CRCR CERTIFICATION REVIEW QUESTION
SET WITH ACCURATE ANSWERS
◉ In addition to being supported by information found in the
patient's chart, a CMS 1500 claim must be coded using what?
Answer: HCPCS (Healthcare Common Procedure Coding system)
◉ What results from a denied claim?
Answer: The provider incurs rework and appeal costs
◉ Why does the financial counselor need pricing for services?
Answer: To calculate the patient's financial responsibility
◉ 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Answer: 120 days passes, but the claim then be withdrawn from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
SET WITH ACCURATE ANSWERS
◉ In addition to being supported by information found in the
patient's chart, a CMS 1500 claim must be coded using what?
Answer: HCPCS (Healthcare Common Procedure Coding system)
◉ What results from a denied claim?
Answer: The provider incurs rework and appeal costs
◉ Why does the financial counselor need pricing for services?
Answer: To calculate the patient's financial responsibility
◉ 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
