CRCR STUDY GUIDE REVIEW LATEST EXAM QUESTIONS AND CORRECT DETAILED ANSWERS GRADED A +

CRCR STUDY GUIDE REVIEW LATEST EXAM QUESTIONS AND CORRECT DETAILED ANSWERS GRADED A + Through what document does a hospital establish compliance standards? -Correct Answers--Code of Conduct What is the purpose of the OIG work plan? -Correct Answers--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 Answers--Diagnostic services and related charges provided on Wednesday, Thursday and Friday before admission. What does a modifier allow a provider to do? -Correct Answers--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 Answers--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 Answers--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 Answers--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 Answers--Unscheduled Patients Which of the following statements apply to the observation patient type? -Correct Answers--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 Answers-- Physician, nursing and pharmacy What is the purpose of the initial step in the outpatient testing scheduling process? -Correct Answers--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 Answers--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 Answers--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 Answers--Documentation of the medical necessity of the test. What is an advantage of a preregistration program? -Correct Answers--It reduces processing times at the time of service What data are required to establish a new MPI (master patient index) entry? -Correct Answers--The patients full legal name, date of birth and sex Which HIPAA transition set provides electronic processing of insurance verification requests and responses? -Correct Answers--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 Answers--The Mothers Plan What is a co-payment? -Correct Answers--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 Answers--$3000 - $2300 = $700 What type of plan allows the subscriber to pay lower premium costs in return for a higher deductible? -Correct Answers--Consumer Directed Health Plan What is a characteristic of a managed care contracting methodology? -Correct Answers--Prospectively set rates for inpatient and outpatient services. Which provision protects the patient from Medical expenses that exceed a preset level? -Correct Answers--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 Answers--Referral What activities are completed when a scheduled, pre-registered patient arrives for service? -Correct Answers-- Activating the record, obtaining signatures, and finalizing financial issues. Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the provider may not ask about a patient's insurance information if it would delay what -Correct Answers--Medical Screening and Stabilizing Treatment Collecting patient liability dollars after service leads to what? -Correct Answers--increased efforts by patient accounting staff to resolve these balances. The important Message from Medicare (IM) provides beneficiaries with information concerning what? -Correct Answers--Right to appeal discharge decision if the patient disagrees with the plan. What circumstances would result in an incorrect nightly room charge? -Correct Answers--If the patient's transfer from the ICU (intensive care unit) to the medical/surgical floor is not reflected in the registration system Which of the following is a step in the discharge process? -Correct Answers--Have case management services complete the discharge plan Which of the following statements describes the goal of financial counseling services? -Correct Answers--To help the patient understand insurance coverage, including what the patient will owe for the current services The hospital has an APC (ambulatory payment classification)-based contract for the payment of outpatient services. Total anticipated charges for the visit are $2.380. The approved APC payment rate is $780. Where will the patient's benefit package be applied? -Correct Answers--To the approved APC payment rate A patient has met the $200 individual deductible and $900 of the $1000 coinsurance responsibility. The coinsurance rate is 20%. The estimated insurance plan responsibility is $1,975. What amount of coinsurance is due from the patient? -Correct Answers--$100 Which of the following items are considered valid proof of income documents? -Correct Answers--Copies of paycheck stubs from the most recent three months When is a patient considered to be medically indigent -Correct Answers--The patient's outstanding medical bills exceed a defined dollar amount or percentage of assets What patient assets are considered in the financial assistance application? -Correct Answers--Sources of readily available finds, such as vehicles, campers, boats, and savings accounts If patient cannot agree to payment arrangements, what is the next option? -Correct Answers--Initiate Medicaid eligibility and financial assistance screenings What are numbered receipts used for? -Correct Answers--To ensure that all payments are properly accounted for and deposited What is an effective tool to help staff collect payments at time of service? -Correct Answers--Develop scripts for the process of requesting payments At the end of each shift, what must happen to cash, checks, and credit card transaction documents? -Correct Answers--They must be balanced Why is it importance to have high quality standards for registration? -Correct Answers--Because quality failures may have legal implications. How does utilization review staff use correct insurance information? -Correct Answers--To obtain approval for inpatients days and coordinate services What core financial activities are resolved within patient access? -Correct Answers--Scheduling, insurance verification, discharge processing, and payment posting of point -of-service receipts. What is an unscheduled direct admission? -Correct Answers--A patient who is admitted from the physician's office on an urgent basis When is it not appropriate to use observation status? -Correct Answers--As a substitute for an inpatient admission Patients who require periodic skilled nursing or therapeutic care receive services from what type of program? -Correct Answers--Home health agency What type of information is typically collected during the scheduling contact? -Correct Answers--Patient name, date of birth, sex, diagnosis, requested test or procedure, preferred date of service, ordering physician, and patient's telephone number Every patient who is new to the healthcare provider must be offered what? -Correct Answers--A printed copy of providers privacy notice Which of the following statement applies to self-insured insurance plans? -Correct Answers--The employer assumes direct responsibility and risk for employee healthcare claims