Certified Revenue Cycle Representative Certification Exam Questions and
Correct Answers
Question 1
How does utilization review staff use correct insurance information?
Correct Answer
To obtain approval for inpatient days and coordinate services
1. The disadvantages of outsourcing include all of the following EXCEPT:
a) The impact of customer service or patient relations
b) The impact of loss of direct control of accounts receivable services
c) Increased costs due to vendor ineffectiveness
d) Reduced internal staffing costs and a reliance on outsourced staff
Ans> Reduced internal staffing costs and a reliance on outsourced staff
>
2. The Medicare fee-for service appeal process for both beneficiaries and providers
includes all of the following levels EXCEPT:
a) Medical necessity review by an independent physician's panel
b) Judicial review by a federal district court
c) Redetermination by the company that handles claims for Medicare
d) Review by the Medicare Appeals Council (Appeals Council)
Ans> Judicial review by a federal district court
>
3. Business ethics, or organizational ethics represent:
a) The principles and standards by which organizations operate
b) Regulations that must be followed by law
c) Definitions of appropriate customer service
d) The code of acceptable conduct
Ans> The principles and standards by which organizations operate
>
,4. A portion of the accounts receivable inventory which has NOT qualified for billing
includes:
a) Charitable pledges
b) Accounts created during pre-registration but not activated
c) Accounts coded but held within the suspense period
d) Accounts assigned to a pre-collection agency
Ans> Charitable pledges
5. > Coverage Determinations (LCD) and National Coverage Determina-tions (NCD) are
Local
Medicare established guideline(s) used to determine:
a) Medicare and Medicaid provider eligibility
b) Medicare outpatient reimbursement rates
c) Which diagnoses, signs, or symptoms are reimbursable
d) What Medicare reimburses and what should be referred to Medicaid
Ans> Which diagnoses, signs, or symptoms are reimbursable
>
6. Days in A/R is calculated based on the value of:
a) The total accounts receivable on a specific date
b) Total anticipated revenue minus expenses
c) The time it takes to collect anticipated revenue
d) Total cash received to date
Ans> The time it takes to collect anticipated revenue
>
7. Patients are contacting hospitals to proactively inquire about costs and fees prior to
agreeing to service. The problem for hospitals in providing such information is:
a) That hospitals don't want to establish a price without knowing if the patient has
insurance and how much reimbursement can be expected
b) The fact that charge master lists the total charge, not net charges that reflect
charges after a payer's contractual adjustment
c) That hospitals don't want to be put in the position of "guaranteeing" price
without having room for additional charges that may arise in the course of
,treatment
d) Their reluctance to share proprietary information
Ans> The fact that charge master lists the total charge, not net charges that reflect charges
>
after a payer's contractual adjustment
8. Across all care settings, if a patient consents to a financial discussion during a
medical
encounter to expedite discharge, the HFMA best practice is to:
a) Make sure that the attending staff can answer questions and
assist in obtaining required patient financial data
b) Have a patient responsibilities kit ready for the patient, containing all of the
required registration forms and instructions
c) Support that choice, providing that the discussion does not interfere with
patient care or disrupt patient flow
d) Decline such request as finance discussions can disrupt patient care and patient flow
Support that choice, providing that the discussion does not interfere with patient care or disrupt
patient flow
Ans>
>
9. A comprehensive "Compliance Program" is defined as
a) Annual legal audit and review for adherence to regulations
b) Educating staff on regulations
c) Systematic procedures to ensure that the provisions of regulations im-posed by a
government
agency are being met
d) The development of operational policies that correspond to regulations
Ans> Systematic procedures to ensure that the provisions of regulations imposed by a
>
government
, 10. 10. Case Management requires that a case manager be assigned
a) To patients of any physician requesting case management
b) To a select patient group
c) To every patient
d) To specific cases designated by third party contractual agreement
Ans> To a select patient group
>
11. 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
a) Identify, compare, and choose providers that offer the desired level of value
b) Customize health care with a personally chosen mix of providers
c) Negotiate the cost of health plan premiums
d) Verify the cost of individual clinicians
Ans> Identify, compare, and choose providers that offer the desired level of
>
value
12. Any healthcare insurance plan that provides or ensures comprehensive health
maintenance and
treatment services for an enrolled group of persons based on a monthly fee is
known as a
a) MSO
b) HMO
c) PPO
d) GPO
Ans> HMO
>
13. In a Chapter 7 Straight Bankruptcy filing
4/
Correct Answers
Question 1
How does utilization review staff use correct insurance information?
