CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representati
(2023) - Materials from HFMA
Study online at https://quizlet.com/_dowhqe
1. In what situation(s) should a provider NOT - CPT already indicates 2-4 lesions
use a modifier? - CPT indicates multiple extremities
2. What are other names for Three-Day Pay- ALL OF THE ABOVE
ment Window?
72-hour rule, DRG window, Three-Day
Window, 1 day window or 24-hour rule
3. What happens during the post-service Final coding, preparation and submission
stage? of claims, payment processing, balance
billing and resolution.
4. What are the below tasks part of? Best practices created by the Medical Debt
- Educate patients Task Force
- Coordinate to avoid duplicate patient con-
tacts
- Be consistent in key aspects of account
resolution
- Follow best practices for communication
5. Which option is NOT a main HFMA Health- Process Compliance
care Dollars & Sense® revenue cycle initia-
tive?
6. Which option is NOT a continuum of care B. Health Plan Contracting
provider?
A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representati
(2023) - Materials from HFMA
Study online at https://quizlet.com/_dowhqe
7. What is "implied certification"? When it is implied that a provider met all
compliance standards before submitting a
claim
8. Which of the following are essential el- A. Established compliance standards and
ements of an effective compliance pro- procedures.
gram?
C. Oversight of personnel by high-level
A. Established compliance standards and personnel.
procedures.
B. Designation of a compliance officer em- E. Reasonable methods to achieve compli-
ployed within the Billing Department. ance with standards, including monitoring
C. Oversight of personnel by high-level per- systems and hotlines.
sonnel.
D. Automatic dismissal of any employee
excluded from participation in a federal
healthcare program.
E. Reasonable methods to achieve compli-
ance with standards, including monitoring
systems and hotlines.
9. When was Health Information Technology FEB 17, 2009
for Economic and Clinical Health (HITECH)
Act signed into law?
10. When did HITECH Act become effective? 2013
11. Annually, the OIG publishes a work plan of D. Standard Unique Employer Identifier
compliance issues and objectives that will
be focused on throughout the following
year. Identify which option is NOT a work
plan task mentioned in this course.
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representati
(2023) - Materials from HFMA
Study online at https://quizlet.com/_dowhqe
A. Payments to Physicians for Co-Surgery
Procedures
B. Denials and Appeals in Medicare Part D
C. Medicare Hospital Payments for Claims
Involving the Acute- and Post-Acute-Care
Transfer Policies
D. Standard Unique Employer Identifier
12. What Plan are the tasks below a part of? The 2020 OIG Work Plan
- Medicare Payments Made Outside of the
Hospice Benefit
- Denials and Appeals in Medicare Part C
and Part D
- Medicare Part B Payments for End-Stage
Renal Disease Dialysis Services
- Review of Home Health Claims for Ser-
vices With 5 to 10 Skilled Visits
13. When was the Preservation of Access to JUNE 25 2010
Care for Medicare Beneficiaries and Pen-
sion Relief Act signed into law?
14. What is the Medicare DRG Three-Day Pay- All Diagnostic services provided to a
ment Window? Medicare patient by a hospital on the Date
of the patient's Inpatient admission or dur-
ing the 3 calendar days (or in the case of a
non-IPPS hospital: 1 calendar day) imme-
diately BEFORE the Date of Admission are
REQUIRED to be included on the bill for the
IP stay (unless there is no Part A coverage)
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representati
(2023) - Materials from HFMA
Study online at https://quizlet.com/_dowhqe
15. Do Outpatient Non-Diagnostic Services No
qualify for separate payments if provided
with the Three-Day Payment Window?
16. What is modifier 59? Used to identify CPTs OTHER THAN E&M
services, NOT normally reported togeth-
er, but are appropriate under the circum-
stances.
Documentation must support a different
session, different procedure or surgery, dif-
ferent site or organ system, separate.
17. What is condition code 51? Code noted on the separate UB-04 OP
claim, thus indicating the charge is unre-
lated to the admission.
18. What kind of hospitals are the following: Non-IPPS hospitals
Cancer treatment facilities, psychiatric, IP
rehabilitation, LTC and children's hospitals
for examples
19. What are the 3 types of medical necessity 1. Advanced Beneficiary Notice of Noncov-
screenings and noncoverage notifications erage (ABN) for Part B services.
required in the Medicare program?
