CRCR Exam Prep: Multiple Choice Questions and Answers, Exams of Law

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What are collection agency fees based on? - Correct answer-A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - Correct answer Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - Correct answer Case rates What customer service improvements might improve the patient accounts department?

• Correct answer-Holding staff accountable for customer service during performance reviews What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - Correct answer Inform a Medicare beneficiary that Medicare may not pay for the order or service What type of account adjustment results from the patient's unwillingness to pay for a self-pay balance? - Correct answer Bad debt adjustment What is the initial hospice benefit? - Correct answer Two 90-day periods and an unlimited number of subsequent periods When does a hospital add ambulance charges to the Medicare inpatient claim? - Correct 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 is billed? - Correct answer-Post a late-charge adjustment to the account

CRCR Exam Multiple Choice, CRCR

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

an increase in the dollars aged greater than 90 days from date of service indicate what about accounts - Correct answer They are not being processed in a timely manner What is an advantage of a preregistration program? - Correct answer It reduces processing times at the time of service What are the two statutory exclusions from hospice coverage? - Correct answer- Medically unnecessary services and custodial care

What is the daily out-of-pocket amount for each lifetime reserve day used? - Correct answer-50% of the current deductible amount What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as an RHC services? - Correct answer Inpatient care

What code indicates the disposition of the patient at the conclusion of service? - Correct answer Patient discharge status code What are hospitals required to do for Medicare credit balance accounts? - Correct answer They result in lost reimbursement and additional cost to collect When an undue delay of payment results from a dispute between the patient and the third party payer, who is responsible for payment? - Correct answer Patient Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include: - Correct 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? - Correct answer-Access their information and perform functions on-line What date is required on all CMS 1500 claim forms? - Correct answer-onset date of current illness What does scheduling allow provider staff to do - Correct answer Review appropriateness of the service request What code is used to report the provider's most common semiprivate room rate? - Correct answer Condition code Regulations and requirements for coding accountable care organizations, which allows providers to begin creating these organizations, were finalized in: - Correct answer- What is a primary responsibility of the Recover Audit Contractor? - Correct answer-To correctly identify proper payments for Medicare Part A & B claims How must providers handle credit balances? - Correct answer Comply with state statutes concerning reporting credit balance Insurance verification results in what? - Correct answer-The accurate identification of the patient's eligibility and benefits

In addition to being supported by information found in the patient's chart, a CMS 1500 claim must be coded using what? - Correct answer-HCPCS (Healthcare Common Procedure Coding system) What results from a denied claim? - Correct answer-The provider incurs rework and appeal costs Why does the financial counselor need pricing for services? - Correct answer-To calculate the patient's financial responsibility What type of provider bills third-party payers using CMS 1500 form - Correct answer- Hospital-based mammography centers How are disputes with nongovernmental payers resolved? - Correct answer-Appeal conditions specified in the individual payer's contract The important message from Medicare provides beneficiaries with information concerning what? - Correct 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? - Correct answer-To improve 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? - Correct 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? - Correct answer-120 days passes, but the claim then be withdrawn from the liability carrier What data are required to establish a new MPI entry? - Correct 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? - Correct answer- Determine the correct payer and notify the incorrect payer of the processing error What do EMTALA regulations require on-call physicians to do? - Correct answer- Personally appear in the emergency department and attend to the patient within a reasonable time

At the end of each shift, what must happen to cash, checks, and credit card transaction documents? - Correct answer-They must be balanced

What will comprehensive patient access processing accomplish? - Correct answer- Minimize the need for follow-up on insurance accounts Through what document does a hospital establish compliance standards? - Correct answer-Code of conduct How does utilization review staff use correct insurance information? - Correct answer- To obtain approval for inpatient days and coordinate services

When is it not appropriate to use observation status? - Correct answer-As a substitute for an inpatient admission What is a serious consequence of misidentifying a patient in the MPI? - Correct answer- The services will be documented in the wrong record When a patient reports directly to a clinical department for service, what will the clinical department staff do? - Correct answer-Redirect the patient to the patient access department for registration What process can be used to shorten claim turnaround time? - Correct answer-Send high-dollar hard-copy claims with required attachments by overnight mail or registered mail How are patient reminder calls used? - Correct answer-To make sure the patient follows the prep instructions and arrives at the scheduled time for service If a patient declares a straight bankruptcy, what must the provider do? - Correct answer- Write off the account to the contractual adjustment account According to the Department of Health and Human Services guidelines, what is NOT considered income? - Correct answer-Sale of property, house, or car The situation where neither the patient nor spouse is employed is described to the patient using: - Correct answer-A condition code What option is an alternative to valid long-term payment plans? - Correct answer-Bank loans What is an advantage of using a collection agency to collect delinquent patient accounts? - Correct answer- Collection agencies collect accounts faster than hospital does What statement DOES NOT apply to revenue codes? - Correct answer-revenue codes identify the payer 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 - Correct answer-catastrophic charity

