CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representative Materials from HFMA
1. In what situation(s) should a provider NOT use a modifier?: - CPT already indicates
2-4 lesions
- CPT indicates multiple extremities
2. What are other names for Three-Day Payment Window?: ALL OF THE ABOVE
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
3. What happens during the post-service stage?: Final coding, preparation and submission
of claims, payment processing, balance billing and resolution.
4. What are the below tasks part of?
- Educate patients
- Coordinate to avoid duplicate patient contacts
- Be consistent in key aspects of account resolution
- Follow best practices for communication: Best practices created by the Medical Debt Task Force
5. Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue
cycle initiative?: Process Compliance
6. Which option is NOT a continuum of care provider?
A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility: B. Health Plan Contracting
7. What is "implied certification"?: When it is implied that a provider met all compliance standards
before submitting a claim
8. Which of the following are essential elements of an effective compliance
program?
A. Established compliance standards and procedures.
B. Designation of a compliance officer employed within the Billing Depart-
ment.
C. Oversight of personnel by high-level personnel.
D. Automatic dismissal of any employee excluded from participation in a
CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representative Materials from HFMA
,CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representative Materials from HFMA
federal healthcare program.
E. Reasonable methods to achieve compliance with standards, including mon-
itoring systems and hotlines.: A. Established compliance standards and procedures.
C. Oversight of personnel by high-level personnel.
E. Reasonable methods to achieve compliance with standards, including monitoring systems and hotlines.
9. When was Health Information Technology for Economic and Clinical Health
(HITECH) Act signed into law?: FEB 17, 2009
10. When did HITECH Act become effective?: 2013
11. Annually, the OIG publishes a work plan of compliance issues and objec-
tives that will be focused on throughout the following year. Identify which
option is NOT a work plan task mentioned in this course.
A. Payments to Physicians for Co-Surgery Procedures
B. Denials and Appeals in Medicare Part D
C. Medicare Hospital Payments for Claims Involving the Acute- and
Post-Acute-Care Transfer Policies
D. Standard Unique Employer Identifier: D. Standard Unique Employer Identifier
12. What Plan are the tasks below a part of?
- Medicare Payments Made Outside of the Hospice Benefit
- Denials and Appeals in Medicare Part C and Part D
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits: The 2020
OIG Work Plan
13. When was the Preservation of Access to Care for Medicare Beneficiaries and
Pension Relief Act signed into law?: JUNE 25 2010
14. What is the Medicare DRG Three-Day Payment Window?: All Diagnostic services
provided to a Medicare patient by a hospital on the Date of the patient's Inpatient admission or during the 3 calendar
CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representative Materials from HFMA
,CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representative Materials from HFMA
days (or in the case of a non-IPPS hospital: 1 calendar day) immediately BEFORE the Date of Admission are REQUIRED
to be included on the bill for the IP stay (unless there is no Part A coverage)
15. Do Outpatient Non-Diagnostic Services qualify for separate payments if
provided with the Three-Day Payment Window?: No
16. What is modifier 59?: Used to identify CPTs OTHER THAN E&M services, NOT normally reported together,
but are appropriate under the circumstances.
Documentation must support a ditterent session, ditterent procedure or surgery, ditterent site or organ system,
separate.
17. What is condition code 51?: Code noted on the separate UB-04 OP claim, thus indicating the charge
is unrelated to the admission.
18. What kind of hospitals are the following:
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's
hospitals for examples: Non-IPPS hospitals
19. What are the 3 types of medical necessity screenings and noncoverage no-
tifications required in the Medicare program?: 1. Advanced Beneficiary Notice of Noncoverage
(ABN) for Part B services.
2. SNF ABN for Part A SNF services.
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
20. What is Medicare Part B ABN?: Used to explain to a Medicare patient that the ordered test or
services probably WILL NOT be covered by the Medicare b/c the DX info provided by the Dr. does NOT support the
need for these services.
