CRCR EXAM TEST BANK LATEST 2023-2025 WITH 200+
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
100% COMPLETE//ALREADY GRADED A+
What is the comprehensive care for joint replacement? - ANSWER-Model that aims to better and make
more efficient care for beneficiaries undergoing the most common inpatient surgeries for Medicare
beneficiaries: hip and knee replacements.
What are the standard quality measures? - ANSWER-Tools that help us measure or quantify healthcare
processes, outcomes, patient perceptions and organizational structure that are associated with the
ability to provide high-quality healthcare.
What is the purpose of a financial report? - ANSWER-Present info that may be used by others to make
determinations regarding the financial status of an organization
What is a balance sheet? - ANSWER-A summary of the organization's wealth as of the date of the
statement. Includes assets, liabilities, and accumulated excesses from operations minus any accumulated
losses
What is net assets? - ANSWER-Net value of excesses and losses
What is an income statement? - ANSWER-A report of net income or loss over an accounting period
What is a cash flow statement? - ANSWER-Summary of how cash was used and where it was obtained
What is accrual accounting? - ANSWER-Revenue is recorded when it is earned to permit the alignment of
revenue with associate expenses
What is cash accounting? - ANSWER-you record when the payment is done
What is fund accounting? - ANSWER-Method to manage categories of net assets to ensure compliance
with the restrictions on those funds
,What is gross revenue? - ANSWER-Total incurred charges entered for all patients for the services they
received
What is net revenue? - ANSWER-Gross revenue minus an estimate of the dollar amount of contractual,
discount or other allowances
What is an explicit price concession? - ANSWER-The discounted contractual agreements between the
provider and the payers which specify the payments due from the payers
What is an implicit price concession? - ANSWER-A concession applied to amounts that are to be paid by
patients based on the expected payment results for a specific portfolio of receivables
What are bad debts? - ANSWER-The portion of patient liability which cannot be collected from the
patient. These accounts represent a failure to pay and not an inability to pay on the part of the patient.
What is charity care? - ANSWER-Care provided to a patient who does not have the ability to pay for the
services or portion of the services received
What are key performance indicators? (KPI) - ANSWER-Standards for A/R and provide a method of
measuring the collection and control of A/R
What are MAP Keys? - ANSWER-Strategic KPIs that set the standard for patient-centric revenue cycle
excellence in the healthcare industry
What is the net A/R? - ANSWER-The balance sheet divided by average daily net patient service revenue
from the income statement
What is cost to collect? - ANSWER-Revenue cycle cost divided by total patient service cash collected
What is net collection rate? - ANSWER-how much cash was collected as a % of available to collect?
What is point of service cash? - ANSWER-the percentage of patient cash collected at or up to seven days
after an encounter as a percentage of total self-pay cash collected for the period
,Which patient types are typically considered acute care patient types? - ANSWER-Observation, newborn,
emergency (ED)
Accurate identification of the patient is the first step in the scheduling process. Identifiers used in various
combination to achieve accurate patient identification include? - ANSWER-Full legal name, date of birth,
sex and social security number
Pre-registration is defined as: - ANSWER-The collection of demographic info, insurance data, financial
info, providing reminders, prep info and identifying the potential need for financial assistance for
scheduled patients
Which of the following statements accurately describe the various Medicare benefit programs: -
ANSWER-Medicare Part A provides benefits for inpatient hospital services, SNF and home health care;
Medicare Part B covers outpatient and professional services; Medicare Part C or Medicare Advantage
plans are managed care plans combining Part A and Part B coverages; and Medicare Part D is the
prescription drug coverage benefit
Which of the following statements about Medicaid eligibility is not true? - ANSWER-Medicaid categories
are restricted to children, pregnant women and elderly in nursing homes
Examples of managed care plans include: - ANSWER-HMO, PPO and EPO plans
POS, Concierge plans, Medicare Advantage plans
Direct contracting for specific services from specific provisions
Patient Financial Communications best practices include all of the following activities except: -
ANSWERCollecting payment or initiating the process to immediately remove the patient from the service
schedule
Which statement includes the required components of an accurate pricing determination: -
ANSWERInsurance coverage and benefits, service or test involved, diagnosis and procedure codes, total
estimated charges, adjudication calculations based on the patient's benefit package.
