CRCR Certification Exam Questions and Answers 2023, Exams of Nursing

Download CRCR Certification Exam Questions and Answers 2023 and more Exams Nursing in PDF only on Docsity! CRCR Certification Exam Questions and Answers 2023 (Verified Answers by Expert) (A+). 1. The 501(r) regulations require not-for-profit providers 501(c) (3) to do which of the following activities? A. Complete a community needs assessment and develop a discount program for patient balances after insurance payment. B. Pursue extraordinary collection activities with all patients eligible for financial assistance. A. Of the potential of fraud and abuse charges from erroneous billing. B. Charges remain one of the few consistent indicators available to monitor resource use. C. Charges are means of measuring physician productivity. D. Charges provide the data used in activity based costing. - answers B. Charges remain one of the few consistent indicators available to monitor resource use 3. The ACO investment model will test the use of pre-paid shared savings to: A. Invest in treatment protocols that reduce costs to Medicare B. Attract physicians to participate in the ACO payment system. required registration forms and instructions. B. Make sure that the attending staff can answer questions and assist in obtaining required patient financial data. C. Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow. D. Decline such request as finance discussions can disrupt patient care and patient flow. - answers C. Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow 5. Activities completed when the scheduled, pre-registered patient arrives for service includes: 6. The activity which results in the accurate recording of patient bed and level of care assessment, patient transfer and patient discharge status on a real-time basis is known as: A. Utilization review B. Case Management C. Census Management D. Patient through-put - answers A. Utilization review 7. or 8. B. Case Management 9. An advantage of a pre- registration program is: A. The markets value of such a program B. The ability to eliminate no-show appointments. C. The opportunity to reduce processing times at the time of service. D. The opportunity to reduce corporate compliance failures D. Meet federal mandates for insurance coverage and obtain the corresponding tax deduction - answers C. Purchase qualified health benefit plans regardless of insured's health status. 11. All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT: A. Offered in an outpatient setting B. Medically unnecessary C. Not delivered in a Medicare licensed care setting. D. Services and procedures that are custodial in nature - answers C. Not delivered in a Medicare licensed care setting A. Placing collections in a lock-box for posting review the next business day. B. Posting the payment to the patient's account C. Completing balancing activities D. Issuing receipts - answers A. Placing collections in a lock-box for posting review the next business day 14. All of the following are steps in verifying insurance EXCEPT: A. Sequencing plans involved in a coordination of benefits (COB) situation. B. The patient signing the statement of financial responsibility. C. Identifying and documenting the patient's health plan benefits reviewed as part of schedule finalization EXCEPT: A. The estimated patient financial obligations B. The service to be provided C. The arrival time and procedure time D. The patient's preparation instructions - answers A. The estimated patient financial obligations 17. Ambulance services are billed directly to the health plan for : A. All pre-admission emergency transports B. Transport deemed medically necessary by the attending paramedic- ambulance crew C. Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take group of persons on a monthly fee is known as a: A. HMO B. PPO C. MSO D. GPO - answers A. HMO 19. Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with: A. The Provider Reimbursement Review Board B. The Department of Health and Human Services Provider Relations Division C. A court appointed federal mediator D. The Office of the Inspector General - answers A. The Provider Reimbursement Review Board A. Patient financial communications best practices specific to staff role B. Financial assistance policies C. Documenting the conversation in the medical record D. Available patient financing options - answers C. Documenting the conversation in the medical record 22. The basis for qualification in Medicaid is typically: A. The Federal Poverty Guidelines B. Financial need as demonstrated by the prior two-years federal income tax fillings C. The patient's score on the Internal Revenue Service's Personal Wealth and Spending indicator C. Build the necessary processes to handle the potentially lengthy payment schedules D. Expedite payment processing of normal accounts receivables to protect cash flow - answers B. Hold financial conversations with patients as soon as possible 24. Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implementation, identifying and processing accounts and: A. Obtain the patients income tax statements from the prior 2 years B. Having the account triaged for any partial payment possibilities C. Monitor compliance covered healthcare through the plan and do not need to worry about "Part A" or "Part B' benefits D. Patients receive significant discounting on services contracted by the federal government - answers C. Patients generally have their entire Medicare-covered healthcare through the plan and do not need to worry about "Part A" or "Part B" benefits 26. A benefit period begins: A. With admission as an inpatient B. Upon the day the coverage premium is paid C. The first day in which a patient is furnished extended care services in the period the patient is entitled to hospital insurance D. Direct in summarizing charges and in requesting prompt payment - answers B. Clear, concise, correct and patient- friendly 28. Case management requires that a case manager be assigned: A. To a select group of resource intensive patient cases B. To every patient C. To specific cases designated by third-party contractual agreement D. To patients of any physician requesting case management - answers B. To every patient 29. Claims edits are: A. Rules developed to verify the accuracy of claims on each health plan's policies 30. Claims with dates of service received later than one year beyond the date of service, will be: A. Denied by Medicare B. The full responsibility of the patient C. The provider's responsibility but can be deemed charity care D. Fully paid with interest - answers A. Denied by Medicare 31. A "Compliance Program" is defined as: A. Educating staff on regulations B. The development of operational policies that correspond to regulations C. Systematic procedures to ensure that the B. Account resolution C. Claims Processing D. Third-party invoicing - answers C. Claims processing 33. Concurrent review and discharge planning: A. Occurs during service B. Is performed by the health plan during the time of service C. Is a significant part of quality and is performed by the clinical treatment team D. Is performed at discharge with the patient - answers C. Is a significant part of quality and is preformed by the clinical treatment team 34. A decision of whether a patient should be admitted as an inpatient or become an outpatient observation patient requires medical B. Possible staff job cuts due to vendor efficiencies C. The impact of customer service or patient relations D. The impact of direct control of accounts receivable - answers B. Possible staff job cuts due to vendor efficiencies 36. During the pre- registration, a search for the patient's MPI is initiated using which of the following data sets? A. Patient's full legal name and address B. Patient's full legal name and health plan group numbers C. Patient's full legal name and date of birth or the patient's Social security number D. A transfer request must be made to staff responsible for bed assignments - answers D. A transfer request must be made to staff responsible for bed assignments 38. The enhanced data-mining opportunities that results from the more detailed coding under ICD-10 allow senior leadership to work with physicians to do all of the following EXCEPT: A. Improve outcomes B. Obtain higher compensation for physicians C. Embrace new reimbursement models D. Drive significant improvements in areas of quality and the patient experience - answers B. Obtain higher D. Could potentially create under "write-offs" - answers B. Could be in violation of a court's order 40. The first thing a health plan does when processing a claim is: A. Review to make sure the claim is complete B. Verify if the provider(s) is(are) in network or not C. Check if the patient is covered D. Confirm if deductibles and con-insurance requirements have been met - answers C. Check if the patient is covered 41. For Medicare patients, an important component of the pre-registration process is: A. Obtaining clear physician's orders A. May take place between the patient and discharge planning B. Should take place between the patient or guarantor and properly trained provider representatives C. Are optional D. Are focused on verifying required third-party information - answers B. Should take place between the patient or guarantor and properly trained provider representatives 43. For scheduled patients, important revenue cycle activities in the time-of- service stage DO NOT include: A. Pre-registration record is activated, consents are signed, and co-payments are collected item in the chargemaster is known as: A. HCPCs codes B. ICD-10 Procedural codes C. CPT codes D. Revenue codes - answers D. Revenue codes 45. The fundamental approach in managing denials is: A. To create billing "double- check" processes B. To analyze the type and sources of denials and consider process changes to eliminate further denials C. To standardize and centralize all billing activity to focus on compliance with contractual agreements D. to review all claims processing for compliance with contractual agreements - answers B. To analyze the D. Commercial third-party payers - answers C. Medicare and Medicaid payments 47. Health Information Management (HIM) is responsible for: A. All patient medical records B. The maintenance of all software applications C. The maintenance of the entire technology infrastructure D. Clean claims being filed - answers A. All patient medical records 48. Health Plan Contracting Departments do all the following EXCEPT: A. Reimbursement rate setting B. Review all managed care contracts for accuracy and load contract terms