CRCR EXAM MULTIPLE CHOICE, CRCR Exam Prep,
Certified Revenue Cycle Representative – CRCR
Questions And Answers Verified 100% Correct
What is a characteristic of a managed contracting methodology? - ANSWER -
Prospectively set rates for inpatient and outpatient services
What do the MSP disability rules require? - ANSWER -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?
- ANSWER -Blue Cross and blue Shield
What is true about screening a beneficiary for possible MSP situations? -
ANSWER -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? -
ANSWER -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? - ANSWER -Receive a fixed for
specific procedures
What will comprehensive patient access processing accomplish? - ANSWER -
Minimize the need for follow-up on insurance accounts
Through what document does a hospital establish compliance standards? -
ANSWER -Code of conduct
How does utilization review staff use correct insurance information? - ANSWER -
To obtain approval for inpatient days and coordinate services
When is it not appropriate to use observation status? - ANSWER -As a substitute
for an inpatient admission
What is a serious consequence of misidentifying a patient in the MPI? - ANSWER
-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? - ANSWER -Redirect the patient to the patient access
department for registration
What process can be used to shorten claim turnaround time? - ANSWER -Send
high-dollar hard-copy claims with required attachments by overnight mail or
registered mail
How are patient reminder calls used? - ANSWER -To make sure the patient
follows the prep instructions and arrives at the scheduled time for service
If a patient declares a straight bankruptcy, what must the provider do? - ANSWER
-Write off the account to the contractual adjustment account
According to the Department of Health and Human Services guidelines, what is
NOT considered income? - ANSWER -Sale of property, house, or car
The situation where neither the patient nor spouse is employed is described to the
patient using: - ANSWER -A condition code
What option is an alternative to valid long-term payment plans? - ANSWER -
Bank loans
What is an advantage of using a collection agency to collect delinquent patient
accounts? - ANSWER -Collection agencies collect accounts faster than hospital
does
What statement DOES NOT apply to revenue codes? - ANSWER -revenue codes
identify the payer
When a patient's illness results in an unusually high amount of medical bills not
covered by insurance or other patient pay resources, what type of account is
created - ANSWER -catastrophic charity
What happens when a patient receives non-emergent services from and out-of-
network provider? - ANSWER -Patient payment responsibility is higher
Every patient who is new to the healthcare provider must be offered what? -
ANSWER -A printed copy of the provider's privacy notice
,How may a collection agency demonstrate its performance? - ANSWER -
Calculate the rate of recovery
What is true of the information the provider supplies to indicate that an
authorization for service has been received from the patient's primary payer? -
ANSWER -It is posted on the remittance advice by the payer
What standard claim forms are currently used by the healthcare industry to submit
claims to third-party payers? - ANSWER -The UB-04 and the CMS 1500
Unless the patient encounter is an emergency, what is the efficient and effective
procedure for obtaining information? - ANSWER -Obtain the required
demographic and insurance information before services are rendered
what protocol was developed through the Patient Friendly Billing Project? -
ANSWER -Provide information using language that is easily understood by the
average reader
What technique is acceptable way to complete the MSP screening for a facility
situation? - ANSWER -Ask if the patient's current services was accident related
What is a valid reason for a payer to delay a claim? - ANSWER -Failure to
complete authorization requirements
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 - ANSWER -They must be combined
with the inpatient bill and paid under the MS-DRG system
What do large adjustments require? - ANSWER -Manager-level approval
What items are valid identifiers to establish a patient's identification? - ANSWER
-Photo identification, date of birth, and social security number
What must a provider do to qualify an account as a Medicare bad debts? -
ANSWER -Pursue the account for 120 days and then refer it to an outside
collection agency
, What restriction does a managed care plan place on locations that must be used if
the plan is to pay for the services provided? - ANSWER -Site-of-service limitation
What is an example of an outcome of the Patient Friendly Billing Project? -
ANSWER -Redesigned patient billing statements using patient-friendly language
What statement describes the APC (Ambulatory payment classification) system? -
ANSWER -APC rates are calculated on a national basis and are wage-adjusted by
geographic region
What is a benefit of insurance verification? - ANSWER -Pre-certification or pre-
authorization requirements are confirmed
What is an effective tool to help staff collect payments at the time of service? -
ANSWER -Develop scripts for the process of requesting payments
What is a benefit of electronic claims processing? - ANSWER -Providers can
electronically view patient's eligibility
What does Medicare Part D provide coverage for? - ANSWER -Prescription drugs
What are some core elements of a board-approved financial policy - ANSWER -
Charity care, payment methods, and installment payment guidelines
What circumstance would result in an incorrect nightly room charge? - ANSWER
-If the patient's discharge, ordered for tomorrow, has not been charted
What is NOT a typical charge master problem that can result in a denial? -
ANSWER -Does not include required modifiers
Access - ANSWER -An individual's ability to obtain medical services on a timely
and financially acceptable level
Administrative Services Only (ASO) - ANSWER -Usually contracted
administrative services to a self-insured health plan
Case management - ANSWER -The process whereby all health-related
components of a case are managed by a designated health professional. Intended to
ensure continuity of healthcare accessibility and services
Certified Revenue Cycle Representative – CRCR
Questions And Answers Verified 100% Correct
What is a characteristic of a managed contracting methodology? - ANSWER -
Prospectively set rates for inpatient and outpatient services
What do the MSP disability rules require? - ANSWER -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?
