CRCR EXAM MULTIPLE CHOICE, CRCR Exam Prep, Certified Revenue Cycle Representative - CRCR, Exams of Nursing

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CRCR EXAM MULTIPLE CHOICE, CRCR Exam Prep,

Certified Revenue Cycle Representative - CRCR (202 3 )

with correct answers

What are collection agency fees based on? A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? Case rates What customer service improvements might improve the patient accounts department? Holding staff accountable for customer service during performance reviews What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? 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? Bad debt adjustment What is the initial hospice benefit? Two 90-day periods and an unlimited number of subsequent periods When does a hospital add ambulance charges to the Medicare inpatient claim? 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? 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 They are not being processed in a timely manner

Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has received what? 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$? When the patient is the insured What are non-emergency patients who come for service without prior notification to the provider called? Unscheduled patients If the insurance verification response reports that a subscriber has a single policy, what is the status of the subscriber's spouse? Neither enrolled not entitled to benefits Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act, establishes what? Disclosure rules for consumer credit sales and consumer loans

What is a principal diagnosis? Primary reason for the patient's admission Collecting patient liability dollars after service leads to what? Lower accounts receivable levels What is the daily out-of-pocket amount for each lifetime reserve day used? 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? Inpatient care What code indicates the disposition of the patient at the conclusion of service? Patient discharge status code What are hospitals required to do for Medicare credit balance accounts? They result in lost reimbursement and additional cost to collect

Condition code Regulations and requirements for coding accountable care organizations, which allows providers to begin creating these organizations, were finalized in: 2012 What is a primary responsibility of the Recover Audit Contractor? To correctly identify proper payments for Medicare Part A & B claims How must providers handle credit balances? Comply with state statutes concerning reporting credit balance Insurance verification results in what? The accurate identification of the patient's eligibility and benefits What form is used to bill Medicare for rural health clinics? CMS 1500

What activities are completed when a scheduled pre-registered patient arrives for service? Registering the patient and directing the patient to the service area In addition to being supported by information found in the patient's chart, a CMS 1500 claim must be coded using what? HCPCS (Healthcare Common Procedure Coding system) What results from a denied claim? The provider incurs rework and appeal costs Why does the financial counselor need pricing for services? To calculate the patient's financial responsibility What type of provider bills third-party payers using CMS 1500 form Hospital-based mammography centers How are disputes with nongovernmental payers resolved? Appeal conditions specified in the individual payer's contract

What should the provider do if both of the patient's insurance plans pay as primary? Determine the correct payer and notify the incorrect payer of the processing error What do EMTALA regulations require on-call physicians to do? 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? They must be balanced What will cause a CMS 1500 claim to be rejected? The provider is billing with a future date of service Under Medicare regulations, which of the following is not included on a valid physician's order for services? The cost of the test how are HCPCS codes and the appropriate modifiers used?

To report the level 1, 2, or 3 code that correctly describes the service provided If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? Diagnostic and clinically-related non-diagnostic charges provided on the Tuesday, Wednesday, Thursday, and Friday before admission What is a benefit of pre-registering patient's for service? Patient arrival processing is expedited, reducing wait times and delays What is a characteristic of a managed contracting methodology? Prospectively set rates for inpatient and outpatient services What do the MSP disability rules require? That the patient's spouse's employer must have less than 20 employees in the group health plan what organization originated the concept of insuring prepaid health care services? Blue Cross and blue Shield

To obtain approval for inpatient days and coordinate services When is it not appropriate to use observation status? As a substitute for an inpatient admission What is a serious consequence of misidentifying a patient in the MPI? 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? Redirect the patient to the patient access department for registration What process can be used to shorten claim turnaround time? Send high-dollar hard-copy claims with required attachments by overnight mail or registered mail How are patient reminder calls used? 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? Write off the account to the contractual adjustment account According to the Department of Health and Human Services guidelines, what is NOT considered income? Sale of property, house, or car The situation where neither the patient nor spouse is employed is described to the patient using: A condition code What option is an alternative to valid long-term payment plans? Bank loans What is an advantage of using a collection agency to collect delinquent patient accounts? Collection agencies collect accounts faster than hospital does What statement DOES NOT apply to revenue codes?

What standard claim forms are currently used by the healthcare industry to submit claims to third-party payers? The UB-04 and the CMS 1500 Unless the patient encounter is an emergency, what is the efficient and effective procedure for obtaining information? Obtain the required demographic and insurance information before services are rendered what protocol was developed through the Patient Friendly Billing Project? 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? Ask if the patient's current services was accident related What is a valid reason for a payer to delay a claim? 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 They must be combined with the inpatient bill and paid under the MS-DRG system What do large adjustments require? Manager-level approval What items are valid identifiers to establish a patient's identification? Photo identification, date of birth, and social security number What must a provider do to qualify an account as a Medicare bad debts? 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? Site-of-service limitation What is an example of an outcome of the Patient Friendly Billing Project? Redesigned patient billing statements using patient-friendly language

What circumstance would result in an incorrect nightly room charge? If the patient's discharge, ordered for tomorrow, has not been charted What is NOT a typical charge master problem that can result in a denial? Does not include required modifiers Access An individual's ability to obtain medical services on a timely and financially acceptable level Administrative Services Only (ASO) Usually contracted administrative services to a self-insured health plan Case management The process whereby all health-related components of a case are managed by a designated health professional. Intended to ensure continuity of healthcare accessibility and services

Claim A demand by an insured person for the benefits provided by the group contract Coordination of benefits (COB) 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 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 Patient status regarding coverage for healthcare insurance benefits First dollar coverage A healthcare insurance policy that has no deductible and covers the first dollar of an insured's expenses Gatekeeping