Crcr certification exam actual questions with revised answers (),
(a+ guarantee)
What are collection agency fees based on? - -A percentage of dollars collected
-Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - -
Birthday
-In what type of payment methodology is a lump sum or bundled payment negotiated between the payer
and some or all providers? - -Case rates
-What customer service improvements might improve the patient accounts department? - -Holding staff
accountable for customer service during performance reviews
-What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - -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? -
-Bad debt adjustment
-What is the initial hospice benefit? - -Two 90-day periods and an unlimited number of subsequent
periods
-When does a hospital add ambulance charges to the Medicare inpatient claim? - -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? - -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 - -
They are not being processed in a timely manner
-What is an advantage of a preregistration program? - -It reduces processing times at the time of service
-What are the two statutory exclusions from hospice coverage? - -Medically unnecessary services and
custodial care
-What core financial activities are resolved within patient access? - -Scheduling, insurance verification,
discharge processing, and payment of point-of-service receipts
-What statement applies to the scheduled outpatient? - -The services do not involve an overnight stay
-How is a mis-posted contractual allowance resolved? - -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? - -Observation
-Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has
received what? - -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$? - -When the patient is the
insured
-What are non-emergency patients who come for service without prior notification to the provider called?
- -Unscheduled patients
-If the insurance verification response reports that a subscriber has a single policy, what is the status of
the subscriber's spouse? - -Neither enrolled not entitled to benefits
-Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act,
establishes what? - -Disclosure rules for consumer credit sales and consumer loans
-What is a principal diagnosis? - -Primary reason for the patient's admission
-Collecting patient liability dollars after service leads to what? - -Lower accounts receivable levels
-What is the daily out-of-pocket amount for each lifetime reserve day used? - -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? - -Inpatient care
-What code indicates the disposition of the patient at the conclusion of service? - -Patient discharge status
code
-What are hospitals required to do for Medicare credit balance accounts? - -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? - -Patient
-Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: - -A valid CPT or HCPCS code
-With advances in internet security and encryption, revenue-cycle processes are expanding to allow
patients to do what? - -Access their information and perform functions on-line
-What date is required on all CMS 1500 claim forms? - -onset date of current illness
-What does scheduling allow provider staff to do - -Review appropriateness of the service request
-What code is used to report the provider's most common semiprivate room rate? - -Condition code
-Regulations and requirements for coding accountable care organizations, which allows providers to
begin creating these organizations, were finalized in: - -2012
-What is a primary responsibility of the Recover Audit Contractor? - -To correctly identify proper
payments for Medicare Part A & B claims
-How must providers handle credit balances? - -Comply with state statutes concerning reporting credit
balance
, -Insurance verification results in what? - -The accurate identification of the patient's eligibility and
benefits
-What form is used to bill Medicare for rural health clinics? - -CMS 1500
-What activities are completed when a scheduled pre-registered patient arrives for service? - -Registering
the patient and directing the patient to the service area
-In addition to being supported by information found in the patient's chart, a CMS 1500 claim must be
coded using what? - -HCPCS (Healthcare Common Procedure Coding system)
-What results from a denied claim? - -The provider incurs rework and appeal costs
-Why does the financial counselor need pricing for services? - -To calculate the patient's financial
responsibility
-What type of provider bills third-party payers using CMS 1500 form - -Hospital-based mammography
centers
-How are disputes with nongovernmental payers resolved? - -Appeal conditions specified in the
individual payer's contract
-The important message from Medicare provides beneficiaries with information concerning what? - -
Right to appeal a discharge decision if the patient disagrees with the services
-Why do managed care plans have agreements with hospitals, physicians, and other healthcare providers
to offer a range of services to plan members? - -To improve access to quality healthcare
-If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days, what is the
SNF permitted to do? - -Submit interim bills to the Medicare program.
