CRCR Exam Questions and Answers (Graded A+) 2024, Exams of Nursing

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ANSWERS (GRADED A+) 2024

CRCR EXAM QUESTIONS WITH

CORRECT ANSWERS 2024

UPDATED LATEST GRADED A+

code of conduct - ANSWER hospital establish compliance standards

Purpose of OIG work plan? - ANSWER communicate issues that will be reviewed during the year for

compliance with Medicare regulations

Medicare pt. admitted on Friday, what services fall within the three day window rule? - ANSWER Dx

services and related charges provided on the W,R, and F before adm.

What does modifier allow a provider to do? - ANSWER Report a specific circumstance that affected a

procedure or service without changing the code or its definition Out pt. dx services provided within 3 days of adm. of a medicare benef. to an IPPS hospt, what must

happen to these charges - ANSWER combined with the in pt. bill and paid under the MS-DRG system

Why is OIG pursuing the medicare Secondary Payer - ANSWER reviews medicare payments for

beneficiaries who have other insurance and assesses the effect. of procedures in preventing inappro. medcare payments for benef. with other ins. coverage

Recurring or series registration? - ANSWER one reg. record is created for multi days of service

Nonemergency pt. who comes for service w/out prior notif. to the provider called? - ANSWER

unscheduled pt.

ANSWERS (GRADED A+) 2024

stmnts apply to observ. pt. type - ANSWER used to evaluate the need for an in pt. adm.

which services are hospice programs required to provide on an around the clock basis - ANSWER

physician, nursing, pharmacy

purpose of initial step in put pt. testing scheduling process - ANSWER identifying the correct pt. in the

providers database or add the pt. to the database

scheduler instructions are used to prompt the scheduler to do what? - ANSWER complete the

scheduling process correctly based on service requested medicare guidelines require that when a test is ordered for which an LCD or NCD exists, the info

provided on the order must include which of the following? - ANSWER documentation of the medical

necessity for the test

advantage of pre reg. program? - ANSWER reduces processing times at the time of serivce

what data are required to est. a new MPI entry? - ANSWER pts. name, DOB, sex

Which HIPAA trans. set provides electronic processing of ins, verif requests and responses? - ANSWER

the 270-271 set a mother and father both cover their 16 yo child as a dep. on their health ins, plans, which both follow

the bday rule. mothers dob is 1-19-68 and fathers dob is 7-19-67; whose plan is primary - ANSWER

mothers

true about third party payers? - ANSWER payments received by the provider from the payer respon.

for reimbursing the provider for the pts. covered services

ANSWERS (GRADED A+) 2024

co-payment? - ANSWER fixed amt. that is due for a specific service

pts annual out of pocket limitation is 3000, excluding deduct. to date this cal. year the pt has satisfied the 500 deduct. and has paid 2300 in co insurance to various providers. max amount of coinsurance the

pt will owe - ANSWER 700

type of plan that allows the subscriber to pay lower premium costs in return for a higher deductible? -

ANSWER consumer directed health plan

characteristic of a managed care contracted methodology - ANSWER prospectively set rates for in pt.

and out pt. services

which provision protects the pt. from medical expenses that exceed a pre set level - ANSWER stop loss

what document must a primary care phys. send to an HMO pt. to authorize a visit to a specialist for add.

testing or care? - ANSWER referral

activities are completed when a scheduled, pre reg pt. arrives for service? - ANSWER activating the

record, obtaining signatures, and finalizing financial issues

under EMTALA reg., the provider may not ask about a pts. ins. info if it would delay what - ANSWER

medical screening and stabilizing treatment

collecting pt liability dollars after service leads to what - ANSWER increased efforts by pt acct staff to

resolve these balanaces

important message from medicare provides beneficiaries with info concerning what? - ANSWER right

to appeal a discharge decision if the pt disagrees with the plan

ANSWERS (GRADED A+) 2024

which of the following is a step in the discharge process? - ANSWER have case management services

complete the discharge plan

what curcumstances would result in an incorrect nightly room charge? - ANSWER if pt. transfer from

the ICU to medical/surgical floor is not reflected in the reg system

which stmnt describes the goal of fin counseling services - ANSWER help the pt. understand insurance

coverage, including what the pt will owe for the current services hospital has an APC based contract for the payment of out pt. services. total anticipated charges for the visit are 2,380. the approved apc payment rate is 780. Where will the patient benefit package be

applied? - ANSWER to the approved APC payment rate

pt. has met the 200 ind. deductible and 900 of the 1000 co-ins. resp. the co-ins. rate is 20%. the est. ins.

