CRCR EXAM MULTIPLE CHOICE,
CRCR Exam Prep, Certified Revenue
Cycle Representative - CRCR (2027)
Questions And Answers
What type of provider bills third-party payers using CMS 1500 form - ANSWER -
Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? - ANSWER -Appeal
conditions specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - ANSWER -Right to appeal a discharge decision if the patient
disagrees with the services
Why do managed care plans have agreements with hospitals, physicians, and other
healthcare providers to offer a range of services to plan members? - ANSWER -To
improve access to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than
30 days, what is the SNF permitted to do? - ANSWER -Submit interim bills to the
Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for
liability claims after what happens? - ANSWER -120 days passes, but the claim
then be withdrawn from the liability carrier
What data are required to establish a new MPI entry? - ANSWER -The patient's
full legal name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as
primary? - ANSWER -Determine the correct payer and notify the incorrect payer
of the processing error
, What do EMTALA regulations require on-call physicians to do? - ANSWER -
Personally appear in the emergency department and attend to the patient within a
reasonable time
At the end of each shift, what must happen to cash, checks, and credit card
transaction documents? - ANSWER -They must be balanced
What will cause a CMS 1500 claim to be rejected? - ANSWER -The provider is
billing with a future date of service
Under Medicare regulations, which of the following is not included on a valid
physician's order for services? - ANSWER -The cost of the test
how are HCPCS codes and the appropriate modifiers used? - ANSWER -To
report the level 1, 2, or 3 code that correctly describes the service provided
If a Medicare patient is admitted on Friday, what services fall within the three-day
DRG window rule? - ANSWER -Diagnostic and clinically-related non-diagnostic
charges provided on the Tuesday, Wednesday, Thursday, and Friday before
admission
What is a benefit of pre-registering patient's for service? - ANSWER -Patient
arrival processing is expedited, reducing wait times and delays
What is a characteristic of a managed contracting methodology? - ANSWER -
Prospectively set rates for inpatient and outpatient services
What do the MSP disability rules require? - ANSWER -That the patient's spouse's
employer must have less than 20 employees in the group health plan
what organization originated the concept of insuring prepaid health care services?
- ANSWER -Blue Cross and blue Shield
, What is true about screening a beneficiary for possible MSP situations? -
ANSWER -It is acceptable to complete the screening form after the patient has
completed the registration process and been sent to the service department
If the patient cannot agree to payment arrangements, what is the next option? -
ANSWER -Warn the patient that unpaid accounts are placed with collection
agencies for further processing
In services lines such as cardiology or orthopedics, what does the case-rate
payment methodology allow providers to do? - ANSWER -Receive a fixed for
specific procedures
What will comprehensive patient access processing accomplish? - ANSWER -
Minimize the need for follow-up on insurance accounts
Through what document does a hospital establish compliance standards? -
ANSWER -Code of conduct
How does utilization review staff use correct insurance information? - ANSWER
-To obtain approval for inpatient days and coordinate services
When is it not appropriate to use observation status? - ANSWER -As a substitute
for an inpatient admission
What is a serious consequence of misidentifying a patient in the MPI? -
ANSWER -The services will be documented in the wrong record
When a patient reports directly to a clinical department for service, what will the
clinical department staff do? - ANSWER -Redirect the patient to the patient access
department for registration
What process can be used to shorten claim turnaround time? - ANSWER -Send
high-dollar hard-copy claims with required attachments by overnight mail or
registered mail
, How are patient reminder calls used? - ANSWER -To make sure the patient
follows the prep instructions and arrives at the scheduled time for service
If a patient declares a straight bankruptcy, what must the provider do? -
ANSWER -Write off the account to the contractual adjustment account
According to the Department of Health and Human Services guidelines, what is
NOT considered income? - ANSWER -Sale of property, house, or car
The situation where neither the patient nor spouse is employed is described to the
patient using: - ANSWER -A condition code
What option is an alternative to valid long-term payment plans? - ANSWER -
Bank loans
What is an advantage of using a collection agency to collect delinquent patient
accounts? - ANSWER -Collection agencies collect accounts faster than hospital
does
What statement DOES NOT apply to revenue codes? - ANSWER -revenue codes
identify the payer
When a patient's illness results in an unusually high amount of medical bills not
covered by insurance or other patient pay resources, what type of account is
created - ANSWER -catastrophic charity
What happens when a patient receives non-emergent services from and out-of-
network provider? - ANSWER -Patient payment responsibility is higher
Every patient who is new to the healthcare provider must be offered what? -
ANSWER -A printed copy of the provider's privacy notice
How may a collection agency demonstrate its performance? - ANSWER -
Calculate the rate of recovery