The value of a robust scheduling and pre-registration process includes all of the following except: -
, ANSWER-Identification of patients who are likely to be no shows
What services to healthcare facilities normally schedule ahead of time? - ANSWER-High-dollar services
and those that require significant pre-processing to ensure appropriate reimbursement; other services
are scheduled ahead of time to reduce wait times and maximize patient flow
What is the most common type of unscheduled admissions? - ANSWER-The emergency department
What is direct or urgent admission? - ANSWER-When a physician sends the patient directly to the
hospital because the condition meets the need for an inpatient stay; if the doctor calls ahead they are
considered scheduled
What are the non-acute patient types? - ANSWER-Skilled nursing, hospice, home health, durable medical
equipment and clinic patients
When does Medicare cover a SNF stay? - ANSWER-When the patient was in the hospital for at least a 3
day inpatient stay
What is a 270 transaction? - ANSWER-The outbound inquiry from the provider to the health plan
What is a 271 transaction? - ANSWER-The response back to the provider's eligibility inquiry
What are the Medicare Part A benefits? - ANSWER-A beneficiary remains in the same "benefit period"
until they are hospitalization/SNF free for 60 days
A deductible is due at the beginning of each benefit period. Medicare will pay full benefits for 60 days in
a benefit period. The full days renew with each benefit period. After the full 60 days in a benefit period,
there are 30 coins days where the beneficiary pays a daily expense equal to 25% of the current
deductible amount due. After the full 60 days and 30 coins days are used, a patient can opt to use
lifetime reserve days. The daily out of pocket for each LTR is 50% of the current deductible amount.
These are used once and never reviewed. Once the 60 full, 30 coins and 60 LTR used, the patient has no
more Part A benefits and part B needs to be billed
Who is eligible for Medicaid? - ANSWER-Low income families, qualified pregnant women and children
and individuals receiving supplemental security income
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
100% COMPLETE//ALREADY GRADED A+
What is the comprehensive care for joint replacement? - ANSWER-Model that aims to better and make
more efficient care for beneficiaries undergoing the most common inpatient surgeries for Medicare
beneficiaries: hip and knee replacements.
What are the standard quality measures? - ANSWER-Tools that help us measure or quantify healthcare
processes, outcomes, patient perceptions and organizational structure that are associated with the
ability to provide high-quality healthcare.
What is the purpose of a financial report? - ANSWER-Present info that may be used by others to make
determinations regarding the financial status of an organization
What is a balance sheet? - ANSWER-A summary of the organization's wealth as of the date of the
statement. Includes assets, liabilities, and accumulated excesses from operations minus any accumulated
losses
What is net assets? - ANSWER-Net value of excesses and losses
What is an income statement? - ANSWER-A report of net income or loss over an accounting period
What is a cash flow statement? - ANSWER-Summary of how cash was used and where it was obtained
What is accrual accounting? - ANSWER-Revenue is recorded when it is earned to permit the alignment of
revenue with associate expenses
What is cash accounting? - ANSWER-you record when the payment is done
What is fund accounting? - ANSWER-Method to manage categories of net assets to ensure compliance
with the restrictions on those funds
,What is gross revenue? - ANSWER-Total incurred charges entered for all patients for the services they
received
What is net revenue? - ANSWER-Gross revenue minus an estimate of the dollar amount of contractual,
discount or other allowances
What is an explicit price concession? - ANSWER-The discounted contractual agreements between the
provider and the payers which specify the payments due from the payers
What is an implicit price concession? - ANSWER-A concession applied to amounts that are to be paid by
patients based on the expected payment results for a specific portfolio of receivables
What are bad debts? - ANSWER-The portion of patient liability which cannot be collected from the
patient. These accounts represent a failure to pay and not an inability to pay on the part of the patient.