plan respon is 1975. what amt. of co-ins. is due from pt. - ANSWER 100

which of the following items are considered valid proof of income documents. - ANSWER copies of

paycheck stubs from the recent three months

When is a pt. considered to be medically indigent? - ANSWER pt. outstanding med bills exceed a

defined dollar amt or percent of asset

what pt assets are considered in the fin assist app - ANSWER primary residence

if the pt cannot agree to payment arrangments, what is the next best option - ANSWER warn pt that

unpaid accts are placed w collection agencies for further processing

what are numbered receipts for - ANSWER ensure all payments are properly acted for and deposited

ANSWERS (GRADED A+) 2024

what is an effective tool to help staff collect payments at time of service - ANSWER develop scripts for

the process of requesting payment

what must happen to cash, checks, and credit card transactions at the end of each shift - ANSWER

balance

why is it important to have a high quality standards for reg. - ANSWER bc quality failures affect the

providers Joint Commish results on review day

how does utilization review staff use correct ins info - ANSWER obtain approval for in pt. days and

coordinate services

what core fin activities are resolved within pt. access - ANSWER scheduling, pre-reg, ins verif, mng

care process

what is an unscheduled direct admission - ANSWER pt. who is admitted from the physicians office on

an urgent basis

when is not appro to use an observ status - ANSWER as a sub for in pt admission

pt who require periodic skilled nursing or therapeutic care receive services from what type of program -

ANSWER home health agency

type of info that is typically collected during the scheduling contact - ANSWER pt name, dob, sex, dx,

req test/proced, prefer dos, ordering phys, pt tele #

every pt who is new to health care provider must be offered what - ANSWER printed copy f providers

privacy notice

ANSWERS (GRADED A+) 2024

which stmnt applies to self insured plans - ANSWER employer assumes direct respon and risk for

employee healthcare claims

info recorded in a 270 transaction - ANSWER dob

process that pt health plan uses to retroact collect payments from liability, auto, or wc - ANSWER

subrogation why do mnged care plans have agreements w/ hospitals physiciansm and other healthcare providers to

offer a range of services to plan members - ANSWER reduce healthcare costs

in what type of pymnt method is lump sum or bndled payment negotiated between payer and some/all

providers - ANSWER packaged pricing

what restriction does a managed care plan place on locations that must be used if the plan is to pay for

the services provided - ANSWER site of service limitations

which stmnt applies to private rooms - ANSWER if med necessity for a private room is docu in chart,

pt ins. will be billed diff

which true about attempting to collevt pt liability amnts after service - ANSWER inefficient and results

in higher bad debt levels

which of the following is true about screening a beneficiary for possible MSP situations - ANSWER

necessary to ask the pt each of the MSP questions

what do MSP disability rules require - ANSWER pt is younger than 65 yo

ANSWERS (GRADED A+) 2024

NOT true of medicare adv plans - ANSWER pts who join medicare adv plan will not receive a health ins

card from the plan they selected

an acceptable way to complete MSP screening for a liability situation - ANSWER ask if the current

service is related to an accident

which of the following is a valid reason for a payer to deny a claim - ANSWER failure to complete auth

requirements

NOT a possible consequence of selecting the wrong pt in the MPI - ANSWER claim is paid in full

comprehensive [re-reg data includes which of the following - ANSWER complete insurance and

emergency contact info

which is true of medicare adv plan - ANSWER a managed care plan for medicare beneficiaries

which is not a characteristics of a Medicaid HMO - ANSWER Medicaid-eligible pts are never required

to join a Medicaid HMO plan

which stmnt describes APC (ambulatory payment classification) system - ANSWER APC rates are

calculated on national basis and are wage adjusted by geographic region process does a managed care plan use to determing if health care servces are approp for a pt. condition -