****May also be used for voluntary notifications, in place of the Notice of Exclusion for Medicare Benefits (NEMB).
21. What is the Two-Midnight Rule?: Hospital admissions spanning 2 midnights would be considered
appropriate for payment under the IPPS rule
22. What are some MSP claims that require additional review by the OIG to
ensure compliance?: - W/C
- Black Lung Program services
CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representative Materials from HFMA
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representative Materials from HFMA
- Veterans Attairs (VA) services
- Federal grant programs
- Public Health Service programs (i.e Medicaid)
23. What are some cases where Medicare is the Secondary Payer?: - Working Aged
(commercial insurance is Primary)
- Accident or other liability (car/tort)
- End-Stage Renal Disease (ESRD)
- Disability
24. What code must be provided on UB-04 when billing Medicare as Primary
for accident or injury?: Occurrence Code 05 - ACCIDENT / NO MEDICAL OR LIABILITY COVERAGE
25. How long should a provider wait to bill Medicare after billing liability insur-
ance(s)?: 120 days
After 120 days, the provider has the option to CX liability claim and bill Medicare. Medicare will process the claim
under IPPS rules and recover payment from the liability health plan.
26. What is the Correct Coding Initiative (CCI)?: The CCI ensures that the most comprehensive
groups of codes, rather than the component parts, are billed.
27. What is a CCI edit?: The edits are built in the OP code editor, check for mutually exclusive code pairs.
The unit-of-service edits determine the max allowed # of services for each Healthcare Common Procedure Coding
System (HCPCS) code.
28. What are examples of Coding initiatives?: Modifiers, Exception, and modifiers used for OPPS
(Outpatient Prospective Payment System)
29. What is the Beneficiary Notices Initiative (BNI)?: Beneficiary Notices Initiative (BNI) details
the 9 ditterent types of financial liability notices required under both the traditional Medicare and Medicare Advantage
programs.
30. What are modifiers?: 2-digit #s OR alpha character that are appended to a CPT/HCPCS code to provide
more info about the service without changing its definition or code.
31. Can a service or procedure have both professional and technical compo-
nent?: Yes
32. How many levels of modifiers are used for OPPS (Outpatient Prospective
Payment System)?: 2 Levels
CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representative Materials from HFMA
1. In what situation(s) should a provider NOT use a modifier?: - CPT already indicates
2-4 lesions
- CPT indicates multiple extremities
2. What are other names for Three-Day Payment Window?: ALL OF THE ABOVE
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
3. What happens during the post-service stage?: Final coding, preparation and submission
of claims, payment processing, balance billing and resolution.
4. What are the below tasks part of?
- Educate patients
- Coordinate to avoid duplicate patient contacts
- Be consistent in key aspects of account resolution
- Follow best practices for communication: Best practices created by the Medical Debt Task Force
5. Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue
cycle initiative?: Process Compliance
6. Which option is NOT a continuum of care provider?
A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility: B. Health Plan Contracting
7. What is "implied certification"?: When it is implied that a provider met all compliance standards
before submitting a claim
8. Which of the following are essential elements of an effective compliance
program?
A. Established compliance standards and procedures.
B. Designation of a compliance officer employed within the Billing Depart-
ment.
C. Oversight of personnel by high-level personnel.
D. Automatic dismissal of any employee excluded from participation in a
CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representative Materials from HFMA
,CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representative Materials from HFMA
federal healthcare program.
E. Reasonable methods to achieve compliance with standards, including mon-
itoring systems and hotlines.: A. Established compliance standards and procedures.
C. Oversight of personnel by high-level personnel.
E. Reasonable methods to achieve compliance with standards, including monitoring systems and hotlines.
9. When was Health Information Technology for Economic and Clinical Health
(HITECH) Act signed into law?: FEB 17, 2009
10. When did HITECH Act become effective?: 2013
11. Annually, the OIG publishes a work plan of compliance issues and objec-
tives that will be focused on throughout the following year. Identify which
option is NOT a work plan task mentioned in this course.
