CRCR Study Guide Review exam with verified
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answers
Through |what |document |does |a |hospital |establish |compliance |standards? |- |correct |answer |
Code |of |Conduct
What |is |the |purpose |of |the |OIG |work |plan? |- |correct |answer |Communicate |Issues |that |will |be |
reviewed |during |the |year |for |compliance |with |Medicare |Regulations
If |a |Medicare |patient |is |admitted |on |Friday, |what |services |fall |within |the |three-day |DRG |
window |rule? |- |correct |answer |Diagnostic |services |and |related |charges |provided |on |
Wednesday, |Thursday |and |Friday |before |admission.
What |does |a |modifier |allow |a |provider |to |do? |- |correct |answer |Report |a |specific |circumstance |
that |affected |a |procedure |or |service |without |changing |the |code |or |its |definition
If |outpatient |diagnostic |services |are |provided |within |three |days |of |the |admission |of |a |
Medicare |beneficiary |to |an |IPPS |(Inpatient |Prospective |Payment |System) |hospital, |what |must |
happen |to |these |charges? |- |correct |answer |They |must |be |combined |with |the |inpatient |bill |and
|paid |under |the |MS-DRG |(diagnosis |related |group) |system.
If |outpatient |diagnostic |services |are |provided |within |three |days |of |the |admission |of |a |
Medicare |beneficiary |to |an |IPPS |(Inpatient |Prospective |Payment |System) |hospital, |what |must |
happen |to |these |charges? |- |correct |answer |It |reviews |Medicare |payments |for |beneficiaries |
who |have |other |insurance |and |assesses |the |effectiveness |of |procedures |in |preventing |
inappropriate |Medicare |payments |for |beneficiaries |with |other |insurance |coverage.
What |is |a |recurring |or |series |registration? |- |correct |answer |One |registration |record |is |created |
for |multiple |days |of |service.
,What |are |nonemergency |patients |who |come |for |service |without |prior |notification |to |the |
provider |called? |- |correct |answer |Unscheduled |Patients
Which |of |the |following |statements |apply |to |the |observation |patient |type? |- |correct |answer |It |
is |used |to |evaluate |the |need |for |an |inpatient |admission.
Which |services |are |hospice |programs |required |to |provide |on |an |around-the-clock |basis? |- |
correct |answer |Physician, |nursing |and |pharmacy
What |is |the |purpose |of |the |initial |step |in |the |outpatient |testing |scheduling |process? |- |correct |
answer |Identify |the |correct |patient |on |the |providers |database |or |add |the |patient |to |the |
database
Scheduler |instructions |are |used |to |prompt |the |scheduler |to |do |what? |- |correct |answer |
Complete |the |scheduling |process |correctly |based |on |service |requested.
The |time |needed |to |prepare |the |patient |before |service |is |the |difference |between |the |patient's
|arrival |time |and |which |of |the |following? |- |correct |answer |Procedure |time
Medicare |guidelines |require |that |when |a |test |is |ordered |for |which |as |LCD |(local |coverage |
determination) |or |NCD |(national |coverage |determination) |exist, |the |information |provided |on |
the |order |must |include |which |of |the |following? |- |correct |answer |Documentation |of |the |
medical |necessity |of |the |test.
What |is |an |advantage |of |a |preregistration |program? |- |correct |answer |It |reduces |processing |
times |at |the |time |of |service
What |data |are |required |to |establish |a |new |MPI |(master |patient |index) |entry? |- |correct |answer |
The |patients |full |legal |name, |date |of |birth |and |sex
, Which |HIPAA |transition |set |provides |electronic |processing |of |insurance |verification |requests |
and |responses? |- |correct |answer |The |270-271 |Set
A |mother |and |father |both |cover |their |16-year-old |child |as |a |dependent |on |their |health |
insurance |plans, |which |both |follow |the |birthday |rule. |The |mothers |date |of |birth |is |January |19, |
1968; |the |father's |date |of |birth |is |July |19, |1967. |Whose |plan |is |the |primary |payer? |- |correct |
answer |The |Mothers |Plan
What |is |a |co-payment? |- |correct |answer |The |fixed |amount |that |is |due |for |a |specific |service
A |patient's |annual |out-of-pocket |limitation |is |$3000, |excluding |the |deductible. |To |date |this |
calendar |year, |the |patient |has |satisfied |the |$500 |deductible |and |has |paid |$2300 |in |coinsurance
|to |various |providers. |For |the |balance |of |the |calendar |year, |what |is |the |maximum |amount |of |
coinsurance |the |patient |will |owe? |- |correct |answer |$3000 |- |$2300 |= |$700
What |type |of |plan |allows |the |subscriber |to |pay |lower |premium |costs |in |return |for |a |higher |
deductible? |- |correct |answer |Consumer |Directed |Health |Plan
What |is |a |characteristic |of |a |managed |care |contracting |methodology? |- |correct |answer |
Prospectively |set |rates |for |inpatient |and |outpatient |services.
