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

CRCR EXAM MULTIPLE CHOICE, CRCR Exam Prep, Certified Revenue Cycle Representative - CRCR (2023)

Typology: Exams

2022/2023

Available from 07/09/2023

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Download CRCR EXAM MULTIPLE CHOICE, CRCR Exam Prep, Certified Revenue Cycle Representative - CRCR ( and more Exams Nursing in PDF only on Docsity!

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

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

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

What is an advantage of a preregistration program? - correct answers It reduces processing times at the time of service What are the two statutory exclusions from hospice coverage? - correct answers Medically unnecessary services and custodial care What core financial activities are resolved within patient access? - correct answers Scheduling, insurance verification, discharge processing, and payment of point-of-service receipts What statement applies to the scheduled outpatient? - correct answers The services do not involve an overnight stay How is a mis-posted contractual allowance resolved? - correct answers Comparing the contract reimbursement rates with the contract on the admittance advice to identify the correct amount What type of patient status is used to evaluate the patient's need for inpatient care? - correct answers Observation Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has received what? - correct answers 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$? - correct answers When the patient is the insured What are non-emergency patients who come for service without prior notification to the provider called? - correct answers Unscheduled patients If the insurance verification response reports that a subscriber has a single policy, what is the status of the subscriber's spouse? - correct answers Neither enrolled not entitled to benefits

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act, establishes what? - correct answers Disclosure rules for consumer credit sales and consumer loans What is a principal diagnosis? - correct answers Primary reason for the patient's admission Collecting patient liability dollars after service leads to what? - correct answers Lower accounts receivable levels What is the daily out-of-pocket amount for each lifetime reserve day used? - correct answers 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 answers Inpatient care What code indicates the disposition of the patient at the conclusion of service? - correct answers Patient discharge status code What are hospitals required to do for Medicare credit balance accounts? - correct answers 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 answers 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 answers 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 answers Access their information and perform functions on-line

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

What date is required on all CMS 1500 claim forms? - correct answers onset date of current illness What does scheduling allow provider staff to do - correct answers Review appropriateness of the service request What code is used to report the provider's most common semiprivate room rate? - correct answers Condition code Regulations and requirements for coding accountable care organizations, which allows providers to begin creating these organizations, were finalized in: - correct answers 2012 What is a primary responsibility of the Recover Audit Contractor? - correct answers To correctly identify proper payments for Medicare Part A & B claims How must providers handle credit balances? - correct answers Comply with state statutes concerning reporting credit balance Insurance verification results in what? - correct answers The accurate identification of the patient's eligibility and benefits What form is used to bill Medicare for rural health clinics? - correct answers CMS 1500 What activities are completed when a scheduled pre-registered patient arrives for service? - correct answers 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? - correct answers HCPCS (Healthcare Common Procedure Coding system)

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

What results from a denied claim? - correct answers The provider incurs rework and appeal costs Why does the financial counselor need pricing for services? - correct answers To calculate the patient's financial responsibility What type of provider bills third-party payers using CMS 1500 form - correct answers Hospital-based mammography centers How are disputes with nongovernmental payers resolved? - correct answers Appeal conditions specified in the individual payer's contract The important message from Medicare provides beneficiaries with information concerning what? - correct answers 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 answers 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 answers Submit interim bills to the Medicare program.

  1. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims after what happens? - correct answers 120 days passes, but the claim then be withdrawn from the liability carrier What data are required to establish a new MPI entry? - correct answers 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 answers Determine the correct payer and notify the incorrect payer of the processing error

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

What do EMTALA regulations require on-call physicians to do? - correct answers 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 answers They must be balanced What will cause a CMS 1500 claim to be rejected? - correct answers 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? - correct answers The cost of the test how are HCPCS codes and the appropriate modifiers used? - correct answers 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? - correct answers 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? - correct answers Patient arrival processing is expedited, reducing wait times and delays What is a characteristic of a managed contracting methodology? - correct answers Prospectively set rates for inpatient and outpatient services What do the MSP disability rules require? - correct answers 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? - correct answers Blue Cross and blue Shield