How may a collection agency demonstrate its performance? - Correct answer-Calculate the rate of recovery 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? - Correct answer-It is posted on the remittance advice by the payer What standard claim forms are currently used by the healthcare industry to submit claims to third-party payers? - Correct answer-The UB-04 and the CMS 1500 Unless the patient encounter is an emergency, what is the efficient and effective procedure for obtaining information? - Correct answer-Obtain the required demographic and insurance information before services are rendered what protocol was developed through the Patient Friendly Billing Project? - Correct answer-Provide information using language that is easily understood by the average reader What technique is acceptable way to complete the MSP screening for a facility situation? - Correct answer- Ask if the patient's current services was accident related What is a valid reason for a payer to delay a claim? - Correct answer-Failure to complete authorization requirements IF outpatient diagnostic services are provided within three days of the admission of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these charges - Correct answer-They must be combined with the inpatient bill and paid under the MS-DRG system What do large adjustments require? - Correct answer-Manager-level approval What items are valid identifiers to establish a patient's identification? - Correct answer- Photo identification, date of birth, and social security number What must a provider do to qualify an account as a Medicare bad debts? - Correct answer-Pursue the account for 120 days and then refer it to an outside collection agency

What restriction does a managed care plan place on locations that must be used if the plan is to pay for the services provided? - Correct answer-Site-of-service limitation What is an example of an outcome of the Patient Friendly Billing Project? - Correct answer-Redesigned patient billing statements using patient-friendly language

Coordination of benefits (COB) - Correct answer-a typical insurance provision that determines the responsibility for primary payment when the patient is covered by more than one employer-sponsored health benefit program Discounted fee-for-service - Correct answer-A reimbursement methodology whereby a provider agrees to provide service on a fee for service basis, but the fees are discounted by certain packages

Eligibility - Correct answer-Patient status regarding coverage for healthcare insurance benefits First dollar coverage - Correct answer-A healthcare insurance policy that has no deductible and covers the first dollar of an insured's expenses Gatekeeping - Correct answer-A concept wherein the primary care physician provides all primary patient care and coordinates all diagnostic testing and specialty referrals required for a patient's medical care Health plan - Correct answer-an insurance company that provides for the delivery or payment of healthcare services Indemnity insurance - Correct answer-negotiated healthcare coverage within a framework of fee schedules, limitations, and exclusions that is offered by insurance companies or benevolent associations Medically necessary - Correct answer-Healthcare services that are required to preserve or maintain a person's health status in accordance with medical practice standards Out-of-area benefits - Correct answer-healthcare plan coverage allowed to covered persons for emergency situations outside of the prescribed geographic area of the HMO Out-of-pocket payments - Correct answer-Cash payments made by the insured for services not covered by the health insurance plan Pre-admission review - Correct answer-the practice of reviewing requests for inpatient admission before the patient is admitted to ensure that the admission is medically necesary Pre-existing condition limitation - Correct answer-A restriction on payments for charges directly resulting from a pre-existing health conditions Same-day admission - Correct answer-A cost containment practice that reduces a surgical patient's inpatient stay by requiring that pre-procedure testing and preparation are completed on an outpatient basis and the patient is admitted the same day as the procedure

Subscriber - Correct answer-An employer, a union, or an association that contracts with an insurance company for the healthcare plan it offers to eligible employees Sub-specialist - Correct answer-A healthcare professional who is recognized to have expertise in a specialty of medicine or surgery Third-part administrator (TPA) - Correct answer-Provides services to employers or insurance companies for utilization review, claims payment and benefit design Third-party reimbursement - Correct answer-A general term used for the healthcare benefit payments - used to identify that for benefit plans there are three parties in the transaction Usual, customary, and reasonable (UCR) - Correct answer-Health insurance plan reimbursement methodology that limits payment to the lower billed charges, the provider's customary charge, or the prevailing charge for the service in the community Utilization review - Correct answer-Review conducted by professional healthcare personnel of the appropriateness of, quality of, and need for healthcare services provided to patients Charge - Correct answer-The dollar amount a provider sets for services rendered before negotiating any discounts. The charge can be different from the amount paid Cost - Correct answer-The definition of cost varies by party incurring the expense Price - Correct answer-the total amount a provider expects to be paid by payers and patients for healthcare services Care purchaser - Correct answer-Individual or entity that contributes to the purchase of healthcare services Payer - Correct answer-An organization that negotiates or sets rates for provider services, collects revenue through premium payments or tax dollars, processes provider claims for service, and pays provider claims using collected premium or tax revenues Provider - Correct answer-An entity, organization, or individual that furnishes a healthcare service

Out of pocket payment - Correct answer-The portion of the total payment for medical services and treatment for which the patient is responsible, including copayments, coinsurance, and deductibles Price transparency - Correct answer-In health care, readily available information on the price of healthcare services that, together, with other information helps define the value