A. Payments to Physicians for Co-Surgery Procedures
B. Denials and Appeals in Medicare Part D
C. Medicare Hospital Payments for Claims Involving the Acute- and
Post-Acute-Care Transfer Policies
D. Standard Unique Employer Identifier: D. Standard Unique Employer Identifier
12. What Plan are the tasks below a part of?
- Medicare Payments Made Outside of the Hospice Benefit
- Denials and Appeals in Medicare Part C and Part D
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits: The 2020
OIG Work Plan
13. When was the Preservation of Access to Care for Medicare Beneficiaries and
Pension Relief Act signed into law?: JUNE 25 2010
14. What is the Medicare DRG Three-Day Payment Window?: All Diagnostic services
provided to a Medicare patient by a hospital on the Date of the patient's Inpatient admission or during the 3 calendar
CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representative Materials from HFMA
,CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representative Materials from HFMA
days (or in the case of a non-IPPS hospital: 1 calendar day) immediately BEFORE the Date of Admission are REQUIRED
to be included on the bill for the IP stay (unless there is no Part A coverage)
15. Do Outpatient Non-Diagnostic Services qualify for separate payments if
provided with the Three-Day Payment Window?: No
16. What is modifier 59?: Used to identify CPTs OTHER THAN E&M services, NOT normally reported together,
but are appropriate under the circumstances.
Documentation must support a ditterent session, ditterent procedure or surgery, ditterent site or organ system,
separate.
17. What is condition code 51?: Code noted on the separate UB-04 OP claim, thus indicating the charge
is unrelated to the admission.
18. What kind of hospitals are the following:
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's
hospitals for examples: Non-IPPS hospitals
19. What are the 3 types of medical necessity screenings and noncoverage no-
tifications required in the Medicare program?: 1. Advanced Beneficiary Notice of Noncoverage
(ABN) for Part B services.
2. SNF ABN for Part A SNF services.
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
20. What is Medicare Part B ABN?: Used to explain to a Medicare patient that the ordered test or
services probably WILL NOT be covered by the Medicare b/c the DX info provided by the Dr. does NOT support the
need for these services.
****May also be used for voluntary notifications, in place of the Notice of Exclusion for Medicare Benefits (NEMB).
21. What is the Two-Midnight Rule?: Hospital admissions spanning 2 midnights would be considered
appropriate for payment under the IPPS rule
22. What are some MSP claims that require additional review by the OIG to
ensure compliance?: - W/C
- Black Lung Program services
CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representative Materials from HFMA
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representative Materials from HFMA
- Veterans Attairs (VA) services
- Federal grant programs
- Public Health Service programs (i.e Medicaid)
23. What are some cases where Medicare is the Secondary Payer?: - Working Aged
(commercial insurance is Primary)
- Accident or other liability (car/tort)
- End-Stage Renal Disease (ESRD)
- Disability
24. What code must be provided on UB-04 when billing Medicare as Primary
for accident or injury?: Occurrence Code 05 - ACCIDENT / NO MEDICAL OR LIABILITY COVERAGE
25. How long should a provider wait to bill Medicare after billing liability insur-
ance(s)?: 120 days
After 120 days, the provider has the option to CX liability claim and bill Medicare. Medicare will process the claim
under IPPS rules and recover payment from the liability health plan.
26. What is the Correct Coding Initiative (CCI)?: The CCI ensures that the most comprehensive
groups of codes, rather than the component parts, are billed.
27. What is a CCI edit?: The edits are built in the OP code editor, check for mutually exclusive code pairs.
The unit-of-service edits determine the max allowed # of services for each Healthcare Common Procedure Coding
System (HCPCS) code.
28. What are examples of Coding initiatives?: Modifiers, Exception, and modifiers used for OPPS
(Outpatient Prospective Payment System)
29. What is the Beneficiary Notices Initiative (BNI)?: Beneficiary Notices Initiative (BNI) details
the 9 ditterent types of financial liability notices required under both the traditional Medicare and Medicare Advantage
programs.
30. What are modifiers?: 2-digit #s OR alpha character that are appended to a CPT/HCPCS code to provide
more info about the service without changing its definition or code.
31. Can a service or procedure have both professional and technical compo-
nent?: Yes
32. How many levels of modifiers are used for OPPS (Outpatient Prospective
Payment System)?: 2 Levels
CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representative Materials from HFMA
