CRCR EXAM MULTIPLE CHOICE, CRCR Exam Prep, Certified Revenue Cycle Representative - CRCR (2021) questions and answers well illustrated.

CRCR EXAM MULTIPLE CHOICE, CRCR Exam Prep, Certified Revenue Cycle Representative - CRCR (2021) questions and answers well illustrated. What are collection agency fees based on? - correct answer. A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - correct answer. Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - correct answer. Case rates What customer service improvements might improve the patient accounts department? - correct answer. Holding staff accountable for customer service during performance reviews What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - correct answer. Inform a Medicare beneficiary that Medicare may not pay for the order or service What type of account adjustment results from the patient's unwillingness to pay for a self-pay balance? - correct answer. Bad debt adjustment What is the initial hospice benefit? - correct answer. Two 90-day periods and an unlimited number of subsequent periods When does a hospital add ambulance charges to the Medicare inpatient claim? - correct answer. If the patient requires ambulance transportation to a skilled nursing facility How should a provider resolve a late-charge credit posted after an account is billed? - correct answer. Post a late-charge adjustment to the account an increase in the dollars aged greater than 90 days from date of service indicate what about accounts - correct answer. They are not being processed in a timely manner What is an advantage of a preregistration program? - correct answer. It reduces processing times at the time of service What are the two statutory exclusions from hospice coverage? - correct answer. Medically unnecessary services and custodial care What core financial activities are resolved within patient access? - correct answer. Scheduling, insurance verification, discharge processing, and payment of point-of-service receipts What statement applies to the scheduled outpatient? - correct answer. The services do not involve an overnight stay How is a mis-posted contractual allowance resolved? - correct answer. Comparing the contract reimbursement rates with the contract on the admittance advice to identify the correct amount What type of patient status is used to evaluate the patient's need for inpatient care? - correct answer. Observation Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has received what? - correct answer. Medically necessary inpatient hospital services for at least 3 consecutive days before the skilled nursing care admission When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - correct answer. When the patient is the insured What are non-emergency patients who come for service without prior notification to the provider called? - correct answer. Unscheduled patients If the insurance verification response reports that a subscriber has a single policy, what is the status of the subscriber's spouse? - correct answer. Neither enrolled not entitled to benefits Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act, establishes what? - correct answer. Disclosure rules for consumer credit sales and consumer loans What is a principal diagnosis? - correct answer. Primary reason for the patient's admission Collecting patient liability dollars after service leads to what? - correct answer. Lower accounts receivable levels What is the daily out-of-pocket amount for each lifetime reserve day used? - correct answer. 50% of the current deductible amount What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as an RHC services? - correct answer. Inpatient care What code indicates the disposition of the patient at the conclusion of service? - correct answer. Patient discharge status code What are hospitals required to do for Medicare credit balance accounts? - correct answer. They result in lost reimbursement and additional cost to collect When an undue delay of payment results from a dispute between the patient and the third party payer, who is responsible for payment? - correct answer. Patient Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include: - correct answer. A valid CPT or HCPCS code With advances in internet security and encryption, revenue-cycle processes are expanding to allow patients to do what? - correct answer. Access their information and perform functions on-line What date is required on all CMS 1500 claim forms? - correct answer. onset date of current illness What does scheduling allow provider staff to do - correct answer. Review appropriateness of the service request What code is used to report the provider's most common semiprivate room rate? - correct answer. Condition code Regulations and requirements for coding accountable care organizations, which allows providers to begin creating these organizations, were finalized in: - correct answer. 2012 What is a primary responsibility of the Recover Audit Contractor? - correct answer. To correctly identify proper payments for Medicare Part A & B claims How must providers handle credit balances? - correct answer. Comply with state statutes concerning reporting credit balance Insurance verification results in what? - correct answer. The accurate identification of the patient's eligibility and benefits What form is used to bill Medicare for rural health clinics? - correct answer. CMS 1500 What activities are completed when a scheduled pre-registered patient arrives for service? - correct answer. Registering the patient and directing the patient to the service area In addition to being supported by information found in the patient's chart, a CMS 1500 claim must be coded using what? - correct answer. HCPCS (Healthcare Common Procedure Coding system) What results from a denied claim? - correct answer. The provider incurs rework and appeal costs Why does the financial counselor need pricing for services? - correct answer. To calculate the patient's financial responsibility What type of provider bills third-party payers using CMS 1500 form - correct answer. Hospital-based mammography centers How are disputes with nongovernmental payers resolved? - correct answer. Appeal conditions specified in the individual payer's contract The important message from Medicare provides beneficiaries with information concerning what? - correct 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? - correct 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? - correct 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? - correct answer. 120 days passes, but the claim then be withdrawn from the liability carrier What data are required to establish a new MPI entry? - correct 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? - correct answer. Determine the correct payer and notify the incorrect payer of the processing error What do EMTALA regulations require on-call physicians to do? - correct 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? - correct answer. They must be balanced What will cause a CMS 1500 claim to be rejected? - correct 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? - correct answer. The cost of the test how are HCPCS codes and the appropriate modifiers used? - correct 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? - correct 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? - correct answer. Patient arrival processing is expedited, reducing wait times and delays What is a characteristic of a managed contracting methodology? - correct answer. Prospectively set rates for inpatient and outpatient services What do the MSP disability rules require? - correct 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? - correct answer. Blue Cross and blue Shield What is true about screening a beneficiary for possible MSP situations? - correct answer. It is acceptable to complete the screening form after the patient has completed the registration process and been sent to the service department