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

What is true about screening a beneficiary for possible MSP situations? - correct answers It is acceptable to complete the screening form after the patient has completed the registration process and been sent to the service department If the patient cannot agree to payment arrangements, what is the next option? - correct answers Warn the patient that unpaid accounts are placed with collection agencies for further processing In services lines such as cardiology or orthopedics, what does the case-rate payment methodology allow providers to do? - correct answers Receive a fixed for specific procedures What will comprehensive patient access processing accomplish? - correct answers Minimize the need for follow-up on insurance accounts Through what document does a hospital establish compliance standards? - correct answers Code of conduct How does utilization review staff use correct insurance information? - correct answers To obtain approval for inpatient days and coordinate services When is it not appropriate to use observation status? - correct answers As a substitute for an inpatient admission What is a serious consequence of misidentifying a patient in the MPI? - correct answers 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 answers Redirect the patient to the patient access department for registration

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

What process can be used to shorten claim turnaround time? - correct answers Send high-dollar hard- copy claims with required attachments by overnight mail or registered mail How are patient reminder calls used? - correct answers 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 answers 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 answers Sale of property, house, or car The situation where neither the patient nor spouse is employed is described to the patient using: - correct answers A condition code What option is an alternative to valid long-term payment plans? - correct answers Bank loans What is an advantage of using a collection agency to collect delinquent patient accounts? - correct answers Collection agencies collect accounts faster than hospital does What statement DOES NOT apply to revenue codes? - correct answers 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 answers catastrophic charity What happens when a patient receives non-emergent services from and out-of-network provider? - correct answers Patient payment responsibility is higher

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

Every patient who is new to the healthcare provider must be offered what? - correct answers A printed copy of the provider's privacy notice How may a collection agency demonstrate its performance? - correct answers 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 answers 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 answers 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 answers Obtain the required demographic and insurance information before services are rendered what protocol was developed through the Patient Friendly Billing Project? - correct answers 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 answers Ask if the patient's current services was accident related What is a valid reason for a payer to delay a claim? - correct answers 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 answers They must be combined with the inpatient bill and paid under the MS-DRG system

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

What do large adjustments require? - correct answers Manager-level approval What items are valid identifiers to establish a patient's identification? - correct answers Photo identification, date of birth, and social security number What must a provider do to qualify an account as a Medicare bad debts? - correct answers 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 answers Site-of-service limitation What is an example of an outcome of the Patient Friendly Billing Project? - correct answers Redesigned patient billing statements using patient-friendly language What statement describes the APC (Ambulatory payment classification) system? - correct answers APC rates are calculated on a national basis and are wage-adjusted by geographic region What is a benefit of insurance verification? - correct answers Pre-certification or pre-authorization requirements are confirmed What is an effective tool to help staff collect payments at the time of service? - correct answers Develop scripts for the process of requesting payments What is a benefit of electronic claims processing? - correct answers Providers can electronically view patient's eligibility What does Medicare Part D provide coverage for? - correct answers Prescription drugs

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

What are some core elements of a board-approved financial policy - correct answers Charity care, payment methods, and installment payment guidelines What circumstance would result in an incorrect nightly room charge? - correct answers 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? - correct answers Does not include required modifiers Access - correct answers An individual's ability to obtain medical services on a timely and financially acceptable level Administrative Services Only (ASO) - correct answers Usually contracted administrative services to a self- insured health plan Case management - correct answers 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 - correct answers A demand by an insured person for the benefits provided by the group contract Coordination of benefits (COB) - correct answers 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 answers 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 answers Patient status regarding coverage for healthcare insurance benefits

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

First dollar coverage - correct answers A healthcare insurance policy that has no deductible and covers the first dollar of an insured's expenses Gatekeeping - correct answers 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 answers an insurance company that provides for the delivery or payment of healthcare services Indemnity insurance - correct answers negotiated healthcare coverage within a framework of fee schedules, limitations, and exclusions that is offered by insurance companies or benevolent associations Medically necessary - correct answers 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 answers healthcare plan coverage allowed to covered persons for emergency situations outside of the prescribed geographic area of the HMO Out-of-pocket payments - correct answers Cash payments made by the insured for services not covered by the health insurance plan Pre-admission review - correct answers 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 answers A restriction on payments for charges directly resulting from a pre-existing health conditions

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

Same-day admission - correct answers 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 Self-insured - correct answers Large employers who assume direct responsibility or risk for paying employees' healthcare without purchasing health insurance Subrogation - correct answers Seeking, by legal or administrative means, reimbursement from another party that is primarily responsible for a patient's medical expenses Subscriber - correct answers 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 answers A healthcare professional who is recognized to have expertise in a specialty of medicine or surgery Third-part administrator (TPA) - correct answers Provides services to employers or insurance companies for utilization review, claims payment and benefit design Third-party reimbursement - correct answers 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 answers 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 answers Review conducted by professional healthcare personnel of the appropriateness of, quality of, and need for healthcare services provided to patients

