CRCR Exam Prep
Ninety. MSP (Medicare Secondary Payer) regulations permit carriers to invoice Medicare for
legal responsibility claims after what happens? - ANS-120 days passes, but the declare then
be withdrawn from the legal responsibility carrier
Access - ANS-An character's potential to attain scientific services on a well timed and
financially perfect level
According to the Department of Health and Human Services pointers, what's NOT
considered earnings? - ANS-Sale of belongings, house, or vehicle
Administrative Services Only (ASO) - ANS-Usually gotten smaller administrative services to
a self-insured health plan
an boom inside the greenbacks elderly more than 90 days from date of carrier suggest what
approximately bills - ANS-They are not being processed in a well timed way
At the cease of every shift, what need to take place to cash, assessments, and credit card
transaction files? - ANS-They must be balanced
Care patron - ANS-Individual or entity that contributes to the purchase of healthcare
offerings
Case management - ANS-The manner wherein all health-associated additives of a case are
controlled via a delegated health professional. Intended to make certain continuity of
healthcare accessibility and services
Charge - ANS-The dollar quantity a company units for offerings rendered before negotiating
any discounts. The charge may be distinctive from the amount paid
Claim - ANS-A call for by way of an insured individual for the blessings supplied by means of
the group contract
Collecting patient liability greenbacks after carrier ends in what? - ANS-Lower money owed
receivable levels
Coordination of benefits (COB) - ANS-a standard insurance provision that determines the
responsibility for number one price while the patient is included by means of more than one
agency-backed health gain program
Cost - ANS-The definition of fee varies by using celebration incurring the fee
, Coverage policies for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has acquired what? - ANS-Medically essential inpatient clinic offerings for at
least three consecutive days earlier than the skilled nursing care admission
Discounted rate-for-provider - ANS-A repayment method wherein a issuer concurs to provide
service on a fee for carrier foundation, but the charges are discounted through positive
programs
Eligibility - ANS-Patient fame regarding coverage for healthcare insurance advantages
ESRD - ANS-End-degree renal disorder. The affected person has permanent kidney failure,
is included via a GHP, and has now not but finished the 30-month coordination duration
Every patient who's new to the healthcare provider have to be provided what? - ANS-A
printed replica of the company's privacy observe
FERA - ANS-Fraud Enforcement and Recovery act
First dollar insurance - ANS-A healthcare insurance coverage that has no deductible and
covers the first greenback of an insured's charges
Gatekeeping - ANS-A concept wherein the primary care medical doctor affords all primary
patient care and coordinates all diagnostic testing and forte referrals required for a patient's
hospital therapy
Health plan - ANS-an insurance agency that provides for the transport or charge of
healthcare offerings
How are disputes with nongovernmental payers resolved? - ANS-Appeal conditions precise
inside the person payer's agreement
how are HCPCS codes and the correct modifiers used? - ANS-To report the extent 1, 2, or 3
code that effectively describes the carrier furnished
How are patient reminder calls used? - ANS-To make sure the patient follows the prep
commands and arrives on the scheduled time for provider
How does utilization assessment personnel use accurate insurance facts? - ANS-To obtain
approval for inpatient days and coordinate offerings
How is a mis-posted contractual allowance resolved? - ANS-Comparing the contract
repayment prices with the agreement on the admittance advice to pick out the perfect
amount
How may a group agency reveal its performance? - ANS-Calculate the price of recovery
How must companies cope with credit balances? - ANS-Comply with kingdom statutes
regarding reporting credit score balance
Ninety. MSP (Medicare Secondary Payer) regulations permit carriers to invoice Medicare for
legal responsibility claims after what happens? - ANS-120 days passes, but the declare then
be withdrawn from the legal responsibility carrier
Access - ANS-An character's potential to attain scientific services on a well timed and
financially perfect level
According to the Department of Health and Human Services pointers, what's NOT
considered earnings? - ANS-Sale of belongings, house, or vehicle
Administrative Services Only (ASO) - ANS-Usually gotten smaller administrative services to
a self-insured health plan
an boom inside the greenbacks elderly more than 90 days from date of carrier suggest what
approximately bills - ANS-They are not being processed in a well timed way
At the cease of every shift, what need to take place to cash, assessments, and credit card
transaction files? - ANS-They must be balanced
Care patron - ANS-Individual or entity that contributes to the purchase of healthcare
offerings
Case management - ANS-The manner wherein all health-associated additives of a case are
controlled via a delegated health professional. Intended to make certain continuity of
healthcare accessibility and services
Charge - ANS-The dollar quantity a company units for offerings rendered before negotiating
any discounts. The charge may be distinctive from the amount paid
Claim - ANS-A call for by way of an insured individual for the blessings supplied by means of
the group contract
Collecting patient liability greenbacks after carrier ends in what? - ANS-Lower money owed
receivable levels
Coordination of benefits (COB) - ANS-a standard insurance provision that determines the
responsibility for number one price while the patient is included by means of more than one
agency-backed health gain program
Cost - ANS-The definition of fee varies by using celebration incurring the fee
, Coverage policies for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has acquired what? - ANS-Medically essential inpatient clinic offerings for at
least three consecutive days earlier than the skilled nursing care admission
Discounted rate-for-provider - ANS-A repayment method wherein a issuer concurs to provide
service on a fee for carrier foundation, but the charges are discounted through positive
programs
Eligibility - ANS-Patient fame regarding coverage for healthcare insurance advantages
ESRD - ANS-End-degree renal disorder. The affected person has permanent kidney failure,
is included via a GHP, and has now not but finished the 30-month coordination duration
Every patient who's new to the healthcare provider have to be provided what? - ANS-A
printed replica of the company's privacy observe
FERA - ANS-Fraud Enforcement and Recovery act
First dollar insurance - ANS-A healthcare insurance coverage that has no deductible and
covers the first greenback of an insured's charges
Gatekeeping - ANS-A concept wherein the primary care medical doctor affords all primary
patient care and coordinates all diagnostic testing and forte referrals required for a patient's
hospital therapy
Health plan - ANS-an insurance agency that provides for the transport or charge of
healthcare offerings
How are disputes with nongovernmental payers resolved? - ANS-Appeal conditions precise
inside the person payer's agreement
how are HCPCS codes and the correct modifiers used? - ANS-To report the extent 1, 2, or 3
code that effectively describes the carrier furnished
How are patient reminder calls used? - ANS-To make sure the patient follows the prep
commands and arrives on the scheduled time for provider
How does utilization assessment personnel use accurate insurance facts? - ANS-To obtain
approval for inpatient days and coordinate offerings
How is a mis-posted contractual allowance resolved? - ANS-Comparing the contract
repayment prices with the agreement on the admittance advice to pick out the perfect
amount
How may a group agency reveal its performance? - ANS-Calculate the price of recovery
How must companies cope with credit balances? - ANS-Comply with kingdom statutes
regarding reporting credit score balance