What is charity care? - ANSWER-Care provided to a patient who does not have the ability to pay for the
services or portion of the services received
What are key performance indicators? (KPI) - ANSWER-Standards for A/R and provide a method of
measuring the collection and control of A/R
What are MAP Keys? - ANSWER-Strategic KPIs that set the standard for patient-centric revenue cycle
excellence in the healthcare industry
What is the net A/R? - ANSWER-The balance sheet divided by average daily net patient service revenue
from the income statement
What is cost to collect? - ANSWER-Revenue cycle cost divided by total patient service cash collected
What is net collection rate? - ANSWER-how much cash was collected as a % of available to collect?
What is point of service cash? - ANSWER-the percentage of patient cash collected at or up to seven days
after an encounter as a percentage of total self-pay cash collected for the period
,Which patient types are typically considered acute care patient types? - ANSWER-Observation, newborn,
emergency (ED)
Accurate identification of the patient is the first step in the scheduling process. Identifiers used in various
combination to achieve accurate patient identification include? - ANSWER-Full legal name, date of birth,
sex and social security number
Pre-registration is defined as: - ANSWER-The collection of demographic info, insurance data, financial
info, providing reminders, prep info and identifying the potential need for financial assistance for
scheduled patients
Which of the following statements accurately describe the various Medicare benefit programs: -
ANSWER-Medicare Part A provides benefits for inpatient hospital services, SNF and home health care;
Medicare Part B covers outpatient and professional services; Medicare Part C or Medicare Advantage
plans are managed care plans combining Part A and Part B coverages; and Medicare Part D is the
prescription drug coverage benefit
Which of the following statements about Medicaid eligibility is not true? - ANSWER-Medicaid categories
are restricted to children, pregnant women and elderly in nursing homes
Examples of managed care plans include: - ANSWER-HMO, PPO and EPO plans
POS, Concierge plans, Medicare Advantage plans
Direct contracting for specific services from specific provisions
Patient Financial Communications best practices include all of the following activities except: -
ANSWERCollecting payment or initiating the process to immediately remove the patient from the service
schedule
Which statement includes the required components of an accurate pricing determination: -
ANSWERInsurance coverage and benefits, service or test involved, diagnosis and procedure codes, total
estimated charges, adjudication calculations based on the patient's benefit package.
The value of a robust scheduling and pre-registration process includes all of the following except: -
, ANSWER-Identification of patients who are likely to be no shows
What services to healthcare facilities normally schedule ahead of time? - ANSWER-High-dollar services
and those that require significant pre-processing to ensure appropriate reimbursement; other services
are scheduled ahead of time to reduce wait times and maximize patient flow
What is the most common type of unscheduled admissions? - ANSWER-The emergency department
What is direct or urgent admission? - ANSWER-When a physician sends the patient directly to the
hospital because the condition meets the need for an inpatient stay; if the doctor calls ahead they are
considered scheduled
What are the non-acute patient types? - ANSWER-Skilled nursing, hospice, home health, durable medical
equipment and clinic patients
When does Medicare cover a SNF stay? - ANSWER-When the patient was in the hospital for at least a 3
day inpatient stay
What is a 270 transaction? - ANSWER-The outbound inquiry from the provider to the health plan
What is a 271 transaction? - ANSWER-The response back to the provider's eligibility inquiry
What are the Medicare Part A benefits? - ANSWER-A beneficiary remains in the same "benefit period"
until they are hospitalization/SNF free for 60 days
A deductible is due at the beginning of each benefit period. Medicare will pay full benefits for 60 days in
a benefit period. The full days renew with each benefit period. After the full 60 days in a benefit period,
there are 30 coins days where the beneficiary pays a daily expense equal to 25% of the current
deductible amount due. After the full 60 days and 30 coins days are used, a patient can opt to use
lifetime reserve days. The daily out of pocket for each LTR is 50% of the current deductible amount.
These are used once and never reviewed. Once the 60 full, 30 coins and 60 LTR used, the patient has no
more Part A benefits and part B needs to be billed
Who is eligible for Medicaid? - ANSWER-Low income families, qualified pregnant women and children
and individuals receiving supplemental security income
