CRCR Review Questions
All diagnostic services provided to a MCR beneficiary by a hospital (or entity owned by the
hospital) on the date of the beneficiary's inpatient admission or during the ____ calendar
days immediately preceding the date of the admission are required to be included on the
inpatient bill. - ANS-3
Annually, the OIG publishes a work plan of compliance issues and objectives that will be
focused on throughout the following year. Identify which option is NOT a work plan task
mentioned in this course.
A) Standard Unique Employer Identifier
B) Provider-based status
C) Medical devices
D) Reconciliation of outlier payments - ANS-A) Standard Unique Employer Identifier
Approximately what ______% of billing information is obtained during the registration
process (Patient Access). - ANS-40%
For which levels of hospice care is only one rate applied to each day? (select all that apply)
A) Routine Home Care
B) Continuous Home Care
C) Inpatient Respite Care
D) General Inpatient Care - ANS-A, C, and D. - Home care is determined by the number of
furnished hours.
Hospice benefits for a Medicare beneficiary who is in a SNF cover professional management
of an individual's hospice care and the room and board for the individual. (T/F) - ANS-False -
It does not cover room and board.
IN order to promote the use of correct coding methods on a national basis and prevent
payment errors due to improper coding, the Centers for Medicare and Medicaid Services
(CMS) developed what?
A) The Correct Coding Initiative (CCI)
B) The Advance Beneficiary Notice of Noncoverage
C) The Medicare Secondary Payer (MSP)
D) Modifiers - ANS-A) The Correct Coding Initiative (CCI)
In order to qualify for Medicare Coverage of Home Health Service a patient must meet 2
conditions. - ANS-1) An MD must certify that a patient is confined to his/her residence (Not
necessarily bedridden). Leaving the home would be a considerable effort
2) Hospitals and SNFs may not be considered a place of residence for purposes of home
health coverage.
In what manner do case managers assist revenue cycle staff?
A) By reviewing a patient's individual case and recommend treatment changes.
B) With monitoring the progression of high resource consumptive cases.
C) By estimating how long the patient will be in the hospital and what the expected outcome
will be.
D) Providing assistance with written appeals to health plans related to utilization and other
care issues. - ANS-D) Providing assistance with written appeals to health plans related to
utilization and other care issues.
, Match each type of plan with the statements below. (HMO, PPO, POS, CDHP0>
A) A health plan that provides comprehensive healthcare services, within a designated
population, on a pre-payment basis.
B) A group of medical providers is identified to furnish services at lower than usual fees.
C) Members can refer themselves outside of the plan and still get some coverage.
D) Subscriber agrees to a high initial deductible, in return for lower premiums. - ANS-A)
HMO- A health plan that provides comprehensive healthcare services, within a designated
population, on a pre-payment basis.
B) PPO - A group of medical providers is identified to furnish services at lower than usual
fees.
C) POS - Members can refer themselves outside of the plan and still get some coverage.
D) CDHP - Subscriber agrees to a high initial deductible, in return for lower premiums.
Name the guideline that Medicare established to determine which diagnoses, signs, or
symptoms are payable.
A) Scheduling Instructions
B) Patient Identifiers
C) Local Coverage Determinations
D) Advance Beneficiary Notice - ANS-C) Local Coverage Determinations
What are claim edits?
A) Various data sources including Medicare and Medicaid bulletins and manuals, individual
health plan manuals.
B) The submission, receipt, and processing of automated claims, thereby eliminating
maintenance time and reducing data entry time.
C) A multi-stakeholder collaboration of more than 130 organizations - providers, health
plans, vendors, and government agencies.
D) Rules developed to verify the accuracy and completeness of claims based on each health
plan's policies. - ANS-D) Rules developed to verify the accuracy and completeness of claims
based on each health plan's policies.
What are KPIs?
A) Days in A/R is calculated based on the value of the total accounts receivable into 30, 60,
90, 120 days and over categories, based on the date of service/discharge.
C) Benchmarks which are used to compete Key Performance indicators is an organization to
an agreed upon average expected standard within the same industry.
D) Key Performance Indicators which set standards for accounts receivables (A/R) and
provide a method for measuring the collection and control of A/R. - ANS-D) Key
Performance Indicators which set standards for accounts receivables (A/R) and provide a
method for measuring the collection and control of A/R.
What do business/organizational ethics represent?
A) An employee's actions influenced by experiences and value system.
B) The patient privacy standard within health care
C) A healthcare provider's practices and principles
D) Principals and standards by which organizations operate. - ANS-D) Principals and
standards by which organizations operate.
What does EMTALA require hospitals to do?
A) To initially triage patients, where a "quick" registration record is generated to specifically
allow order entry.
B) To complete a standardized form signed by all patients that is used to inform the patient
about the admission and conditions with must be agreed upon.
