔With any remaining open balances, after insurance payments have been posted, the
account financial liability is - ✔✔Potentially transferred to the patient
✔✔Pricing transparency is defined as readily available information on the price of
healthcare services, that together with other information, help define the value of those
services and enable consumers to - ✔✔Identify, compare, and choose providers that
offer the desired level of value
✔✔All of the following are potential causes of credit balances EXCEPT - ✔✔A patient's
choice to build up a credit against future medical bills
✔✔A comprehensive "Compliance Program" is defined as - ✔✔Systematic procedures
to ensure that the provisions of regulations imposed by a government agency are being
met
✔✔An originating site is - ✔✔The location of the patient at the time the service is
provided
, ✔✔Local Coverage Determinations (LCD) and National Coverage Determinations
(NCD) are Medicare established guideline(s) used to determine: - ✔✔Which diagnoses,
signs, or symptoms are reimbursable
✔✔If further treatment can only be provided in a hospital setting, the patient's condition
cannot be evaluated and/or treated within 24 hours, or if there is not an anticipation of
improvement in the patient's condition with 24 hours, the patient - ✔✔Will be admitted
as an inpatient
✔✔The benefit of Medicare Advantage Plan is - ✔✔Patients generally have their
Medicare-coverage healthcare through the plan and do not need to worry about "part a"
or "part b" benefits
✔✔The process of creating the pre-registration record ensures - ✔✔Accurate billing
✔✔Claims with dates of service received later than one calendar year beyond the date
of service, will be - ✔✔Denied by Medicare
✔✔A portion of the accounts receivable inventory which has NOT qualified for billing
includes - ✔✔Charitable pledges
✔✔The standard claim form used for billing by hospitals, nursing facilities, and other in-
patient - ✔✔UB-04
✔✔Once the price is estimated in the pre-service stage, a provider's financial best
practice is to - ✔✔Explain to the patient their financial responsibility and to determine
the plan for payment
✔✔Internal controls addressing coding and reimbursement changes are put in place to
guard against - ✔✔Compliance fraud by upcoding
✔✔Health Plan Contracting Departments do all of the following EXCEPT - ✔✔Establish
a global reimbursement rate to use with all third-party payer
✔✔For routine scenarios, such as patients with insurance coverage or a known ability to
pay, financial discussions: - ✔✔Should take place between the patient or guarantor and
properly trained provider representatives
✔✔What type of account adjustment results from the patient's unwillingness to pay a
self-pay balance? - ✔✔Bad debt adjustment
✔✔Most major health plans including Medicare and Medicaid, offer - ✔✔Electronic
and/or web portal verification
SET A+
✔✔When there is a request for service, the scheduling staff member must confirm the
patient's unique identification information to - ✔✔Ensure that she/he accesses the
correct information in the historical database
✔✔Maintaining routine contact with the health plan or liability payer, making sure all
required information is provided and all needed approvals are obtained is the
responsibility of: - ✔✔Case Management
✔✔Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and
- ✔✔Provide a method of measuring the collection and control of A/R
✔✔With any remaining open balances, after insurance payments have been posted, the
account financial liability is - ✔✔Potentially transferred to the patient
✔✔Pricing transparency is defined as readily available information on the price of
healthcare services, that together with other information, help define the value of those
services and enable consumers to - ✔✔Identify, compare, and choose providers that
offer the desired level of value
✔✔All of the following are potential causes of credit balances EXCEPT - ✔✔A patient's
choice to build up a credit against future medical bills
✔✔A comprehensive "Compliance Program" is defined as - ✔✔Systematic procedures
to ensure that the provisions of regulations imposed by a government agency are being
met
✔✔An originating site is - ✔✔The location of the patient at the time the service is
provided
, ✔✔Local Coverage Determinations (LCD) and National Coverage Determinations
(NCD) are Medicare established guideline(s) used to determine: - ✔✔Which diagnoses,
signs, or symptoms are reimbursable
✔✔If further treatment can only be provided in a hospital setting, the patient's condition
cannot be evaluated and/or treated within 24 hours, or if there is not an anticipation of
improvement in the patient's condition with 24 hours, the patient - ✔✔Will be admitted
as an inpatient
✔✔The benefit of Medicare Advantage Plan is - ✔✔Patients generally have their
Medicare-coverage healthcare through the plan and do not need to worry about "part a"
or "part b" benefits
✔✔The process of creating the pre-registration record ensures - ✔✔Accurate billing
✔✔Claims with dates of service received later than one calendar year beyond the date
of service, will be - ✔✔Denied by Medicare
✔✔A portion of the accounts receivable inventory which has NOT qualified for billing
includes - ✔✔Charitable pledges
✔✔The standard claim form used for billing by hospitals, nursing facilities, and other in-
patient - ✔✔UB-04
✔✔Once the price is estimated in the pre-service stage, a provider's financial best
practice is to - ✔✔Explain to the patient their financial responsibility and to determine
the plan for payment
✔✔Internal controls addressing coding and reimbursement changes are put in place to
guard against - ✔✔Compliance fraud by upcoding
✔✔Health Plan Contracting Departments do all of the following EXCEPT - ✔✔Establish
a global reimbursement rate to use with all third-party payer
✔✔For routine scenarios, such as patients with insurance coverage or a known ability to
pay, financial discussions: - ✔✔Should take place between the patient or guarantor and
properly trained provider representatives
✔✔What type of account adjustment results from the patient's unwillingness to pay a
self-pay balance? - ✔✔Bad debt adjustment
✔✔Most major health plans including Medicare and Medicaid, offer - ✔✔Electronic
and/or web portal verification
