CRCR EXAM STUDY GUIDE FOR CERTIFIED REVENUE CYCLE
REPRESENTATIVE WITH VERIFIED ANSWERS.
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 _
REPRESENTATIVE WITH VERIFIED ANSWERS.
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 _
