CRCR Exam Prep
What are collection agency fees based on? - ANS-A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? - ANS-Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - ANS-Case rates
What customer service improvements might improve the patient accounts department?
- ANS-Holding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
ANS-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? - ANS-Bad debt adjustment
What is the initial hospice benefit? - ANS-Two 90-day periods and an unlimited number
of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - ANS-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? -
ANS-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 - ANS-They are not being processed in a timely manner
What is an advantage of a preregistration program? - ANS-It reduces processing times
at the time of service
What are the two statutory exclusions from hospice coverage? - ANS-Medically
unnecessary services and custodial care
, What core financial activities are resolved within patient access? - ANS-Scheduling,
insurance verification, discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - ANS-The services do not involve
an overnight stay
How is a mis-posted contractual allowance resolved? - ANS-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? -
ANS-Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - ANS-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$? -
ANS-When the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - ANS-Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what
is the status of the subscriber's spouse? - ANS-Neither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - ANS-Disclosure rules for consumer credit sales and consumer
loans
What is a principal diagnosis? - ANS-Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - ANS-Lower accounts
receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - ANS-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? - ANS-Inpatient care
What are collection agency fees based on? - ANS-A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? - ANS-Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - ANS-Case rates
What customer service improvements might improve the patient accounts department?
- ANS-Holding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
ANS-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? - ANS-Bad debt adjustment
What is the initial hospice benefit? - ANS-Two 90-day periods and an unlimited number
of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - ANS-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? -
ANS-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 - ANS-They are not being processed in a timely manner
What is an advantage of a preregistration program? - ANS-It reduces processing times
at the time of service
What are the two statutory exclusions from hospice coverage? - ANS-Medically
unnecessary services and custodial care
, What core financial activities are resolved within patient access? - ANS-Scheduling,
insurance verification, discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - ANS-The services do not involve
an overnight stay
How is a mis-posted contractual allowance resolved? - ANS-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? -
ANS-Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - ANS-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$? -
ANS-When the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - ANS-Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what
is the status of the subscriber's spouse? - ANS-Neither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - ANS-Disclosure rules for consumer credit sales and consumer
loans
What is a principal diagnosis? - ANS-Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - ANS-Lower accounts
receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - ANS-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? - ANS-Inpatient care