All diagnostic services provided to a MCR beneficiary by a hospital (or entity owned by the
hospital) on the date of the beneficiary's inpatient admission or during the ____ calendar
days immediately preceding the date of the admission are required to be included on the
inpatient bill. - ANS-3
Annually, the OIG publishes a work plan of compliance issues and objectives that will be
focused on throughout the following year. Identify which option is NOT a work plan task
mentioned in this course.
A) Standard Unique Employer Identifier
B) Provider-based status
C) Medical devices
D) Reconciliation of outlier payments - ANS-A) Standard Unique Employer Identifier
Approximately what ______% of billing information is obtained during the registration
process (Patient Access). - ANS-40%
For which levels of hospice care is only one rate applied to each day? (select all that apply)
A) Routine Home Care
B) Continuous Home Care
C) Inpatient Respite Care
D) General Inpatient Care - ANS-A, C, and D. - Home care is determined by the number of
furnished hours.
Hospice benefits for a Medicare beneficiary who is in a SNF cover professional management
of an individual's hospice care and the room and board for the individual. (T/F) - ANS-False -
It does not cover room and board.
IN order to promote the use of correct coding methods on a national basis and prevent
payment errors due to improper coding, the Centers for Medicare and Medicaid Services
(CMS) developed what?
A) The Correct Coding Initiative (CCI)
B) The Advance Beneficiary Notice of Noncoverage
C) The Medicare Secondary Payer (MSP)
D) Modifiers - ANS-A) The Correct Coding Initiative (CCI)
In order to qualify for Medicare Coverage of Home Health Service a patient must meet 2
conditions. - ANS-1) An MD must certify that a patient is confined to his/her residence (Not
necessarily bedridden). Leaving the home would be a considerable effort
2) Hospitals and SNFs may not be considered a place of residence for purposes of home
health coverage.
In what manner do case managers assist revenue cycle staff?
A) By reviewing a patient's individual case and recommend treatment changes.
B) With monitoring the progression of high resource consumptive cases.
C) By estimating how long the patient will be in the hospital and what the expected outcome
will be.
D) Providing assistance with written appeals to health plans related to utilization and other
care issues. - ANS-D) Providing assistance with written appeals to health plans related to
utilization and other care issues.
, Match each type of plan with the statements below. (HMO, PPO, POS, CDHP0>
A) A health plan that provides comprehensive healthcare services, within a designated
population, on a pre-payment basis.
B) A group of medical providers is identified to furnish services at lower than usual fees.
C) Members can refer themselves outside of the plan and still get some coverage.
D) Subscriber agrees to a high initial deductible, in return for lower premiums. - ANS-A)
HMO- A health plan that provides comprehensive healthcare services, within a designated
population, on a pre-payment basis.
B) PPO - A group of medical providers is identified to furnish services at lower than usual
fees.
C) POS - Members can refer themselves outside of the plan and still get some coverage.
D) CDHP - Subscriber agrees to a high initial deductible, in return for lower premiums.
Name the guideline that Medicare established to determine which diagnoses, signs, or
symptoms are payable.
A) Scheduling Instructions
B) Patient Identifiers
C) Local Coverage Determinations
D) Advance Beneficiary Notice - ANS-C) Local Coverage Determinations
What are claim edits?
A) Various data sources including Medicare and Medicaid bulletins and manuals, individual
health plan manuals.
B) The submission, receipt, and processing of automated claims, thereby eliminating
maintenance time and reducing data entry time.
C) A multi-stakeholder collaboration of more than 130 organizations - providers, health
plans, vendors, and government agencies.
D) Rules developed to verify the accuracy and completeness of claims based on each health
plan's policies. - ANS-D) Rules developed to verify the accuracy and completeness of claims
based on each health plan's policies.
What are KPIs?
A) Days in A/R is calculated based on the value of the total accounts receivable into 30, 60,
90, 120 days and over categories, based on the date of service/discharge.
C) Benchmarks which are used to compete Key Performance indicators is an organization to
an agreed upon average expected standard within the same industry.
D) Key Performance Indicators which set standards for accounts receivables (A/R) and
provide a method for measuring the collection and control of A/R. - ANS-D) Key
Performance Indicators which set standards for accounts receivables (A/R) and provide a
method for measuring the collection and control of A/R.
What do business/organizational ethics represent?
A) An employee's actions influenced by experiences and value system.
B) The patient privacy standard within health care
C) A healthcare provider's practices and principles
D) Principals and standards by which organizations operate. - ANS-D) Principals and
standards by which organizations operate.
What does EMTALA require hospitals to do?
A) To initially triage patients, where a "quick" registration record is generated to specifically
allow order entry.
B) To complete a standardized form signed by all patients that is used to inform the patient
about the admission and conditions with must be agreed upon.