-90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims after
what happens? - -120 days passes, but the claim then be withdrawn from the liability carrier
-What data are required to establish a new MPI entry? - -The patient's full legal name, date of birth, and
sex
-What should the provider do if both of the patient's insurance plans pay as primary? - -Determine the
correct payer and notify the incorrect payer of the processing error
-What do EMTALA regulations require on-call physicians to do? - -Personally appear in the emergency
department and attend to the patient within a reasonable time
-At the end of each shift, what must happen to cash, checks, and credit card transaction documents? - -
They must be balanced
-What will cause a CMS 1500 claim to be rejected? - -The provider is billing with a future date of service
-Under Medicare regulations, which of the following is not included on a valid physician's order for
services? - -The cost of the test
, -how are HCPCS codes and the appropriate modifiers used? - -To report the level 1, 2, or 3 code that
correctly describes the service provided
-If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? -
-Diagnostic and clinically-related non-diagnostic charges provided on the Tuesday, Wednesday,
Thursday, and Friday before admission
-What is a benefit of pre-registering patient's for service? - -Patient arrival processing is expedited,
reducing wait times and delays
-What is a characteristic of a managed contracting methodology? - -Prospectively set rates for inpatient
and outpatient services
-What do the MSP disability rules require? - -That the patient's spouse's employer must have less than 20
employees in the group health plan
-what organization originated the concept of insuring prepaid health care services? - -Blue Cross and
blue Shield
-What is true about screening a beneficiary for possible MSP situations? - -It is acceptable to complete
the screening form after the patient has completed the registration process and been sent to the service
department
-If the patient cannot agree to payment arrangements, what is the next option? - -Warn the patient that
unpaid accounts are placed with collection agencies for further processing
-In services lines such as cardiology or orthopedics, what does the case-rate payment methodology allow
providers to do? - -Receive a fixed for specific procedures
-What will comprehensive patient access processing accomplish? - -Minimize the need for follow-up on
insurance accounts
-Through what document does a hospital establish compliance standards? - -Code of conduct
-How does utilization review staff use correct insurance information? - -To obtain approval for inpatient
days and coordinate services
-When is it not appropriate to use observation status? - -As a substitute for an inpatient admission
-What is a serious consequence of misidentifying a patient in the MPI? - -The services will be
documented in the wrong record
-When a patient reports directly to a clinical department for service, what will the clinical department
staff do? - -Redirect the patient to the patient access department for registration
-What process can be used to shorten claim turnaround time? - -Send high-dollar hard-copy claims with
required attachments by overnight mail or registered mail
-How are patient reminder calls used? - -To make sure the patient follows the prep instructions and
arrives at the scheduled time for service
(a+ guarantee)
What are collection agency fees based on? - -A percentage of dollars collected
-Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - -
Birthday
-In what type of payment methodology is a lump sum or bundled payment negotiated between the payer
and some or all providers? - -Case rates
-What customer service improvements might improve the patient accounts department? - -Holding staff
accountable for customer service during performance reviews
-What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - -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? -
-Bad debt adjustment
-What is the initial hospice benefit? - -Two 90-day periods and an unlimited number of subsequent
periods
-When does a hospital add ambulance charges to the Medicare inpatient claim? - -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? - -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 - -
They are not being processed in a timely manner
-What is an advantage of a preregistration program? - -It reduces processing times at the time of service
-What are the two statutory exclusions from hospice coverage? - -Medically unnecessary services and
custodial care
-What core financial activities are resolved within patient access? - -Scheduling, insurance verification,
discharge processing, and payment of point-of-service receipts
-What statement applies to the scheduled outpatient? - -The services do not involve an overnight stay
-How is a mis-posted contractual allowance resolved? - -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? - -Observation
-Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has
received what? - -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$? - -When the patient is the
insured
-What are non-emergency patients who come for service without prior notification to the provider called?
