Download CRCR Certification exam review 2023 questions and answers.docx and more Exams Nursing in PDF only on Docsity! CRCR Certification exam review 2023 questions and answers 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 review 2023 questions and answers 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 review 2023 questions and answers 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 arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility CRCR Certification exam review 2023 questions and answers 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 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 CRCR Certification exam review 2023 questions and answers 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 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 standard claim form used for billing by hospitals, nursing facilities, and other inpatient - correct answer UB-04 CRCR Certification exam review 2023 questions and answers 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 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 CRCR Certification exam review 2023 questions and answers 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 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 CRCR Certification exam review 2023 questions and answers 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 What is likely to occur if credit balances are not identified separately from debit balances in accounts receivable? - correct answer The accounts receivable level would be understated The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as - correct answer insurance verification and reimbursable charges Unless the patient encounter is an emergency, it is more efficient and effective to - correct answer Collect all information after the patient has been discharged Applying the contracted payment amount to the amount of total charges yields - correct answer A pricing agreement CRCR Certification exam review 2023 questions and answers 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 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 CRCR Certification exam review 2023 questions and answers 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 All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT - correct answer Services and procedures that are custodial in nature CRCR Certification exam review 2023 questions and answers Medicare beneficiaries remain in the same "benefit period" - correct answer Until the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days It is important to calculate reserves to ensure - correct answer Stable financial operations and accurate financial reporting A claim is denied for the following reasons, EXCEPT: - correct answer The submitted claim does not have the physicians signature HFMA best practices call for patient financial discussions to be reinforced - correct answer By changing policies to programs Patients should be informed that costs presented in a price estimate may - correct answer Vary from estimates, depending on the actual services performed The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physicians to do all of the following EXCEPT: - correct answer Obtain higher compensation for physicians CRCR Certification exam review 2023 questions and answers 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 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 CRCR Certification exam review 2023 questions and answers 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 The process of creating the pre-registration record ensures - correct answer Accurate billing Claims with dates of service received later than one calendar year beyond the date of service, will be - correct answer Denied by Medicare A portion of the accounts receivable inventory which has NOT qualified for billing includes - correct answer Charitable pledges CRCR Certification exam review 2023 questions and answers The standard claim form used for billing by hospitals, nursing facilities, and other in-patient - correct answer UB-04 Once the price is estimated in the pre-service stage, a provider's financial best practice is to - correct answer Explain to the patient their financial responsibility and to determine the plan for payment Internal controls addressing coding and reimbursement changes are put in place to guard against - correct answer Compliance fraud by upcoding Health Plan Contracting Departments do all of the following EXCEPT - correct answer Establish a global reimbursement rate to use with all third-party payer For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: - correct answer Should take place between the patient or guarantor and properly trained provider representatives What type of account adjustment results from the patient's unwillingness to pay a self-pay balance? - correct answer Bad debt adjustment CRCR Certification exam review 2023 questions and answers 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 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 CRCR Certification exam review 2023 questions and answers Days in A/R is calculated based on the value of: - correct answer The time it takes to collect anticipated revenue To maximize the value derived from customer complaints, all consumer complaints should be - correct answer Responded to within two business days A scheduled inpatient represents an opportunity for the provider to do which of the following? - correct answer Complete registration and insurance approval before service In the pre-service stage, the requested service is screened for medical necessity, health - correct answer Pre-authorization are obtained Hospitals need which of the following information sets to assess a patient's financial status: - correct answer Patient and guarantor's income, expenses and assets CRCR Certification exam review 2023 questions and answers Patients are contacting hospitals to proactively inquire about costs and fees prior to - correct answer The fact that charge master lists the total charge, not net charges that reflect charges after a payer's contractual adjustment HIPAA had adopted Employer Identification Numbers (EIN) to be used in standard transactions to identify the employer of an individual described in a transaction EIN's are assigned by - correct answer The Internal Revenue Service The HCAHPS (hospital consumer assessment of healthcare providers and systems) initiative - correct answer Provide a standardized method for evaluating patient's perspective on hospital care. A large number of credit balances are not the result of overpayments but of - correct answer Posting errors in the patient accounting system A Medicare Part A benefit period begins: - correct answer With admission as an inpatient Chapter 13 Bankruptcy, debtor rehabilitation, is a court proceeding - correct answer That reorganizes a debtor's holdings and instructs creditors to look to the debtor's future earnings for payment CRCR Certification exam review 2023 questions and answers 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 review 2023 questions and answers In a Chapter 7 Straight Bankruptcy filing - correct answer The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt When there is a request for service the scheduling staff member must confirm the patient's - correct answer Ensure that she/he accesses the correct information in the historical database A four digit number code established by the National Uniform Billing Committee (NUBC)that categorizes/classifies a line item in the charge master is known as - correct answer Revenue codes Appropriate training for patient financial counseling staff must cover all of the following EXCEPT: - correct answer Documenting the conversation in the medical records The ACO investment model will test the use of pre-paid shared savings to - correct answer Encourage new ACOs to form in rural and underserved areas CRCR Certification exam review 2023 questions and answers When recovery audit contractors (RAC) identify improper payments as over payments the claims processing contractor must - correct answer Send a demand letter to the provider to recover the over payment amount The purpose of the ACA mandated Community Health Needs Assessment is - correct answer To identify significant health needs, prioritize those needs and identify resources to address them A balance sheet is - correct answer A statement of assets, liabilities, and capital for an organization at a specified point in time Hospitals can only convert an inpatient case to observation if the hospital utilization review committee determines this status before the patient is discharged and - correct answer Prior to billing, that an observation setting will be more appropriate During pre-registration, a search for the patients MPI number is initiated using which of the following data sets? - correct answer Patient's full legal name and date of birth or the patient's Social Security number CRCR Certification exam review 2023 questions and answers 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 Which of the following is NOT included in the Standardized Quality Measures? - correct answer Account Receivable (A/R) Aging reports - correct answer Divide accounts receivable into 30, 60, 90 ,120 days past due categories CRCR Certification exam review 2023 questions and answers Patients expect value for their healthcare dollar, including greater transparency of - correct answer Quality and price information The impact of denials on the revenue cycle includes all of the following EXCEPT - correct answer Patient outcomes Examples of ethics violations that impact the revenue cycle include all of the following EXCEPT - correct answer Seeking payment options for patient self-pay Scheduled procedures routinely include - correct answer Patient preparation instructions ICD-10-CM and ICD-10-PCS codes sets are modifications of - correct answer The International ICD-10 codes as developed by the WHO (World Health Organization) The result of accurate census balancing on a daily basis is - correct answer The correct recording of room charges CRCR Certification exam review 2023 questions and answers All of the following are steps in verifying insurance EXCEPT - correct answer The patient signing the statement of financial responsibility Health Information Management (HIM) is responsible for - correct answer All patient medical records This form contains major items, subdivided into a total of 55 detailed items, and is used by professional service providers and not hospitals for submitting claims for services to health plans this form is called - correct answer The 1500 Which of the following is NOT a factor in self-pay follow-up? - correct answer The type of patient (inpatient, out-patient) The Office of Inspector General (OIG) was created - correct answer Detect and prevent fraud, waste, and abuse - correct answer