Certified Revenue Cycle Representative -
CRCR (2021) Practice Exam
(Cumulative): Questions & Answers:
Complete Solution
Which of the following statements are true of HFMA's Financial Communications
Best Practices - Answer The best practices were developed specifically to help
patients understand the cost of services, their individual insurance benefits, and
their responsibility for balances after insurance, if any.
The patient experience includes all of the following except: - Answer The average
number of positive mentions received by the health system or practice and the
public comments refuting unfriendly posts on social media sites.
In what manner do case managers assist revenue cycle staff? - Answer 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.
,Why is it critical that a chargemaster is reviewed and updated regularly? - Answer
**A. To ensure it supports and represents the services provided within the
organization.
B. To ensure the most appropriate measure of the utilization of resources.
C. So the CPT databases can have the most current and accurate information.
D. Because charge descriptions can vary greatly between providers.
What is the responsibility of HIM? - Answer **A. To maintain all patient medical
records
B. To make information available instantly and securely to authorized users
C. To denote the medical procedures performed by a healthcare provider on a
patient
D. To substantiate health insurance claims filed by the patient, the physician, and
the provider
What are claim edits? - Answer A. Various data sources including Medicare and
Medicaid bulletins and manuals, individual health plan manuals
B. A multi-stakeholder collaboration of more than 130 organizations — providers,
health plans, vendors, and government agencies
,**C. Rules developed to verify the accuracy and completeness of claims based on
each health plan's policies
D. The submission, receipt, and processing of automated claims, thereby
eliminating mail time and reducing data entry time
Which statement is NOT a unique billing rule specific to providers? - Answer A.
Overall aggregate payments made to a hospice are subject to a "cap amount",
calculated by the MAC at the end of the hospice cap period.
B. With the exception of physician services, Medicare reimbursement for hospice
care is made at one of four pre-determined rates for each day of hospice care.
C. When billing services on a UB-04/837-I, specific CPT codes are collapsed into a
single revenue code (520 or 521).
**D. A patient may be balance billed for whatever amount the non-contracting
physician charges above the health plan's reimbursement amount.
Which of the following statements does not apply to billing during the COVID-19
public health emergency: - Answer A. Hospitals may change a sub-acute unit into
an acute care unit without advanced approval from CMS.
**B. Telemedicine claims are not payable if the patient conducts the telemedicine
visit from home.
C. CMS developed the concept of hospitals without walls to increase ICU and
med-surge inpatient capacity during the COVID-19 pandemic.
, D. Cost sharing has been waived for testing for COVID-19 in the ED, physician
office, urgent care center or other ambulatory location.
What is the sequential order for a Silent PPO scheme? - Answer The patient's
claims is sent to the listed primary insurance carrier
The patient's insurance company (a silent PPO) runs the healthcare provider's tax
ID number through a PPO discount database or provides a repricing company a
copy of the claim
After a successful "hit", the claim is "re-priced" based on the PPO discounts that
were accessed.
After applying the discount, the silent PPO states on the EOB that the healthcare
provider agreed to reduce your bill based on your contract with the PPO
The medical provider accepts the health plan's statement on the EOB and writes
the discount off-never knowing that the discount was invalid.
Which concept is NOT a contracted payment model? - Answer **A. Stop-Loss
Provision
CRCR (2021) Practice Exam
(Cumulative): Questions & Answers:
Complete Solution
Which of the following statements are true of HFMA's Financial Communications
Best Practices - Answer The best practices were developed specifically to help
patients understand the cost of services, their individual insurance benefits, and
their responsibility for balances after insurance, if any.
The patient experience includes all of the following except: - Answer The average
number of positive mentions received by the health system or practice and the
public comments refuting unfriendly posts on social media sites.
In what manner do case managers assist revenue cycle staff? - Answer 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.
,Why is it critical that a chargemaster is reviewed and updated regularly? - Answer
**A. To ensure it supports and represents the services provided within the
organization.
B. To ensure the most appropriate measure of the utilization of resources.
C. So the CPT databases can have the most current and accurate information.
D. Because charge descriptions can vary greatly between providers.
What is the responsibility of HIM? - Answer **A. To maintain all patient medical
records
B. To make information available instantly and securely to authorized users
C. To denote the medical procedures performed by a healthcare provider on a
patient
D. To substantiate health insurance claims filed by the patient, the physician, and
the provider
What are claim edits? - Answer A. Various data sources including Medicare and
Medicaid bulletins and manuals, individual health plan manuals
B. A multi-stakeholder collaboration of more than 130 organizations — providers,
health plans, vendors, and government agencies
,**C. Rules developed to verify the accuracy and completeness of claims based on
each health plan's policies
D. The submission, receipt, and processing of automated claims, thereby
eliminating mail time and reducing data entry time
Which statement is NOT a unique billing rule specific to providers? - Answer A.
Overall aggregate payments made to a hospice are subject to a "cap amount",
calculated by the MAC at the end of the hospice cap period.
B. With the exception of physician services, Medicare reimbursement for hospice
care is made at one of four pre-determined rates for each day of hospice care.
C. When billing services on a UB-04/837-I, specific CPT codes are collapsed into a
single revenue code (520 or 521).
**D. A patient may be balance billed for whatever amount the non-contracting
physician charges above the health plan's reimbursement amount.
Which of the following statements does not apply to billing during the COVID-19
public health emergency: - Answer A. Hospitals may change a sub-acute unit into
an acute care unit without advanced approval from CMS.
**B. Telemedicine claims are not payable if the patient conducts the telemedicine
visit from home.
C. CMS developed the concept of hospitals without walls to increase ICU and
med-surge inpatient capacity during the COVID-19 pandemic.
, D. Cost sharing has been waived for testing for COVID-19 in the ED, physician
office, urgent care center or other ambulatory location.
What is the sequential order for a Silent PPO scheme? - Answer The patient's
claims is sent to the listed primary insurance carrier
The patient's insurance company (a silent PPO) runs the healthcare provider's tax
ID number through a PPO discount database or provides a repricing company a
copy of the claim
After a successful "hit", the claim is "re-priced" based on the PPO discounts that
were accessed.
After applying the discount, the silent PPO states on the EOB that the healthcare
provider agreed to reduce your bill based on your contract with the PPO
The medical provider accepts the health plan's statement on the EOB and writes
the discount off-never knowing that the discount was invalid.
Which concept is NOT a contracted payment model? - Answer **A. Stop-Loss
Provision