2. SNF ABN for Part A SNF services.
3. HINN - Hospital-Issued Notice of
Non-Coverage (Part A)
20. What is Medicare Part B ABN?
(2023) - Materials from HFMA
Study online at https://quizlet.com/_dowhqe
1. In what situation(s) should a provider NOT - CPT already indicates 2-4 lesions
use a modifier? - CPT indicates multiple extremities
2. What are other names for Three-Day Pay- ALL OF THE ABOVE
ment Window?
72-hour rule, DRG window, Three-Day
Window, 1 day window or 24-hour rule
3. What happens during the post-service Final coding, preparation and submission
stage? of claims, payment processing, balance
billing and resolution.
4. What are the below tasks part of? Best practices created by the Medical Debt
- Educate patients Task Force
- Coordinate to avoid duplicate patient con-
tacts
- Be consistent in key aspects of account
resolution
- Follow best practices for communication
5. Which option is NOT a main HFMA Health- Process Compliance
care Dollars & Sense® revenue cycle initia-
tive?
6. Which option is NOT a continuum of care B. Health Plan Contracting
provider?
A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representati
(2023) - Materials from HFMA
Study online at https://quizlet.com/_dowhqe
7. What is "implied certification"? When it is implied that a provider met all
compliance standards before submitting a
claim
8. Which of the following are essential el- A. Established compliance standards and
ements of an effective compliance pro- procedures.
gram?
C. Oversight of personnel by high-level
A. Established compliance standards and personnel.
procedures.
B. Designation of a compliance officer em- E. Reasonable methods to achieve compli-
ployed within the Billing Department. ance with standards, including monitoring
C. Oversight of personnel by high-level per- systems and hotlines.
sonnel.
D. Automatic dismissal of any employee
excluded from participation in a federal
healthcare program.
E. Reasonable methods to achieve compli-
ance with standards, including monitoring
systems and hotlines.
9. When was Health Information Technology FEB 17, 2009
for Economic and Clinical Health (HITECH)
Act signed into law?
10. When did HITECH Act become effective? 2013
11. Annually, the OIG publishes a work plan of D. Standard Unique Employer Identifier
compliance issues and objectives that will
be focused on throughout the following
year. Identify which option is NOT a work
plan task mentioned in this course.
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representati
(2023) - Materials from HFMA
Study online at https://quizlet.com/_dowhqe
A. Payments to Physicians for Co-Surgery
Procedures
B. Denials and Appeals in Medicare Part D
C. Medicare Hospital Payments for Claims
Involving the Acute- and Post-Acute-Care
Transfer Policies
D. Standard Unique Employer Identifier
12. What Plan are the tasks below a part of? The 2020 OIG Work Plan
- Medicare Payments Made Outside of the
Hospice Benefit
- Denials and Appeals in Medicare Part C
and Part D
- Medicare Part B Payments for End-Stage
Renal Disease Dialysis Services
- Review of Home Health Claims for Ser-
vices With 5 to 10 Skilled Visits
13. When was the Preservation of Access to JUNE 25 2010
Care for Medicare Beneficiaries and Pen-
sion Relief Act signed into law?
14. What is the Medicare DRG Three-Day Pay- All Diagnostic services provided to a
ment Window? Medicare patient by a hospital on the Date
of the patient's Inpatient admission or dur-
ing the 3 calendar days (or in the case of a
non-IPPS hospital: 1 calendar day) imme-
diately BEFORE the Date of Admission are
REQUIRED to be included on the bill for the
IP stay (unless there is no Part A coverage)
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representati
(2023) - Materials from HFMA
Study online at https://quizlet.com/_dowhqe
15. Do Outpatient Non-Diagnostic Services No
qualify for separate payments if provided
with the Three-Day Payment Window?
16. What is modifier 59? Used to identify CPTs OTHER THAN E&M
services, NOT normally reported togeth-
er, but are appropriate under the circum-
stances.
Documentation must support a different
session, different procedure or surgery, dif-
ferent site or organ system, separate.
17. What is condition code 51? Code noted on the separate UB-04 OP
claim, thus indicating the charge is unre-
lated to the admission.
18. What kind of hospitals are the following: Non-IPPS hospitals
Cancer treatment facilities, psychiatric, IP
rehabilitation, LTC and children's hospitals
for examples
19. What are the 3 types of medical necessity 1. Advanced Beneficiary Notice of Noncov-
screenings and noncoverage notifications erage (ABN) for Part B services.
required in the Medicare program?
2. SNF ABN for Part A SNF services.
3. HINN - Hospital-Issued Notice of
Non-Coverage (Part A)
20. What is Medicare Part B ABN?
