CRCR Exam Prep
1. 90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for
liability claims after what happens? - ANS-120 days passes, but the claim then be
withdrawn from the liability carrier
2. Access - ANS-An individual's ability to obtain medical services on a timely and
financially acceptable level
3. According to the Department of Health and Human Services guidelines, what is NOT
considered income? - ANS-Sale of property, house, or car
4. Administrative Services Only (ASO) - ANS-Usually contracted administrative services
to a self-insured health plan
5. an increase in the dollars aged greater than 90 days from date of service indicate
what about accounts - ANS-They are not being processed in a timely manner
6. At the end of each shift, what must happen to cash, checks, and credit card
transaction documents? - ANS-They must be balanced
7. Care purchaser - ANS-Individual or entity that contributes to the purchase of
healthcare services
8. Case management - ANS-The process whereby all health-related components of a
case are managed by a designated health professional. Intended to ensure continuity
of healthcare accessibility and services
9. Charge - ANS-The dollar amount a provider sets for services rendered before
negotiating any discounts. The charge can be different from the amount paid
10. Claim - ANS-A demand by an insured person for the benefits provided by the group
contract
11. Collecting patient liability dollars after service leads to what? - ANS-Lower accounts
receivable levels
12. Coordination of benefits (COB) - ANS-a typical insurance provision that determines
the responsibility for primary payment when the patient is covered by more than one
employer-sponsored health benefit program
13. Cost - ANS-The definition of cost varies by party incurring the expense
14. Coverage rules for Medicare beneficiaries receiving skilled nursing care require that
the beneficiary has received what? - ANS-Medically necessary inpatient hospital
services for at least 3 consecutive days before the skilled nursing care admission
15. Discounted fee-for-service - ANS-A reimbursement methodology whereby a provider
agrees to provide service on a fee for service basis, but the fees are discounted by
certain packages
16. Eligibility - ANS-Patient status regarding coverage for healthcare insurance benefits
17. ESRD - ANS-End-stage renal disease. The patient has permanent kidney failure, is
covered by a GHP, and has not yet completed the 30-month coordination period
18. Every patient who is new to the healthcare provider must be offered what? - ANS-A
printed copy of the provider's privacy notice
19. FERA - ANS-Fraud Enforcement and Recovery act
20. First dollar coverage - ANS-A healthcare insurance policy that has no deductible and
covers the first dollar of an insured's expenses
, 21. Gatekeeping - ANS-A concept wherein the primary care physician provides all
primary patient care and coordinates all diagnostic testing and specialty referrals
required for a patient's medical care
22. Health plan - ANS-an insurance company that provides for the delivery or payment of
healthcare services
23. How are disputes with nongovernmental payers resolved? - ANS-Appeal conditions
specified in the individual payer's contract
24. how are HCPCS codes and the appropriate modifiers used? - ANS-To report the
level 1, 2, or 3 code that correctly describes the service provided
25. How are patient reminder calls used? - ANS-To make sure the patient follows the
prep instructions and arrives at the scheduled time for service
26. How does utilization review staff use correct insurance information? - ANS-To obtain
approval for inpatient days and coordinate services
27. How is a mis-posted contractual allowance resolved? - ANS-Comparing the contract
reimbursement rates with the contract on the admittance advice to identify the correct
amount
28. How may a collection agency demonstrate its performance? - ANS-Calculate the rate
of recovery
29. How must providers handle credit balances? - ANS-Comply with state statutes
concerning reporting credit balance
30. How should a provider resolve a late-charge credit posted after an account is billed?
- ANS-Post a late-charge adjustment to the account
31. If a Medicare patient is admitted on Friday, what services fall within the three-day
DRG window rule? - ANS-Diagnostic and clinically-related non-diagnostic charges
provided on the Tuesday, Wednesday, Thursday, and Friday before admission
32. If a patient declares a straight bankruptcy, what must the provider do? - ANS-Write
off the account to the contractual adjustment account
33. If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30
days, what is the SNF permitted to do? - ANS-Submit interim bills to the Medicare
program.
