CRCR STUDY GUIDE REVIEW EXAM
CRCR STUDY GUIDE REVIEW EXAM QUESTIONS AND ANSWERS GRADED A+
Through what document does a hospital establish compliance
standards? ANS >> Code of Conduct
What is the purpose of the OIG work plan? ANS >>
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? ANS >> Diagnostic
services and related charges provided on Wednesday, Thursday
and Friday before admission.
,CRCR STUDY GUIDE REVIEW EXAM
What does a modifier allow a provider to do? ANS >> 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? ANS >> 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? ANS >> 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? ANS >> One
registration record is created for multiple days of service.
,CRCR STUDY GUIDE REVIEW EXAM
What are nonemergency patients who come for service without
prior notification to the provider called? ANS >> Unscheduled
Patients
Which of the following statements apply to the observation
patient type? ANS >> 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? ANS >> Physician, nursing and
pharmacy
What is the purpose of the initial step in the outpatient testing
scheduling process? ANS >> 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? ANS >> 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? ANS >> Procedure time
, CRCR STUDY GUIDE REVIEW EXAM
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? ANS >>
Documentation of the medical necessity of the test.
What is an advantage of a preregistration program? ANS >> It
reduces processing times at the time of service
What data are required to establish a new MPI (master patient
index) entry? ANS >> The patients full legal name, date of
birth and sex
Which HIPAA transition set provides electronic processing of
insurance verification requests and responses? ANS >> 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? ANS >> The Mothers Plan
CRCR STUDY GUIDE REVIEW EXAM QUESTIONS AND ANSWERS GRADED A+
Through what document does a hospital establish compliance
standards? ANS >> Code of Conduct
What is the purpose of the OIG work plan? ANS >>
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? ANS >> Diagnostic
services and related charges provided on Wednesday, Thursday
and Friday before admission.
,CRCR STUDY GUIDE REVIEW EXAM
What does a modifier allow a provider to do? ANS >> 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? ANS >> 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? ANS >> 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? ANS >> One
registration record is created for multiple days of service.
,CRCR STUDY GUIDE REVIEW EXAM
What are nonemergency patients who come for service without
prior notification to the provider called? ANS >> Unscheduled
Patients
Which of the following statements apply to the observation
patient type? ANS >> 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? ANS >> Physician, nursing and
pharmacy
What is the purpose of the initial step in the outpatient testing
scheduling process? ANS >> 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? ANS >> 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? ANS >> Procedure time
, CRCR STUDY GUIDE REVIEW EXAM
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? ANS >>
Documentation of the medical necessity of the test.
What is an advantage of a preregistration program? ANS >> It
reduces processing times at the time of service
What data are required to establish a new MPI (master patient
index) entry? ANS >> The patients full legal name, date of
birth and sex
Which HIPAA transition set provides electronic processing of
insurance verification requests and responses? ANS >> 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? ANS >> The Mothers Plan
