CRCR Certification exam questions and answers latest 2023 rated A plus, Exams of Nursing

Download CRCR Certification exam questions and answers latest 2023 rated A plus and more Exams Nursing in PDF only on Docsity! CRCR Certification exam questions and answers latest 2023 rated A plus Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - correct answer ✅The Medicare Administrative Contractor (MAC) at the end of the hospice cap period Which of the following is required for participation in Medicaid - correct answer ✅Meet Income and Assets Requirements In choosing a setting for patient financial discussions, organizations should first and foremost - correct answer ✅Respect the patients privacy A nightly room charge will be incorrect if the patient's - correct answer ✅Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can - correct answer ✅Purchase qualified health benefit plans regardless of insured's health status CRCR Certification exam questions and answers latest 2023 rated A plus A portion of the accounts receivable inventory which has NOT qualified for billing includes: - correct answer ✅Charitable pledges What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? - correct answer ✅Revenue codes This directive was developed to promote and ensure healthcare quality and value and also to protect consumers and workers in the healthcare system. This directive is called - correct answer ✅Patient bill of rights 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 - correct answer ✅Case management Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? - correct answer ✅Registration staff may routinely contact managed are plans for prior authorizations before the patient is seen by the on-duty physician CRCR Certification exam questions and answers latest 2023 rated A plus Duplicate payments occur: - correct answer ✅When providers re-bill claims based on nonpayment from the initial bill submission An individual enrolled in Medicare who is dissatisfied with the government's claim determination is entitled to reconsideration of the decision. This type of appeal is known as - correct answer ✅A beneficiary appeal Insurance verification results in which of the following - correct answer ✅The accurate identification of the patient's eligibility and benefits The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: - correct answer ✅Judicial review by a federal district court Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the providermay not ask about a patient's insurance information if it would delay what? - correct answer ✅Medical screening and stabilizing treatment Ambulance services are billed directly to the health plan for - correct answer ✅Services provided before a patient is admitted and for ambulance rides CRCR Certification exam questions and answers latest 2023 rated A plus arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility Key performance indicators (KPIs) set standards for accounts receivables (A/R) and - correct answer ✅Provide a method of measuring the collection and control of A/R he patient discharge process begins when - correct answer ✅The physician writes the discharge orders The nightly room charge will be incorrect if the patient's - correct answer ✅Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system. The soft cost of a dissatisfied customer is - correct answer ✅The customer passing on info about their negative experience to potential pts or through social media channels CRCR Certification exam questions and answers latest 2023 rated A plus An advantage of a pre-registration program is - correct answer ✅The opportunity to reduce the corporate compliance failures within the registration process It is important to have high registration quality standards because - correct answer ✅Inaccurate or incomplete patient data will delay payment or cause denials Telemed seeks to improve a patient's health by - correct answer ✅Permitting 2-way real time interactive communication between the patient and the clinical professional Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a monthly fee is known as a - correct answer ✅HMO Identifying the patient, in the MPI, creating the registration record, completing medical necessity screening, determining insurance eligibility and benefits resolving managed care, requirements and completing financial education/resolution are all - correct answer ✅The data collection steps for scheduling and pre-registering a patient CRCR Certification exam questions and answers latest 2023 rated A plus Medicare Part B has an annual deductible and the beneficiary is responsible for - correct answer ✅a co-insurance payment for all Part B covered services The two types of claims denial appeals are - correct answer ✅Beneficiary and Provider Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) - correct answer ✅Registration staff members routinely contact managed care plans for prior authorizations before the patient is seen by the on duty physician Rural Health Clinics (RHC) personnel can provide services in all of the following locations, EXCEPT - correct answer ✅Providing inpatient services in the RHC The patient discharge process begins when - correct answer ✅The physician writes the discharge order Departments that need to be included in charge master maintenance include all of the following EXCEPT - correct answer ✅Quality Assurance CRCR Certification exam questions and answers latest 2023 rated A plus The first thing a health plan does when processing a claim is - correct answer ✅Check if the patient is a health plan beneficiary and what is the coverage Vital to accurate calculations of a patient's self-pay amount is - correct answer ✅ The most accurate way to validate patient information is to - correct answer ✅require clinical staff to verify information at each treatment encounter In order for Regulation Z to apply, a hospital must - correct answer ✅ All of the following are minimum requirements for new patients with no MPI number EXCEPT - correct answer ✅Address A typical routine patient financial discussion would include - correct answer ✅Explaining the benefits identified through verifying the patients insurance CRCR Certification exam questions and answers latest 2023 rated A plus Components of financial education include informing the patient of the hospital's financial policies, assessing the patient's ability to pay and - correct answer ✅Reviewing payment alternatives with the patient so appropriate resolution of the health care financial obligation is achieved HFMA best practices indicate that the technology evaluation is conducted to - correct answer ✅Continually align technology with processes rather than technology dictating processes Scheduler instructions are used to prompt the scheduler to - correct answer ✅Complete the scheduling process