- -Unscheduled patients
-If the insurance verification response reports that a subscriber has a single policy, what is the status of
the subscriber's spouse? - -Neither enrolled not entitled to benefits
-Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act,
establishes what? - -Disclosure rules for consumer credit sales and consumer loans
-What is a principal diagnosis? - -Primary reason for the patient's admission
-Collecting patient liability dollars after service leads to what? - -Lower accounts receivable levels
-What is the daily out-of-pocket amount for each lifetime reserve day used? - -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? - -Inpatient care
-What code indicates the disposition of the patient at the conclusion of service? - -Patient discharge status
code
-What are hospitals required to do for Medicare credit balance accounts? - -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? - -Patient
-Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: - -A valid CPT or HCPCS code
-With advances in internet security and encryption, revenue-cycle processes are expanding to allow
patients to do what? - -Access their information and perform functions on-line
-What date is required on all CMS 1500 claim forms? - -onset date of current illness
-What does scheduling allow provider staff to do - -Review appropriateness of the service request
-What code is used to report the provider's most common semiprivate room rate? - -Condition code
-Regulations and requirements for coding accountable care organizations, which allows providers to
begin creating these organizations, were finalized in: - -2012
-What is a primary responsibility of the Recover Audit Contractor? - -To correctly identify proper
payments for Medicare Part A & B claims
-How must providers handle credit balances? - -Comply with state statutes concerning reporting credit
balance
, -Insurance verification results in what? - -The accurate identification of the patient's eligibility and
benefits
-What form is used to bill Medicare for rural health clinics? - -CMS 1500
-What activities are completed when a scheduled pre-registered patient arrives for service? - -Registering
the patient and directing the patient to the service area
-In addition to being supported by information found in the patient's chart, a CMS 1500 claim must be
coded using what? - -HCPCS (Healthcare Common Procedure Coding system)
-What results from a denied claim? - -The provider incurs rework and appeal costs
-Why does the financial counselor need pricing for services? - -To calculate the patient's financial
responsibility
-What type of provider bills third-party payers using CMS 1500 form - -Hospital-based mammography
centers
-How are disputes with nongovernmental payers resolved? - -Appeal conditions specified in the
individual payer's contract
-The important message from Medicare provides beneficiaries with information concerning what? - -
Right to appeal a discharge decision if the patient disagrees with the services
-Why do managed care plans have agreements with hospitals, physicians, and other healthcare providers
to offer a range of services to plan members? - -To improve access to quality healthcare
-If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days, what is the
SNF permitted to do? - -Submit interim bills to the Medicare program.
-90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims after
what happens? - -120 days passes, but the claim then be withdrawn from the liability carrier
-What data are required to establish a new MPI entry? - -The patient's full legal name, date of birth, and
sex
-What should the provider do if both of the patient's insurance plans pay as primary? - -Determine the
correct payer and notify the incorrect payer of the processing error
-What do EMTALA regulations require on-call physicians to do? - -Personally appear in the emergency
department and attend to the patient within a reasonable time
-At the end of each shift, what must happen to cash, checks, and credit card transaction documents? - -
They must be balanced
-What will cause a CMS 1500 claim to be rejected? - -The provider is billing with a future date of service
-Under Medicare regulations, which of the following is not included on a valid physician's order for
services? - -The cost of the test
, -how are HCPCS codes and the appropriate modifiers used? - -To report the level 1, 2, or 3 code that
correctly describes the service provided
-If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? -
-Diagnostic and clinically-related non-diagnostic charges provided on the Tuesday, Wednesday,
Thursday, and Friday before admission
-What is a benefit of pre-registering patient's for service? - -Patient arrival processing is expedited,
reducing wait times and delays
-What is a characteristic of a managed contracting methodology? - -Prospectively set rates for inpatient
and outpatient services
-What do the MSP disability rules require? - -That the patient's spouse's employer must have less than 20
employees in the group health plan
-what organization originated the concept of insuring prepaid health care services? - -Blue Cross and
blue Shield
-What is true about screening a beneficiary for possible MSP situations? - -It is acceptable to complete
the screening form after the patient has completed the registration process and been sent to the service
department
-If the patient cannot agree to payment arrangements, what is the next option? - -Warn the patient that
unpaid accounts are placed with collection agencies for further processing
-In services lines such as cardiology or orthopedics, what does the case-rate payment methodology allow
providers to do? - -Receive a fixed for specific procedures
-What will comprehensive patient access processing accomplish? - -Minimize the need for follow-up on
insurance accounts
-Through what document does a hospital establish compliance standards? - -Code of conduct
-How does utilization review staff use correct insurance information? - -To obtain approval for inpatient
days and coordinate services
-When is it not appropriate to use observation status? - -As a substitute for an inpatient admission
-What is a serious consequence of misidentifying a patient in the MPI? - -The services will be
documented in the wrong record
-When a patient reports directly to a clinical department for service, what will the clinical department
staff do? - -Redirect the patient to the patient access department for registration
-What process can be used to shorten claim turnaround time? - -Send high-dollar hard-copy claims with
required attachments by overnight mail or registered mail
-How are patient reminder calls used? - -To make sure the patient follows the prep instructions and
arrives at the scheduled time for service
