CRCR EXAM PREP QUESTION AND ANSWERS
LATEST VERSION VERIFIED RATIONALE GRADED
A+
With advances in internet security and encryption, revenue-cycle processes are expanding to allow
patients to do what? - ansAccess their information and perform functions on-line
Why does the financial counselor need pricing for services? - ansTo calculate the patient's financial
responsibility
Why do managed care plans have agreements with hospitals, physicians, and other healthcare providers
to offer a range of services to plan members? - ansTo improve access to quality healthcare
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - ansWhen the patient is
the insured
When is it not appropriate to use observation status? - ansAs a substitute for an inpatient admission
When does a hospital add ambulance charges to the Medicare inpatient claim? - ansIf the patient
requires ambulance transportation to a skilled nursing facility
When an undue delay of payment results from a dispute between the patient and the third party payer,
who is responsible for payment? - ansPatient
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 - anscatastrophic charity
When a patient reports directly to a clinical department for service, what will the clinical department
staff do? - ansRedirect the patient to the patient access department for registration
What will comprehensive patient access processing accomplish? - ansMinimize the need for follow-up on
insurance accounts
What will cause a CMS 1500 claim to be rejected? - ansThe provider is billing with a future date of
service
What type of provider bills third-party payers using CMS 1500 form - ansHospital-based mammography
centers
What type of patient status is used to evaluate the patient's need for inpatient care? - ansObservation
What type of account adjustment results from the patient's unwillingness to pay for a self-pay balance? -
ansBad debt adjustment
What technique is acceptable way to complete the MSP screening for a facility situation? - ansAsk if the
patient's current services was accident related
What statement DOES NOT apply to revenue codes? - ansrevenue codes identify the payer
,CRCR EXAM PREP QUESTION AND ANSWERS
LATEST VERSION VERIFIED RATIONALE GRADED
A+
What statement describes the APC (Ambulatory payment classification) system? - ansAPC rates are
calculated on a national basis and are wage-adjusted by geographic region
What statement applies to the scheduled outpatient? - ansThe services do not involve an overnight stay
What standard claim forms are currently used by the healthcare industry to submit claims to third-party
payers? - ansThe UB-04 and the CMS 1500
What should the provider do if both of the patient's insurance plans pay as primary? - ansDetermine the
correct payer and notify the incorrect payer of the processing error
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as an RHC
services? - ansInpatient care
What results from a denied claim? - ansThe provider incurs rework and appeal costs
What restriction does a managed care plan place on locations that must be used if the plan is to pay for
the services provided? - ansSite-of-service limitation
what protocol was developed through the Patient Friendly Billing Project? - ansProvide information using
language that is easily understood by the average reader
What process can be used to shorten claim turnaround time? - ansSend high-dollar hard-copy claims
with required attachments by overnight mail or registered mail
what organization originated the concept of insuring prepaid health care services? - ansBlue Cross and
blue Shield
What option is an alternative to valid long-term payment plans? - ansBank loans
What must a provider do to qualify an account as a Medicare bad debts? - ansPursue the account for 120
days and then refer it to an outside collection agency
What MSP situation requires LGHP - ansDisability
What items are valid identifiers to establish a patient's identification? - ansPhoto identification, date of
birth, and social security number
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? - ansIt is posted on the remittance advice by the payer
What is true about screening a beneficiary for possible MSP situations? - ansIt is acceptable to complete
the screening form after the patient has completed the registration process and been sent to the service
department
, CRCR EXAM PREP QUESTION AND ANSWERS
LATEST VERSION VERIFIED RATIONALE GRADED
A+
What is the purpose of a compliance program? - ansMitigate potential fraud and abuse in the industry-
specific key risk areas
What is the initial hospice benefit? - ansTwo 90-day periods and an unlimited number of subsequent
periods
What is the daily out-of-pocket amount for each lifetime reserve day used? - ans50% of the current
deductible amount
What is NOT a typical charge master problem that can result in a denial? - ansDoes not include required
modifiers
What is important about an effective corporate compliance program? - ansA program that embodies
many elements to create a program that is transparent, clearly articulated and emphasized at all
employee levels as a seriously held personal and organizational responsibility, one that relies on full
communication inside and outside the organization
What is an example of an outcome of the Patient Friendly Billing Project? - ansRedesigned patient billing
statements using patient-friendly language
What is an effective tool to help staff collect payments at the time of service? - ansDevelop scripts for
the process of requesting payments
What is an advantage of using a collection agency to collect delinquent patient accounts? - ansCollection
agencies collect accounts faster than hospital does
What is an advantage of a preregistration program? - ansIt reduces processing times at the time of
service
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - ansInform a Medicare
beneficiary that Medicare may not pay for the order or service
What is a valid reason for a payer to delay a claim? - ansFailure to complete authorization requirements
What is a serious consequence of misidentifying a patient in the MPI? - ansThe services will be
documented in the wrong record
What is a principal diagnosis? - ansPrimary reason for the patient's admission
What is a primary responsibility of the Recover Audit Contractor? - ansTo correctly identify proper
payments for Medicare Part A & B claims
What is a characteristic of a managed contracting methodology? - ansProspectively set rates for