- ANSWER -Blue Cross and blue Shield
What is true about screening a beneficiary for possible MSP situations? -
ANSWER -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? -
ANSWER -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? - ANSWER -Receive a fixed for
specific procedures
What will comprehensive patient access processing accomplish? - ANSWER -
Minimize the need for follow-up on insurance accounts
Through what document does a hospital establish compliance standards? -
ANSWER -Code of conduct
How does utilization review staff use correct insurance information? - ANSWER -
To obtain approval for inpatient days and coordinate services
When is it not appropriate to use observation status? - ANSWER -As a substitute
for an inpatient admission
What is a serious consequence of misidentifying a patient in the MPI? - ANSWER
-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? - ANSWER -Redirect the patient to the patient access
department for registration
What process can be used to shorten claim turnaround time? - ANSWER -Send
high-dollar hard-copy claims with required attachments by overnight mail or
registered mail
How are patient reminder calls used? - ANSWER -To make sure the patient
follows the prep instructions and arrives at the scheduled time for service
If a patient declares a straight bankruptcy, what must the provider do? - ANSWER
-Write off the account to the contractual adjustment account
According to the Department of Health and Human Services guidelines, what is
NOT considered income? - ANSWER -Sale of property, house, or car
The situation where neither the patient nor spouse is employed is described to the
patient using: - ANSWER -A condition code
What option is an alternative to valid long-term payment plans? - ANSWER -
Bank loans
What is an advantage of using a collection agency to collect delinquent patient
accounts? - ANSWER -Collection agencies collect accounts faster than hospital
does
What statement DOES NOT apply to revenue codes? - ANSWER -revenue codes
identify the payer
When a patient's illness results in an unusually high amount of medical bills not
covered by insurance or other patient pay resources, what type of account is
created - ANSWER -catastrophic charity
What happens when a patient receives non-emergent services from and out-of-
network provider? - ANSWER -Patient payment responsibility is higher
Every patient who is new to the healthcare provider must be offered what? -
ANSWER -A printed copy of the provider's privacy notice
,How may a collection agency demonstrate its performance? - ANSWER -
Calculate the rate of recovery
What is true of the information the provider supplies to indicate that an
authorization for service has been received from the patient's primary payer? -
ANSWER -It is posted on the remittance advice by the payer
What standard claim forms are currently used by the healthcare industry to submit
claims to third-party payers? - ANSWER -The UB-04 and the CMS 1500
Unless the patient encounter is an emergency, what is the efficient and effective
procedure for obtaining information? - ANSWER -Obtain the required
demographic and insurance information before services are rendered
what protocol was developed through the Patient Friendly Billing Project? -
ANSWER -Provide information using language that is easily understood by the
average reader
What technique is acceptable way to complete the MSP screening for a facility
situation? - ANSWER -Ask if the patient's current services was accident related
What is a valid reason for a payer to delay a claim? - ANSWER -Failure to
complete authorization requirements
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 - ANSWER -They must be combined
with the inpatient bill and paid under the MS-DRG system
What do large adjustments require? - ANSWER -Manager-level approval
What items are valid identifiers to establish a patient's identification? - ANSWER
-Photo identification, date of birth, and social security number
What must a provider do to qualify an account as a Medicare bad debts? -
ANSWER -Pursue the account for 120 days and then refer it to an outside
collection agency
, What restriction does a managed care plan place on locations that must be used if
the plan is to pay for the services provided? - ANSWER -Site-of-service limitation
What is an example of an outcome of the Patient Friendly Billing Project? -
ANSWER -Redesigned patient billing statements using patient-friendly language
What statement describes the APC (Ambulatory payment classification) system? -
ANSWER -APC rates are calculated on a national basis and are wage-adjusted by
geographic region
What is a benefit of insurance verification? - ANSWER -Pre-certification or pre-
authorization requirements are confirmed
What is an effective tool to help staff collect payments at the time of service? -
ANSWER -Develop scripts for the process of requesting payments
What is a benefit of electronic claims processing? - ANSWER -Providers can
electronically view patient's eligibility
What does Medicare Part D provide coverage for? - ANSWER -Prescription drugs
What are some core elements of a board-approved financial policy - ANSWER -
Charity care, payment methods, and installment payment guidelines
What circumstance would result in an incorrect nightly room charge? - ANSWER
-If the patient's discharge, ordered for tomorrow, has not been charted
What is NOT a typical charge master problem that can result in a denial? -
ANSWER -Does not include required modifiers
Access - ANSWER -An individual's ability to obtain medical services on a timely
and financially acceptable level
Administrative Services Only (ASO) - ANSWER -Usually contracted
administrative services to a self-insured health plan
Case management - ANSWER -The process whereby all health-related
components of a case are managed by a designated health professional. Intended to
ensure continuity of healthcare accessibility and services