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

Charge - correct answers The dollar amount a provider sets for services rendered before negotiating any discounts. The charge can be different from the amount paid Cost - correct answers The definition of cost varies by party incurring the expense Price - correct answers the total amount a provider expects to be paid by payers and patients for healthcare services Care purchaser - correct answers Individual or entity that contributes to the purchase of healthcare services Payer - correct answers 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 answers An entity, organization, or individual that furnishes a healthcare service Out of pocket payment - correct answers 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 answers In health care, readily available information on the price of healthcare services that, together, with other information helps define the value of those services and enables patients and other care purchasers to identify, compare, and choose providers that offer the desired level of value Value - correct answers The quality of a healthcare service in relation to the total price paid for the service by care purchasers What areas does the code of conduct typically focus on? - correct answers Human resources. Privacy/confidentiality. Quality of care. Billing/coding. Conflicts of interest. Laws/regulations

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

FERA - correct answers Fraud Enforcement and Recovery act ESRD - correct answers End-stage renal disease. The patient has permanent kidney failure, is covered by a GHP, and has not yet completed the 30-month coordination period What is the purpose of a compliance program? - correct answers Mitigate potential fraud and abuse in the industry-specific key risk areas What is important about an effective corporate compliance program? - correct answers A program that embodies many elements to create a program that is transparent, clearly articulated and emphasized at all employee levels as a seriously held personal and organizational responsibility, one that relies on full communication inside and outside the organization What is a CCO - correct answers Chief compliance officer - they typically report directly to the board of directors/trustees as well as the chief executive officer, and has limited responsibilities for other operational aspects of the organization What are the situations where another payer may be completely responsible for payment? - correct answers Work-related accidents, black lung program services, patient is enrolled in Medicare Advantage, Federal grant programs Under Medicare rules, certain outpatient services that are provided within three days of the admission date, by hospitals or by entities owned or controlled by hospitals, must be billed as part of an inpatient stay. - correct answers TRUE The OIG has issued compliance guidance/model compliance plans for all of the following entities: - correct answers hospices. physician practices. ambulance providers Providers who are found to be in violation of CMS regulations are subject to: - correct answers Corporate integrity agreements

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

What MSP situation requires LGHP - correct answers Disability The disadvantages of outsourcing include all of the following EXCEPT: a) The impact of customer service or patient relations b) The impact of loss of direct control of accounts receivable services c) Increased costs due to vendor ineffectiveness d) Reduced internal staffing costs and a reliance on outsourced staff - correct answers D The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: a) Medical necessity review by an independent physician's panel b) Judicial review by a federal district court c) Redetermination by the company that handles claims for Medicare d) Review by the Medicare Appeals Council (Appeals Council) - correct answers B Business ethics, or organizational ethics represent: a) The principles and standards by which organizations operate b) Regulations that must be followed by law c) Definitions of appropriate customer service d) The code of acceptable conduct - correct answers A A portion of the accounts receivable inventory which has NOT qualified for billing

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

includes: a) Charitable pledges b) Accounts created during pre-registration but not activated c) Accounts coded but held within the suspense period d) Accounts assigned to a pre-collection agency - correct answers A Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare established guideline(s) used to determine: a) Medicare and Medicaid provider eligibility b) Medicare outpatient reimbursement rates c) Which diagnoses, signs, or symptoms are reimbursable d) What Medicare reimburses and what should be referred to Medicaid - correct answers C Days in A/R is calculated based on the value of: a) The total accounts receivable on a specific date b) Total anticipated revenue minus expenses c) The time it takes to collect anticipated revenue d) Total cash received to date - correct answers C Patients are contacting hospitals to proactively inquire about costs and fees prior to agreeing to service. The problem for hospitals in providing such information is:

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

a) That hospitals don't want to establish a price without knowing if the patient has insurance and how much reimbursement can be expected b) The fact that charge master lists the total charge, not net charges that reflect charges after a payer's contractual adjustment c) That hospitals don't want to be put in the position of "guaranteeing" price without having room for additional charges that may arise in the course of treatment d) Their reluctance to share proprietary information - correct answers B Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite discharge, the HFMA best practice is to: a) Make sure that the attending staff can answer questions and assist in obtaining required patient financial data b) Have a patient financial responsibilities kit ready for the patient, containing all of the required registration forms and instructions 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 - correct answers C A comprehensive "Compliance Program" is defined as a) Annual legal audit and review for adherence to regulations b) Educating staff on regulations

