CRCR EXAM TEST BANK LATEST 2025 WITH 400+
QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) 100% COMPLETE
When does a hospital add ambulance charges to the Medicare inpatient claim?
- ANSWER- If the patient requires ambulance transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account isbilled? -
ANSWER- 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 - ANSWER- They are not being processed in a timely manner
What is an advantage of a preregistration program? - ANSWER- It reduces processing
times at the time of service
What are the two statutory exclusions from hospice coverage? - ANSWER- Medically
unnecessary services and custodial care
What core financial activities are resolved within patient access? - ANSWER- Scheduling, insurance
verification, discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - ANSWER- The services donot involve an
overnight stay
How is a mis-posted contractual allowance resolved? - ANSWER- Comparing the contract
reimbursement rates with the contract on the admittance advice to identifythe correct amount
What type of patient status is used to evaluate the patient's need for inpatient care?
- ANSWER- Observation
1|Page
,Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - ANSWER- 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$? - ANSWER-
When the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - ANSWER- Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what is the status
of the subscriber's spouse? - ANSWER- Neither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act,
establishes what? - ANSWER- Disclosure rules for consumer credit sales and consumer loans
What is a principal diagnosis? - ANSWER- Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - ANSWER- Lower accounts
receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - ANSWER-
50% of the current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) isnot billable as an
RHC services? - ANSWER- Inpatient care
What code indicates the disposition of the patient at the conclusion of service?
-ANSWER- Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - ANSWER-
They result in lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient andthe third party
payer, who is responsible for payment? - ANSWER- Patient
2|Page
,Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - ANSWER- A valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are expanding to
allow patients to do what? - ANSWER- Access their information and perform functions on-line
What date is required on all CMS 1500 claim forms? - ANSWER- onset date of current illness
What does scheduling allow provider staff to do - ANSWER- Review appropriateness of
the service request
What code is used to report the provider's most common semiprivate room rate?
-ANSWER- Condition code
Regulations and requirements for coding accountable care organizations, whichallows
providers to begin creating these organizations, were finalized in: - ANSWER- 2012
What is a primary responsibility of the Recover Audit Contractor? - ANSWER- To correctly
identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - ANSWER- Comply with state statutes
concerning reporting credit balance
Insurance verification results in what? - ANSWER- The accurate identification of the patient's
eligibility and benefits
What form is used to bill Medicare for rural health clinics? - ANSWER- CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for service? -
ANSWER- Registering the patient and directing the patient to the service area
3|Page
, In addition to being supported by information found in the patient's chart, a CMS 1500 claim must
be coded using what? - ANSWER- HCPCS (Healthcare Common Procedure Coding system)
What results from a denied claim? - ANSWER- The provider incurs rework and appeal costs
Why does the financial counselor need pricing for services? - ANSWER- To calculate the
patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - ANSWER- Hospital-
based mammography centers
How are disputes with nongovernmental payers resolved? - ANSWER- Appeal conditions specified
in the individual payer's contract
The important message from Medicare provides beneficiaries with information concerning what? -
ANSWER- Right to appeal a discharge decision if the patient disagrees with the services
Why do managed care plans have agreements with hospitals, physicians, and other healthcare
providers to offer a range of services to plan members? - ANSWER- Toimprove access to quality
healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days, what is the
SNF permitted to do? - ANSWER- Submit interim bills to the Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - ANSWER- 120 days passes, but the claim then be withdrawn
from the liability carrier
What data are required to establish a new MPI entry? - ANSWER- The patient's full legal name,
date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as primary? - ANSWER-
Determine the correct payer and notify the incorrect payerof the processing error
4|Page
QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) 100% COMPLETE
When does a hospital add ambulance charges to the Medicare inpatient claim?
- ANSWER- If the patient requires ambulance transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account isbilled? -
ANSWER- 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 - ANSWER- They are not being processed in a timely manner
What is an advantage of a preregistration program? - ANSWER- It reduces processing
times at the time of service
What are the two statutory exclusions from hospice coverage? - ANSWER- Medically
unnecessary services and custodial care
What core financial activities are resolved within patient access? - ANSWER- Scheduling, insurance
verification, discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - ANSWER- The services donot involve an
overnight stay
How is a mis-posted contractual allowance resolved? - ANSWER- Comparing the contract
reimbursement rates with the contract on the admittance advice to identifythe correct amount
What type of patient status is used to evaluate the patient's need for inpatient care?
- ANSWER- Observation
1|Page
,Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - ANSWER- 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$? - ANSWER-
When the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - ANSWER- Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what is the status
of the subscriber's spouse? - ANSWER- Neither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act,
establishes what? - ANSWER- Disclosure rules for consumer credit sales and consumer loans
What is a principal diagnosis? - ANSWER- Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - ANSWER- Lower accounts
receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - ANSWER-
50% of the current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) isnot billable as an
RHC services? - ANSWER- Inpatient care
What code indicates the disposition of the patient at the conclusion of service?
-ANSWER- Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - ANSWER-
They result in lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient andthe third party
payer, who is responsible for payment? - ANSWER- Patient
2|Page
,Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - ANSWER- A valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are expanding to
allow patients to do what? - ANSWER- Access their information and perform functions on-line
What date is required on all CMS 1500 claim forms? - ANSWER- onset date of current illness
What does scheduling allow provider staff to do - ANSWER- Review appropriateness of
the service request
What code is used to report the provider's most common semiprivate room rate?
-ANSWER- Condition code
Regulations and requirements for coding accountable care organizations, whichallows
providers to begin creating these organizations, were finalized in: - ANSWER- 2012
What is a primary responsibility of the Recover Audit Contractor? - ANSWER- To correctly
identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - ANSWER- Comply with state statutes
concerning reporting credit balance
Insurance verification results in what? - ANSWER- The accurate identification of the patient's
eligibility and benefits
What form is used to bill Medicare for rural health clinics? - ANSWER- CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for service? -
ANSWER- Registering the patient and directing the patient to the service area
3|Page
, In addition to being supported by information found in the patient's chart, a CMS 1500 claim must
be coded using what? - ANSWER- HCPCS (Healthcare Common Procedure Coding system)
What results from a denied claim? - ANSWER- The provider incurs rework and appeal costs
Why does the financial counselor need pricing for services? - ANSWER- To calculate the
patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - ANSWER- Hospital-
based mammography centers
How are disputes with nongovernmental payers resolved? - ANSWER- Appeal conditions specified
in the individual payer's contract
The important message from Medicare provides beneficiaries with information concerning what? -
ANSWER- Right to appeal a discharge decision if the patient disagrees with the services
Why do managed care plans have agreements with hospitals, physicians, and other healthcare
providers to offer a range of services to plan members? - ANSWER- Toimprove access to quality
healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days, what is the
SNF permitted to do? - ANSWER- Submit interim bills to the Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - ANSWER- 120 days passes, but the claim then be withdrawn
from the liability carrier
What data are required to establish a new MPI entry? - ANSWER- The patient's full legal name,
date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as primary? - ANSWER-
Determine the correct payer and notify the incorrect payerof the processing error
4|Page