CRCR Exam Prep, Certified Revenue
Cycle Representative - CRCR (2027)
Questions And Answers
What type of provider bills third-party payers using CMS 1500 form - ANSWER -
Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? - ANSWER -Appeal
conditions specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - ANSWER -Right to appeal a discharge decision if the patient
disagrees with the services
Why do managed care plans have agreements with hospitals, physicians, and other
healthcare providers to offer a range of services to plan members? - ANSWER -To
improve access to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than
30 days, what is the SNF permitted to do? - ANSWER -Submit interim bills to the
Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for
liability claims after what happens? - ANSWER -120 days passes, but the claim
then be withdrawn from the liability carrier
What data are required to establish a new MPI entry? - ANSWER -The patient's
full legal name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as
primary? - ANSWER -Determine the correct payer and notify the incorrect payer
of the processing error
, What do EMTALA regulations require on-call physicians to do? - ANSWER -
Personally appear in the emergency department and attend to the patient within a
reasonable time
At the end of each shift, what must happen to cash, checks, and credit card
transaction documents? - ANSWER -They must be balanced
What will cause a CMS 1500 claim to be rejected? - ANSWER -The provider is
billing with a future date of service
Under Medicare regulations, which of the following is not included on a valid
physician's order for services? - ANSWER -The cost of the test
how are HCPCS codes and the appropriate modifiers used? - ANSWER -To
report the level 1, 2, or 3 code that correctly describes the service provided
If a Medicare patient is admitted on Friday, what services fall within the three-day
DRG window rule? - ANSWER -Diagnostic and clinically-related non-diagnostic
charges provided on the Tuesday, Wednesday, Thursday, and Friday before
admission
What is a benefit of pre-registering patient's for service? - ANSWER -Patient
arrival processing is expedited, reducing wait times and delays
What is a characteristic of a managed contracting methodology? - ANSWER -
Prospectively set rates for inpatient and outpatient services
What do the MSP disability rules require? - ANSWER -That the patient's spouse's
employer must have less than 20 employees in the group health plan
what organization originated the concept of insuring prepaid health care services?
- ANSWER -Blue Cross and blue Shield
, What is true about screening a beneficiary for possible MSP situations? -
ANSWER -It is acceptable to complete the screening form after the patient has
completed the registration process and been sent to the service department
If the patient cannot agree to payment arrangements, what is the next option? -
ANSWER -Warn the patient that unpaid accounts are placed with collection
agencies for further processing
In services lines such as cardiology or orthopedics, what does the case-rate
payment methodology allow providers to do? - ANSWER -Receive a fixed for
specific procedures
What will comprehensive patient access processing accomplish? - ANSWER -
Minimize the need for follow-up on insurance accounts
Through what document does a hospital establish compliance standards? -
ANSWER -Code of conduct
How does utilization review staff use correct insurance information? - ANSWER
-To obtain approval for inpatient days and coordinate services
When is it not appropriate to use observation status? - ANSWER -As a substitute
for an inpatient admission
What is a serious consequence of misidentifying a patient in the MPI? -
ANSWER -The services will be documented in the wrong record
When a patient reports directly to a clinical department for service, what will the
clinical department staff do? - ANSWER -Redirect the patient to the patient access
department for registration
What process can be used to shorten claim turnaround time? - ANSWER -Send
high-dollar hard-copy claims with required attachments by overnight mail or
registered mail
, How are patient reminder calls used? - ANSWER -To make sure the patient
follows the prep instructions and arrives at the scheduled time for service
If a patient declares a straight bankruptcy, what must the provider do? -
ANSWER -Write off the account to the contractual adjustment account
According to the Department of Health and Human Services guidelines, what is
NOT considered income? - ANSWER -Sale of property, house, or car
The situation where neither the patient nor spouse is employed is described to the
patient using: - ANSWER -A condition code
What option is an alternative to valid long-term payment plans? - ANSWER -
Bank loans
What is an advantage of using a collection agency to collect delinquent patient
accounts? - ANSWER -Collection agencies collect accounts faster than hospital
does
What statement DOES NOT apply to revenue codes? - ANSWER -revenue codes
identify the payer
When a patient's illness results in an unusually high amount of medical bills not
covered by insurance or other patient pay resources, what type of account is
created - ANSWER -catastrophic charity
What happens when a patient receives non-emergent services from and out-of-
network provider? - ANSWER -Patient payment responsibility is higher
Every patient who is new to the healthcare provider must be offered what? -
ANSWER -A printed copy of the provider's privacy notice
How may a collection agency demonstrate its performance? - ANSWER -
Calculate the rate of recovery