correctly based on service requested When billing Rural Health Clinic services on a UB-04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521). Although codes are collapsed into a single revenue code, it is still important to list the appropriate CPT codes as part - correct answer ✅These codes will be used to determine medical necessity and useful in determining what happened during the encounter CRCR Certification exam questions and answers latest 2023 rated A plus There are unique billing requirements based on - correct answer ✅The provider type The unscheduled "direct" admission represents a patient who: - correct answer ✅Is admitted from a physician's office on an urgent basis In resolving medical accounts, a law firm may be used as: - correct answer ✅A substitute for a collection agency The legal authority to request and analyze provider claim documentation to ensure that - correct answer ✅The Office of the U.S. Inspector General (OIG) The office of inspector general (OIG) publishes a compliance work plan - correct answer ✅Annually Room and bed charges are typically posted - correct answer ✅From the midnight census CRCR Certification exam questions and answers latest 2023 rated A plus All of the following information should be reviewed as part of schedule finalization EXCEPT: - correct answer ✅The results of any and all test Revenue cycle activities occurring at the point-of-service include all of the following EXCEPT: - correct answer ✅Providing charges to the third-party payer as they are incurred HFMA's patient financial communications best practices specify that pts should be told about the - correct answer ✅The service providers that typically participate in the service, e.g. radiologists ,pathologists, etc. The core financial activities resolved within patient access include: - correct answer ✅Scheduling, pre-registration, insurance verification and managed care processing A decision on whether a patient should be admitted as an inpatient or become about patient observation patient requires medical judgments based on all of the following EXCEPT - correct answer ✅The patient's home care coverage CRCR Certification exam questions and answers latest 2023 rated A plus Which option is a benefit of pre-registering a patient for services - correct answer ✅The patient arrival process is expedited, reducing wait times and delays Days in A/R is calculated based on the value of - correct answer ✅The total accounts receivable on a specific date Case Management requires that a case manager be assigned - correct answer ✅To a select patient group Which of the following is required for participation in Medicaid? - correct answer ✅Meet income and assets requirements All of the following are steps in safeguarding collections EXCEPT - correct answer ✅Issuing receipts The Electronic Remittance Advice (ERA) data set is : - correct answer ✅A standardized form that provides third party payment details to providers CRCR Certification exam questions and answers latest 2023 rated A plus Chapter 13 Bankruptcy, debtor rehabilitation is a court proceeding - correct answer ✅That reorganizes a debtor's holdings and instructs creditors to look to the debtors' future earnings for payment This concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits - correct answer ✅Claims processing The importance of Medical records being maintained by HIM is that the patient records: - correct answer ✅Are the primary source for clinical data required for reimbursement When there is a request for service, the scheduling staff member must confirm the patient's unique identification information to - correct answer ✅Ensure that she/he accesses the correct information in the historical database CRCR Certification exam questions and answers latest 2023 rated A plus Maintaining routine contact with the health plan or liability payer, making sure all required information is provided and all needed approvals are obtained is the responsibility of: - correct answer ✅Case Management Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and - correct answer ✅Provide a method of measuring the collection and control of A/R With any remaining open balances, after insurance payments have been posted, the account financial liability is - correct answer ✅Potentially transferred to the patient Pricing transparency is defined as readily available information on the price of healthcare services, that together with other information, help define the value of those services and enable consumers to - correct answer ✅Identify, compare, and choose providers that offer the desired level of value All of the following are potential causes of credit balances EXCEPT - correct answer ✅A patient's choice to build up a credit against future medical bills CRCR Certification exam questions and answers latest 2023 rated A plus A comprehensive "Compliance Program" is defined as - correct answer ✅Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met An originating site is - correct answer ✅The location of the patient at the time the service is provided Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare established guideline(s) used to determine: - correct answer ✅Which diagnoses, signs, or symptoms are reimbursable If further treatment can only be provided in a hospital setting, the patient's condition cannot be evaluated and/or treated within 24 hours, or if there is not an anticipation of improvement in the patient's condition with 24 hours, the patient - correct answer ✅Will be admitted as an inpatient The benefit of Medicare Advantage Plan is - correct answer ✅Patients generally have their Medicare-coverage healthcare through the plan and do not need to worry about "part a" or "part b" benefits CRCR Certification exam questions and answers latest 2023 rated A plus 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 answer ✅Medical screening and stabilizing treatment Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implement - correct answer ✅Monitor compliance Medicare will only pay for tests and services that - correct answer ✅Medicare determines are "reasonable and necessary" The physician who wrote the order for an inpatient service and is in charge of the patients - correct answer ✅The attending physician When primary payment is received, the actual reimbursement - correct answer ✅Is compared to the expected reimbursement, the remaining contractual adjustments are posted, and secondary claims are submitted CRCR Certification exam questions and answers latest 2023 rated A plus The ICD-10 codes set and CPT/HCPCS code sets combines provide - correct answer ✅The specificity and coding needed to support reimbursement claims In a self-insured (or self-funded) plan, the costs of medical care are - correct answer ✅Borne by the employer on a pay-as-you-go basis Indemnity