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

c) Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met d) The development of operational policies that correspond to regulations - correct answers C Case Management requires that a case manager be assigned a) To patients of any physician requesting case management b) To a select patient group c) To every patient d) To specific cases designated by third party contractual agreement - correct answers B 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 a) Identify, compare, and choose providers that offer the desired level of value b) Customize health care with a personally chosen mix of providers c) Negotiate the cost of health plan premiums d) Verify the cost of individual clinicians - correct answers A 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

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

a) MSO b) HMO c) PPO d) GPO - correct answers B In a Chapter 7 Straight Bankruptcy filing a) The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt b) The court liquidates the debtor's nonexempt property, pays creditors, and begins to pay off the largest claims first. All claims are paid some portion of the amount owed c) The court vacates all claims against a debtor with the understanding that the debtor may not apply for credit without court supervision d) The court establishes a creditor payment schedule with the longest outstanding claims paid first - correct answers A The core financial activities resolved within patient access include: a) Scheduling, pre-registration, insurance verification and managed care processing b) Scheduling, insurance verification, clinical discharge processing and payment posting of point of service receipts c) Scheduling, registration, charge entry and managed care processing

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

d) Scheduling, pre-registration, registration, medical necessity screening and patient refunds - correct answers A Which of the following is NOT contained in a collection agency agreement? a) A clear understanding that the provider retains ownership of any outsourced activities b) Specific language as to who will pay legal fees, if needed c) An annual renewal clause d) A mutual hold-harmless clause - correct answers D 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: a) Patient Accounts b) Managed Care Contract Staff c) HIM staff d) Case Management - correct answers D What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? a) Revenue codes b) Correct Part A and B procedural codes c) The CMS 1500 Part B attachment

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

d) Medical necessity documentation - correct answers A Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implement procedures for identifying and processing accounts: a) Monitor compliance b) Have the account triaged for any partial payment possibilities c) Assist in arranging for a commercial bank loan d) Obtain the patients income tax statements from the prior 2 years - correct answers A For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: a) Are optional b) Should take place between the patient or guarantor and properly trained provider representatives c) May take place between the patient and discharge planning d) Are focused on verifying required third-party payer information - correct answers B The purpose of a financial report is to: a) Provide a public record, if reqluested b) Present financial information to decision makers c) Prepare tax documents d) Monitor expenses - correct answers B Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act)

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

violation? a) Registration staff may routinely contact managed are plans for prior authorizations before the patient is seen by the on-duty physician b) Initial registration activities may occur so long as these activities do not delay treatment or suggest that treatment with not be provided to uninsured individuals c) Co-payments may be collected at the time of service once the medical screening and stabilization activities are completed d) Signage must be posted where it can be easily seen and read by patients - correct answers A A claim is denied for the following reasons, EXCEPT: a) The health plan cannot identify the subscriber b) The frequency of service was outside the coverage timeline c) The submitted claim does not have the physicians signature d) The subscriber was not enrolled at the time of service - correct answers C 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) A court appointed federal mediator b) The Department of Health and Human Services Provider Relations

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

Division c) The Office of the Inspector General d) The Provider Reimbursement Review Board - correct answers D Charges, as the most appropriate measurement of utilization, enables a) Generation of timely and accurate billing b) Managing of expense budgets c) Accuracy of expense and cost capture d) Effective HIM planning - correct answers ???Number 24??? Ambulance services are billed directly to the health plan for a) All pre-admission emergency transports b) 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 c) The portion of the bill outside of the patient's self-pay d) Transports deemed medically necessary by the attending paramedic-ambulance crew - correct answers C 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 a) A beneficiary appeal b) A Medicare supplemental review c) A payment review

Exam Prep, Certified Revenue Cycle

Representative - CRCR (2023)

d) A Medicare determination appeal - correct answers A The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physicians to do all of the following EXCEPT: a) Drive significant improvements in the areas of quality and the patient experience b) Embrace new reimbursement models c) Improve outcomes d) Obtain higher compensation for physicians - correct answers D Duplicate payments occur: a) When providers re-bill claims based on nonpayment from the initial bill submission b) When service departments do not process charges with the organization's suspense days c) When the payer's coordination of benefits is not captured correctly at the time of patient registration d) When there are other healthcare claims in process and the anticipated deductibles and co-insurance amounts still show open but will be met by the in-process claims - correct answers a The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can