Correct Answer
To obtain approval for inpatient days and coordinate services
1. The disadvantages of outsourcing include all of the following EXCEPT:
a) The impact of customer service or patient relations
b) The impact of loss of direct control of accounts receivable services
c) Increased costs due to vendor ineffectiveness
d) Reduced internal staffing costs and a reliance on outsourced staff
Ans> Reduced internal staffing costs and a reliance on outsourced staff
>
2. The Medicare fee-for service appeal process for both beneficiaries and providers
includes all of the following levels EXCEPT:
a) Medical necessity review by an independent physician's panel
b) Judicial review by a federal district court
c) Redetermination by the company that handles claims for Medicare
d) Review by the Medicare Appeals Council (Appeals Council)
Ans> Judicial review by a federal district court
>
3. Business ethics, or organizational ethics represent:
a) The principles and standards by which organizations operate
b) Regulations that must be followed by law
c) Definitions of appropriate customer service
d) The code of acceptable conduct
Ans> The principles and standards by which organizations operate
>
,4. A portion of the accounts receivable inventory which has NOT qualified for billing
includes:
a) Charitable pledges
b) Accounts created during pre-registration but not activated
c) Accounts coded but held within the suspense period
d) Accounts assigned to a pre-collection agency
Ans> Charitable pledges
5. > Coverage Determinations (LCD) and National Coverage Determina-tions (NCD) are
Local
Medicare established guideline(s) used to determine:
a) Medicare and Medicaid provider eligibility
b) Medicare outpatient reimbursement rates
c) Which diagnoses, signs, or symptoms are reimbursable
d) What Medicare reimburses and what should be referred to Medicaid
Ans> Which diagnoses, signs, or symptoms are reimbursable
>
6. Days in A/R is calculated based on the value of:
a) The total accounts receivable on a specific date
b) Total anticipated revenue minus expenses
c) The time it takes to collect anticipated revenue
d) Total cash received to date
Ans> The time it takes to collect anticipated revenue
>
7. Patients are contacting hospitals to proactively inquire about costs and fees prior to
agreeing to service. The problem for hospitals in providing such information is:
a) That hospitals don't want to establish a price without knowing if the patient has
insurance and how much reimbursement can be expected
b) The fact that charge master lists the total charge, not net charges that reflect
charges after a payer's contractual adjustment
c) That hospitals don't want to be put in the position of "guaranteeing" price
without having room for additional charges that may arise in the course of
,treatment
d) Their reluctance to share proprietary information
Ans> The fact that charge master lists the total charge, not net charges that reflect charges
>
after a payer's contractual adjustment
8. Across all care settings, if a patient consents to a financial discussion during a
medical
encounter to expedite discharge, the HFMA best practice is to:
a) Make sure that the attending staff can answer questions and
assist in obtaining required patient financial data
b) Have a patient responsibilities kit ready for the patient, containing all of the
required registration forms and instructions
c) Support that choice, providing that the discussion does not interfere with
patient care or disrupt patient flow
d) Decline such request as finance discussions can disrupt patient care and patient flow
Support that choice, providing that the discussion does not interfere with patient care or disrupt
patient flow
Ans>
>
9. A comprehensive "Compliance Program" is defined as
a) Annual legal audit and review for adherence to regulations
b) Educating staff on regulations
c) Systematic procedures to ensure that the provisions of regulations im-posed by a
government
agency are being met
d) The development of operational policies that correspond to regulations
Ans> Systematic procedures to ensure that the provisions of regulations imposed by a
>
government
, 10. 10. Case Management requires that a case manager be assigned
a) To patients of any physician requesting case management
b) To a select patient group
c) To every patient
d) To specific cases designated by third party contractual agreement
Ans> To a select patient group
>
11. 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
a) Identify, compare, and choose providers that offer the desired level of value
b) Customize health care with a personally chosen mix of providers
c) Negotiate the cost of health plan premiums
d) Verify the cost of individual clinicians
Ans> Identify, compare, and choose providers that offer the desired level of
>
value
12. Any healthcare insurance plan that provides or ensures comprehensive health
maintenance and
treatment services for an enrolled group of persons based on a monthly fee is
known as a
a) MSO
b) HMO
c) PPO
d) GPO
Ans> HMO
>
13. In a Chapter 7 Straight Bankruptcy filing
4/