Which |provision |protects |the |patient |from |Medical |expenses |that |exceed |a |preset |level? |- |
correct |answer |Stop |Loss
What |document |must |a |primary |care |physician |send |to |an |HMO |(health |maintenance |
organization) |patient |to |authorize |a |visit |to |a |specialist |for |additional |testing |or |care? |- |correct |
answer |Referral
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answers
Through |what |document |does |a |hospital |establish |compliance |standards? |- |correct |answer |
Code |of |Conduct
What |is |the |purpose |of |the |OIG |work |plan? |- |correct |answer |Communicate |Issues |that |will |be |
reviewed |during |the |year |for |compliance |with |Medicare |Regulations
If |a |Medicare |patient |is |admitted |on |Friday, |what |services |fall |within |the |three-day |DRG |
window |rule? |- |correct |answer |Diagnostic |services |and |related |charges |provided |on |
Wednesday, |Thursday |and |Friday |before |admission.
What |does |a |modifier |allow |a |provider |to |do? |- |correct |answer |Report |a |specific |circumstance |
that |affected |a |procedure |or |service |without |changing |the |code |or |its |definition
If |outpatient |diagnostic |services |are |provided |within |three |days |of |the |admission |of |a |
Medicare |beneficiary |to |an |IPPS |(Inpatient |Prospective |Payment |System) |hospital, |what |must |
happen |to |these |charges? |- |correct |answer |They |must |be |combined |with |the |inpatient |bill |and
|paid |under |the |MS-DRG |(diagnosis |related |group) |system.
If |outpatient |diagnostic |services |are |provided |within |three |days |of |the |admission |of |a |
Medicare |beneficiary |to |an |IPPS |(Inpatient |Prospective |Payment |System) |hospital, |what |must |
happen |to |these |charges? |- |correct |answer |It |reviews |Medicare |payments |for |beneficiaries |
who |have |other |insurance |and |assesses |the |effectiveness |of |procedures |in |preventing |
inappropriate |Medicare |payments |for |beneficiaries |with |other |insurance |coverage.
What |is |a |recurring |or |series |registration? |- |correct |answer |One |registration |record |is |created |
for |multiple |days |of |service.
,What |are |nonemergency |patients |who |come |for |service |without |prior |notification |to |the |
provider |called? |- |correct |answer |Unscheduled |Patients
Which |of |the |following |statements |apply |to |the |observation |patient |type? |- |correct |answer |It |
is |used |to |evaluate |the |need |for |an |inpatient |admission.
Which |services |are |hospice |programs |required |to |provide |on |an |around-the-clock |basis? |- |
correct |answer |Physician, |nursing |and |pharmacy
What |is |the |purpose |of |the |initial |step |in |the |outpatient |testing |scheduling |process? |- |correct |
answer |Identify |the |correct |patient |on |the |providers |database |or |add |the |patient |to |the |
database
Scheduler |instructions |are |used |to |prompt |the |scheduler |to |do |what? |- |correct |answer |
Complete |the |scheduling |process |correctly |based |on |service |requested.
The |time |needed |to |prepare |the |patient |before |service |is |the |difference |between |the |patient's
|arrival |time |and |which |of |the |following? |- |correct |answer |Procedure |time
Medicare |guidelines |require |that |when |a |test |is |ordered |for |which |as |LCD |(local |coverage |
determination) |or |NCD |(national |coverage |determination) |exist, |the |information |provided |on |
the |order |must |include |which |of |the |following? |- |correct |answer |Documentation |of |the |
medical |necessity |of |the |test.
What |is |an |advantage |of |a |preregistration |program? |- |correct |answer |It |reduces |processing |
times |at |the |time |of |service
What |data |are |required |to |establish |a |new |MPI |(master |patient |index) |entry? |- |correct |answer |
The |patients |full |legal |name, |date |of |birth |and |sex
, Which |HIPAA |transition |set |provides |electronic |processing |of |insurance |verification |requests |
and |responses? |- |correct |answer |The |270-271 |Set
A |mother |and |father |both |cover |their |16-year-old |child |as |a |dependent |on |their |health |
insurance |plans, |which |both |follow |the |birthday |rule. |The |mothers |date |of |birth |is |January |19, |
1968; |the |father's |date |of |birth |is |July |19, |1967. |Whose |plan |is |the |primary |payer? |- |correct |
answer |The |Mothers |Plan
What |is |a |co-payment? |- |correct |answer |The |fixed |amount |that |is |due |for |a |specific |service
A |patient's |annual |out-of-pocket |limitation |is |$3000, |excluding |the |deductible. |To |date |this |
calendar |year, |the |patient |has |satisfied |the |$500 |deductible |and |has |paid |$2300 |in |coinsurance
|to |various |providers. |For |the |balance |of |the |calendar |year, |what |is |the |maximum |amount |of |
coinsurance |the |patient |will |owe? |- |correct |answer |$3000 |- |$2300 |= |$700
What |type |of |plan |allows |the |subscriber |to |pay |lower |premium |costs |in |return |for |a |higher |
deductible? |- |correct |answer |Consumer |Directed |Health |Plan
What |is |a |characteristic |of |a |managed |care |contracting |methodology? |- |correct |answer |
Prospectively |set |rates |for |inpatient |and |outpatient |services.
Which |provision |protects |the |patient |from |Medical |expenses |that |exceed |a |preset |level? |- |
correct |answer |Stop |Loss
What |document |must |a |primary |care |physician |send |to |an |HMO |(health |maintenance |
organization) |patient |to |authorize |a |visit |to |a |specialist |for |additional |testing |or |care? |- |correct |
answer |Referral