34. IF outpatient diagnostic services are provided within three days of the admission of a
Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital,
what must happen to these charges - ANS-They must be combined with the inpatient
bill and paid under the MS-DRG system
35. If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse? - ANS-Neither enrolled not entitled to
benefits
36. If the patient cannot agree to payment arrangements, what is the next option? -
ANS-Warn the patient that unpaid accounts are placed with collection agencies for
further processing
37. In addition to being supported by information found in the patient's chart, a CMS
1500 claim must be coded using what? - ANS-HCPCS (Healthcare Common
Procedure Coding system)
38. In services lines such as cardiology or orthopedics, what does the case-rate payment
methodology allow providers to do? - ANS-Receive a fixed for specific procedures
39. In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - ANS-Case rates
1. 90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for
liability claims after what happens? - ANS-120 days passes, but the claim then be
withdrawn from the liability carrier
2. Access - ANS-An individual's ability to obtain medical services on a timely and
financially acceptable level
3. According to the Department of Health and Human Services guidelines, what is NOT
considered income? - ANS-Sale of property, house, or car
4. Administrative Services Only (ASO) - ANS-Usually contracted administrative services
to a self-insured health plan
5. an increase in the dollars aged greater than 90 days from date of service indicate
what about accounts - ANS-They are not being processed in a timely manner
6. At the end of each shift, what must happen to cash, checks, and credit card
transaction documents? - ANS-They must be balanced
7. Care purchaser - ANS-Individual or entity that contributes to the purchase of
healthcare services
8. Case management - ANS-The process whereby all health-related components of a
case are managed by a designated health professional. Intended to ensure continuity
of healthcare accessibility and services
9. Charge - ANS-The dollar amount a provider sets for services rendered before
negotiating any discounts. The charge can be different from the amount paid
10. Claim - ANS-A demand by an insured person for the benefits provided by the group
contract
11. Collecting patient liability dollars after service leads to what? - ANS-Lower accounts
receivable levels
12. Coordination of benefits (COB) - ANS-a typical insurance provision that determines
the responsibility for primary payment when the patient is covered by more than one
employer-sponsored health benefit program
13. Cost - ANS-The definition of cost varies by party incurring the expense
14. Coverage rules for Medicare beneficiaries receiving skilled nursing care require that
the beneficiary has received what? - ANS-Medically necessary inpatient hospital
services for at least 3 consecutive days before the skilled nursing care admission
15. Discounted fee-for-service - ANS-A reimbursement methodology whereby a provider
agrees to provide service on a fee for service basis, but the fees are discounted by
certain packages
16. Eligibility - ANS-Patient status regarding coverage for healthcare insurance benefits
17. ESRD - ANS-End-stage renal disease. The patient has permanent kidney failure, is
covered by a GHP, and has not yet completed the 30-month coordination period
18. Every patient who is new to the healthcare provider must be offered what? - ANS-A
printed copy of the provider's privacy notice
19. FERA - ANS-Fraud Enforcement and Recovery act
20. First dollar coverage - ANS-A healthcare insurance policy that has no deductible and
covers the first dollar of an insured's expenses
, 21. Gatekeeping - ANS-A concept wherein the primary care physician provides all
primary patient care and coordinates all diagnostic testing and specialty referrals
required for a patient's medical care
22. Health plan - ANS-an insurance company that provides for the delivery or payment of
healthcare services
23. How are disputes with nongovernmental payers resolved? - ANS-Appeal conditions
specified in the individual payer's contract
24. how are HCPCS codes and the appropriate modifiers used? - ANS-To report the
level 1, 2, or 3 code that correctly describes the service provided
25. How are patient reminder calls used? - ANS-To make sure the patient follows the
prep instructions and arrives at the scheduled time for service
26. How does utilization review staff use correct insurance information? - ANS-To obtain
approval for inpatient days and coordinate services
27. How is a mis-posted contractual allowance resolved? - ANS-Comparing the contract
reimbursement rates with the contract on the admittance advice to identify the correct
amount
28. How may a collection agency demonstrate its performance? - ANS-Calculate the rate
of recovery
29. How must providers handle credit balances? - ANS-Comply with state statutes
concerning reporting credit balance
30. How should a provider resolve a late-charge credit posted after an account is billed?
- ANS-Post a late-charge adjustment to the account
31. If a Medicare patient is admitted on Friday, what services fall within the three-day
DRG window rule? - ANS-Diagnostic and clinically-related non-diagnostic charges
provided on the Tuesday, Wednesday, Thursday, and Friday before admission
32. If a patient declares a straight bankruptcy, what must the provider do? - ANS-Write
off the account to the contractual adjustment account
33. If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30
days, what is the SNF permitted to do? - ANS-Submit interim bills to the Medicare
program.
34. IF outpatient diagnostic services are provided within three days of the admission of a
Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital,
what must happen to these charges - ANS-They must be combined with the inpatient
bill and paid under the MS-DRG system
35. If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse? - ANS-Neither enrolled not entitled to
benefits
36. If the patient cannot agree to payment arrangements, what is the next option? -
ANS-Warn the patient that unpaid accounts are placed with collection agencies for
further processing
37. In addition to being supported by information found in the patient's chart, a CMS
1500 claim must be coded using what? - ANS-HCPCS (Healthcare Common
Procedure Coding system)
38. In services lines such as cardiology or orthopedics, what does the case-rate payment
methodology allow providers to do? - ANS-Receive a fixed for specific procedures
39. In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - ANS-Case rates