inpatient and outpatient services
LATEST VERSION VERIFIED RATIONALE GRADED
A+
With advances in internet security and encryption, revenue-cycle processes are expanding to allow
patients to do what? - ansAccess their information and perform functions on-line
Why does the financial counselor need pricing for services? - ansTo calculate the patient's financial
responsibility
Why do managed care plans have agreements with hospitals, physicians, and other healthcare providers
to offer a range of services to plan members? - ansTo improve access to quality healthcare
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - ansWhen the patient is
the insured
When is it not appropriate to use observation status? - ansAs a substitute for an inpatient admission
When does a hospital add ambulance charges to the Medicare inpatient claim? - ansIf the patient
requires ambulance transportation to a skilled nursing facility
When an undue delay of payment results from a dispute between the patient and the third party payer,
who is responsible for payment? - ansPatient
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 - anscatastrophic charity
When a patient reports directly to a clinical department for service, what will the clinical department
staff do? - ansRedirect the patient to the patient access department for registration
What will comprehensive patient access processing accomplish? - ansMinimize the need for follow-up on
insurance accounts
What will cause a CMS 1500 claim to be rejected? - ansThe provider is billing with a future date of
service
What type of provider bills third-party payers using CMS 1500 form - ansHospital-based mammography
centers
What type of patient status is used to evaluate the patient's need for inpatient care? - ansObservation
What type of account adjustment results from the patient's unwillingness to pay for a self-pay balance? -
ansBad debt adjustment
What technique is acceptable way to complete the MSP screening for a facility situation? - ansAsk if the
patient's current services was accident related
What statement DOES NOT apply to revenue codes? - ansrevenue codes identify the payer
,CRCR EXAM PREP QUESTION AND ANSWERS
LATEST VERSION VERIFIED RATIONALE GRADED
A+
What statement describes the APC (Ambulatory payment classification) system? - ansAPC rates are
calculated on a national basis and are wage-adjusted by geographic region
What statement applies to the scheduled outpatient? - ansThe services do not involve an overnight stay
What standard claim forms are currently used by the healthcare industry to submit claims to third-party
payers? - ansThe UB-04 and the CMS 1500
What should the provider do if both of the patient's insurance plans pay as primary? - ansDetermine the
correct payer and notify the incorrect payer of the processing error
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as an RHC
services? - ansInpatient care
What results from a denied claim? - ansThe provider incurs rework and appeal costs
What restriction does a managed care plan place on locations that must be used if the plan is to pay for
the services provided? - ansSite-of-service limitation
what protocol was developed through the Patient Friendly Billing Project? - ansProvide information using
language that is easily understood by the average reader
What process can be used to shorten claim turnaround time? - ansSend high-dollar hard-copy claims
with required attachments by overnight mail or registered mail
what organization originated the concept of insuring prepaid health care services? - ansBlue Cross and
blue Shield
What option is an alternative to valid long-term payment plans? - ansBank loans
What must a provider do to qualify an account as a Medicare bad debts? - ansPursue the account for 120
days and then refer it to an outside collection agency
What MSP situation requires LGHP - ansDisability
What items are valid identifiers to establish a patient's identification? - ansPhoto identification, date of
birth, and social security number
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? - ansIt is posted on the remittance advice by the payer
What is true about screening a beneficiary for possible MSP situations? - ansIt is acceptable to complete
the screening form after the patient has completed the registration process and been sent to the service
department
, CRCR EXAM PREP QUESTION AND ANSWERS
LATEST VERSION VERIFIED RATIONALE GRADED
A+
What is the purpose of a compliance program? - ansMitigate potential fraud and abuse in the industry-
specific key risk areas
What is the initial hospice benefit? - ansTwo 90-day periods and an unlimited number of subsequent
periods
What is the daily out-of-pocket amount for each lifetime reserve day used? - ans50% of the current
deductible amount
What is NOT a typical charge master problem that can result in a denial? - ansDoes not include required
modifiers
What is important about an effective corporate compliance program? - ansA program that embodies
many elements to create a program that is transparent, clearly articulated and emphasized at all
employee levels as a seriously held personal and organizational responsibility, one that relies on full
communication inside and outside the organization
What is an example of an outcome of the Patient Friendly Billing Project? - ansRedesigned patient billing
statements using patient-friendly language
What is an effective tool to help staff collect payments at the time of service? - ansDevelop scripts for
the process of requesting payments
What is an advantage of using a collection agency to collect delinquent patient accounts? - ansCollection
agencies collect accounts faster than hospital does
What is an advantage of a preregistration program? - ansIt reduces processing times at the time of
service
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - ansInform a Medicare
beneficiary that Medicare may not pay for the order or service
What is a valid reason for a payer to delay a claim? - ansFailure to complete authorization requirements
What is a serious consequence of misidentifying a patient in the MPI? - ansThe services will be
documented in the wrong record
What is a principal diagnosis? - ansPrimary reason for the patient's admission
What is a primary responsibility of the Recover Audit Contractor? - ansTo correctly identify proper
payments for Medicare Part A & B claims
What is a characteristic of a managed contracting methodology? - ansProspectively set rates for
inpatient and outpatient services