ANSWER auth services beofer they are provided and strictly limit days of in pt. care approved w/out

additional clinical info from the provider

a violation of EMTALA - ANSWER registration staff members routinely contact mnged care plans for

prior auth before pt is seen by the on duty physician

ANSWERS (GRADED A+) 2024

stmnt is trueof important message from medicare notification requirements - ANSWER notification

can be issued no earlier than 7 days before admission and no more than 2 days before discharge

true stmnt of internal in pt tansfers - ANSWER transfers are coordinated by the bed-placement

coordinator and are not recorded in the system until the pt is moved to the receiving unit and bed

what is the self pay balance after insurance - ANSWER portion of the adjudicated claim that is fure

from the patient

which of the following is an alternative to valid lonf-term payment plans - ANSWER bank loans

pt has the following benefit plan: 400 per family member deductible, to max of 1200 per year and 2000 per family member co-ins, toa family max of 6000 per year, excluding the deductible. 5 family memebers are enrolled in this benefit plan. what is the max out of pocket exp that the family can occur during the

calender year - ANSWER 6000

type of plan restricts benefits for nonemergency care to approced providers only - ANSWER A PPO

plan

what does scheduling allow a provider staff to do - ANSWER review the approp of the service

requested when an adult pt is covered by both his own and his spouses health ins plan, which of the stmnt is true -

ANSWER pt ins is the primary ins.

claim is related to an accident, what must the hospital report - ANSWER county in which the accident

occured

ANSWERS (GRADED A+) 2024 mrs jones, a med beneficiary, was admitted to the hospital on june 20, 2010. as of the admission date, she had only used 8 in pt. days in the current benefit period. if not discharged, on what date will mrs.

jones exhaust her full coverage days - ANSWER August 9, 2010

in order to meet eligibility guidlelines for healthcare beneifts, Medicaid beneficiaries must fall into a

specified need category and meet what other type of requirment - ANSWER income and expense

most managed care plans do not permit pt balances billing except for what cirumstances - ANSWER

deductible and copayments requirements fee for service plans pay claims based on a percentage of charges. how are pt out of pocket costs

calculated? - ANSWER limited be federal ERISA statues

MSP rules allow providers to bill medicare for liability claims after what happens - ANSWER 120 days

pass, but claim must be withdrawn from liability carrier

what form is used to bill medicare - ANSWER ub-

two statutory exclusions from hospice coverage - ANSWER medically unnecessary services and

custodial care

examples of hospital-based physicians - ANSWER ED physicans, radiologist, and pathologists

advantage of provider based clinic - ANSWER ability to bill both the technical component and the

professional component by the provider

example of a technical denial - ANSWER exceeding frequency limitations

ANSWERS (GRADED A+) 2024

how does financial counseling process begin - ANSWER explain the hospitals credit and collection

policies and what they mean to the patients

hoe does a health pln recover dollars paid for a liability claim from the liability carrier - ANSWER

subrogation

type of acct adjustment results from the pt inability to pay a self balance - ANSWER charity

adjustment according to the department of health and human services guidelines, which of the following is not

considered income - ANSWER sale of property , house, or car

what must a provider do to qualify an acct as a medicare bad debt - ANSWER pursue the acct for 120

days and then refer it to an outside collection agency

revenue cycle begins with scheduling a pt. for service and ends with what - ANSWER archiving of the

fully resolved acct

how does increasing the provision for bad debts affect the financial statements - ANSWER reduces

gross receivables and increase operating expense for the period

a successful medicare pay for performance initiative will likely result iin what - ANSWER higher

payments while covering sicker beneficiaries

what are some component of the charge master - ANSWER room charges and detailed ancillary

charges using pt specific info, calculate the pt liability for MRI of the right knww. the charge master price based on CPT code for MRI is 2500; the payers contract discount wtht the provider is 20% of the charges; the pt

benefit plan deductible of 80/20 with no limit on pt portion was met - ANSWER 400

ANSWERS (GRADED A+) 2024

how are charges recorded as charity care treated - ANSWER as a deduction from the revenue that is

reported as a footnote to the financial statments what type of utilization review are used to ensure that resources and services are provided in the most

efficient and effective ways - ANSWER prospective review, concurrent review, and retrospective

review

the situation where neither the pt nor spouse is employed is described to the payer using: - ANSWER

a condition code regulations and requirements for creating accountable care organizations which allowed providers to

beign creating these organization were finalized - ANSWER 2012

what is correct discharge status code for a pt who is discharged to a swing bed unit in the same hospital -

ANSWER 61

what is the primary responsibility of the recovery audit contractor - ANSWER to correct identity

proper payments for medicare part a and b claims