plans usually reimburse: - correct answer ✅A certain percentage of the charges after the patient meets the policy's annual deductible The first and most critical step in registering a patient, whether scheduled or unscheduled, is - correct answer ✅Verifying the patient's identification When Recovery Audit Contractors (RAC) identify improper payments as over payments, the - correct answer ✅Send a demand letter to the provider to recover the over payment amount Across all care settings, if a patient consents to a financial discussion during a medical encounter - correct answer ✅Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow CRCR Certification exam questions and answers latest 2023 rated A plus Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by: - correct answer ✅Each state's Medicaid plan Medicare patients are NOT required to produce a physician order to receive which of these services - correct answer ✅Screening Mammography, flu vaccine or pneumonia vaccine EFT (electronic funds transfer) is - correct answer ✅An electronic transfer of funds from payer to payee The importance of medical records being maintained by HIM is that the patient records - correct answer ✅Are the primary source for clinical data required for reimbursement by health plans and liability payers Days in A/R is calculated based on the value of: - correct answer ✅The time it takes to collect anticipated revenue CRCR Certification exam questions and answers latest 2023 rated A plus Which of the following in NOT included in the Standardized Quality Measures - correct answer ✅Cost of services The disadvantages of outsourcing include all of the following EXCEPT: - correct answer ✅Reduced internal staffing costs and a reliance on outsourced staff Improving the overall patient experience requires revenue cycle leadership and staff to simultaneously be: - correct answer ✅Clear on policies and consistent in applying the policies Because 501(r) regulations focus on identifying potential eligible financial assistants patients hospitals must: - correct answer ✅Hold financial conversations with patients as soon as possible Which of the following is NOT contained in a collection agency agreement? - correct answer ✅A mutual hold-harmless clause CRCR Certification exam questions and answers latest 2023 rated A plus HFMA best practices stipulate that a reasonable attempt should be made to have the financial - correct answer ✅As early as possible, before a financial obligation is incurred Recognizing that health coverage is complicated and not all pts are able to navigate this terrain, HFMA best practices specify that - correct answer ✅Patients should be given the opportunity to request a patient advocate, family member or other designee to help them In these discussions For scheduled patients, important revenue cycle activities In the Time of Service stage DO NOT INCLUDE: - correct answer ✅Final bill is presented for payment HFMA's patient financial communication best practices specify that patients should be told about the types of services provided and - correct answer ✅The service providers that typically participate in the service, e.g., radiologists, pathologists, etc. Successful account resolution begins with - correct answer ✅Collecting all deductibles and copayments during the pre-service stage CRCR Certification exam questions and answers latest 2023 rated A plus Recognizing that health coverage is complicated and not all patients are able to navigate this terrain, HFMA best practices specify that - correct answer ✅Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions In the balance resolution process, providers should: - correct answer ✅Ask the patient if he or she would like to receive information about payment options and supportive financial assistance programs Business ethics, or organizational ethics represent: - correct answer ✅The principles and standards by which organizations operate Which option is a government-sponsored health care program that is financed through taxes and general revenue funds - correct answer ✅Medicare Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on; a monthly fee is known as a - correct answer ✅HMO CRCR Certification exam questions and answers latest 2023 rated A plus Because case managers document the clinical reasons for treatment, they are - correct answer ✅A good resource when developing written appeals of denials The Truth in Lending Act establishes - correct answer ✅Disclosure rules for consumer credit sales and consumer loans What is Continuum of Care? - correct answer ✅The coordination and linkage of resources needed to avoid the duplication of services and the facilitation of a seamless movement among care settings HIPAA privacy rules require covered entities to take all of the following actions EXCEPT - correct answer ✅Use only designated software platforms to secure patient data The Two Midnight Rule allows hospitals to account for total hospital time when determining if an inpatient admission order should be written based on - correct answer ✅A beneficiary needing a minimum of 48 hours of care CRCR Certification exam questions and answers latest 2023 rated A plus Since passage of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to - correct answer ✅Assist patients in understanding their insurance coverage and their financial obligation HFMA patient financial communications best practices call for annual training for all staff EXCEPT - correct answer ✅Nursing The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as - correct answer ✅Insurance verification of reimbursable charges Net Accounts Receivable is - correct answer ✅The amount an entity is reasonably confident of collecting from overall accounts receivable. ED patients should be informed that their ability to pay - correct answer ✅Will not interfere with treatment of any emergency medical conditions CRCR Certification exam questions and answers latest 2023 rated A plus Providers are advised that it is best to establish patient financial responsibility and assistance policies and make sure they are followed internally and by - correct answer ✅Business affiliates Incorrect data gathering can cause all of the following EXCEPT - correct answer ✅The inability to discuss quality with physicians All Hospitals are required to establish a written financial assistance policy that applies to - correct answer ✅All emergency and medically necessary care All of the following are reference resources used to help guide in the application of business ethics EXCEPT - correct answer ✅Consumer satisfaction reports Each patient is assigned a unique number, commonly called the - correct answer ✅Master Patient Index (MPI) number HIPAA contains all of the following goals EXCEPT - correct answer ✅To ensure proper coding across the continuum of care