CRCR Exam Study Guide (Latest 2023 – 2024) With Complete Solutions, Exams of Finance

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CRCR Exam Study Guide (Latest 2023 – 2024)

With Complete Solutions

p atient Centric Revenue Cycle - This includes all the major processing steps required to process a pt account from the request for service through closing the account with a zero balance and purging it from the system

pre-service - this is the period in which scheduling and pre-access takes place, including different steps that will be completed

pre-service - what is it when the requested service is screened for medical necessity, health plan coverage & benefits are verified, and pre-auth is obtained

scheduled patient- Time of Service - what is it when a final account review is completed prior to the patient's arrival? (Pre-reg record is activated, consents are signed, and co-payments and other amounts are collected)

express arrival - pre-processed patient's can report to this, which is a desk located in a centralized access, upon their arrival.

post-service - this includes account activities that occur after the patient is d/c until the account reaches a zero balance

post-service - Final coding of all services, perparation and submission of claims, payment processing and balance billing are all included and finalized when?

Patient Financial Communications Best Practices - This brings consistency, clarity, and transparency to patient financial communications

Patient Financial Communications Best Practices - this outlines steps to help patient's understand the cost of services they receive, their insurance coverage, and their individual responsibility (review Patient Financial Comm. Best Practice document)

true - true or false: Conversations should occur in a location and manner that are sensitive to the patient's needs

timely discussions - this type of discussion will help ensure that patient's understand their financial obligation and that providers are aware of the patient's ability to pay

guarantor - the person responsible for payment of the bill

true - true or false: A financial counselor or supervisor should be involved for complex situations such as uninsured or underinsured patient's

false; NO patient financial discussions should occur before a patient is screened and stabilized - true or false: You MUST obtain basic registration info and insurance coverage before the patient is cared for in the ED.

true - true or false: When the provider takes the initiative to communicate financial matters with the patient, it actually take a burden off the patient.

false; Technology evaluation may be performed by ANY qualified individual or organization, internal or external - true or false: Technology evaluation can ONLY be done by a qualified individual, internal to the facililty

HFMA's Adopter Program - this program is a recognition for providers who implement and support the best practices are eligible and encouraged to apply

Code of Conduct - Through what document does a hospital est. compliance standards?

Identify acceptable compliance programs in various provider setting - what is the purpose OIG work plan?

non-diagnostic services provided on Tuesday through Friday - If a Medicare pt is admitted on Friday, what services fall within the 3-day DRG window rule?

reports a specific circumstance that affects a procedure or service without changing the code or its definition. - What does a modifier allow a provider to do?

they must be billed separately to the Part B carrier - if OP diagnostic services are provided within 3 day of admission of a medicare beneficiary to an IPPS (Inpatient Prospective Payment system) hospital, what must happen?

One registration record is created for multiple days of service - What is recurring or series registration?

unscheduled patients - what are non-emergency pt who come for service w/o prior notification to the provider called?

used to evaluate the need for an IP admission - Which of the following statements apply to the Obs patient type?

physician, nursing, and pharmacy - which services are hospice programs required to provide on a around-the-clock patient?q

complete the scheduling process correctly based on service requested - Scheduler instructions are used to prompt the scheduler to do what?

procedure time - This is the time needed to prepare the patient before services is the difference between the patients arrival time?

Documentation of the medical necessity for the test - Medicare guidelines require that when a test is ordered for which an LCD (local cover determination) or NCD (national coverage determination) exists, the info on the order must include what?

it reduces processing times at the time of service - what is an advantage of a pre-registration program?

the responsible party's full legal name, DOB, and SSN - what data is required to est. a new MPI (Master patient index) entry?

parents are received by the provider from the payer responsible for reimbursing the provider for the pt covered services - which of the following statements is true about third-party payments?

stop loss - which provision protects the patient from medical expenses that exceed pre-set level?

referral - What is it called when a PCP send an HMO (health maintenance organization) pt to authorize a visit to a specialist for additional testing or care?

Medical screening and stabilizing - under the EMTALA (emergency medical treatment and labor act) regulations, the provider may not ask the patient about their ins info if it would delay what?

to the approved APC rate - the hospital has a APC (ambulatory payment classification) - based contract for the payment of OP services. Total anticipated charges for the visit are $2,380. The approved APC payment rate is $780. Where will the patients benefit package be applied?

$100 - a patient has met their $200 deductible and $900 of the $1000 coins responsibility. the coins rate is 20%. The estimated ins plan responsibility is $1975.00. What amount of coins is due from the patient?

the pt outstanding medical bills exceed a defined dollar amount or percentage of assets - when is a pt considered to be medically indigent?

sources of readily available funds, such as vehicles, campers, boats and savings accounts - what patient assets are considered in the financial assistance applications?

warn the pt that any unpaid accounts are placed with collection agencies for further processing - if the pt cannot agree to payment arrangements, what is the next option?

scheduling, pre-reg, ins verification, and managed care processing - what core financial activities are resolved within patient access?

a pt who arrives at the hospital via EMS for treatment in the ER - what is an unscheduled direct admission?

as a substitute for an IP admission - when is not appropriate to use observation status?

home health - parents who require periodic skilled nursing or therapeutic care receive services from what type of program?

printed copy of the providers privacy notice - every pt who is new to the healthcare provider must be offered what?

the employer provides a traditional HMP health plan - which of the following statements applies to self-insured ins plans?

Subrogation - what process does a pt health plan use to retroactively collect payments from liability, automobile, or workers comp plans?

DRG rates (diagnosis-related groups) - what type of payment methodology is a lump sum or bundled payment negotiated b/w the payer and some or all providers?

site-of-service limitation - what restriction does a managed care plan place on locations that must be used if the plan is to pay for the service provided?

if medical necessity for a private room is documented in the chart, pt ins will be billed for the differential, pay per the contract - which of the following statements applies to private rooms?

a pt must have both medicare part A & B benefits to be eligible for a medicare advantage plan - which of the following is NOT true of Medicare advantage plans?

failure to complete authorization - what is a valid reason for a payor to deny a claim?

claim is paid in full - which of the following statements is NOT a possible consequence of selecting the wrong pt in the MPI (master patient index)?

medicaid-eligible pt are neve4r required to join a medicaid HMO plan - which of the following is not a characteristic of a medicaid HMP plan?

registration staff members routinely contact managed care plans for prior auth before the pt is seen by the on-duty physician - what is a violation of the EMTALA (Emergency medical treatment and labor act)?

notification can be issued no earlier than 7 days before admission and no more than 2 days before discharge - which of the following statements is TRUE of the important message from medicare notification requirements?

self-pay balance - this is the portion of the adjudication claim that is due from the patient after claim is paid

bank loans - which of the following options is an alternative to valid long-term payment plans?

$6,000 - the pt has the following benefit plan

: $400 per family member deductible, maximum of $1200 per year and $2000 per family member coins, to a family maximum of $6000 per year, excluding the deductible. Five family members are enrolled in this benefit plan. What is the maximum out-of-pocket expense that the family could incur during the calendar year?

POS (point-of-service) plan - what type of plan restricts benefits for non-emergency car to approve providers only?

review the appropriateness of the service requested - what does scheduling allow provider staff to do?

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

august 9, 2010 - Mrs. Jones, a medicare beneficiary, was admitted to the hospital on June 20, 2010. As of the admission date, she had only used 8 IP days in the current benefit period. If she is not discharged, on what date will Mrs. Jones exhaust her full coverage days?

income and asset - In order to meet eligibility guidelines for medicaid benefits, the beneficiary must fall into specific need category and meet what other types of requirements?

they are calculated quarterly - fee-for-service plans pay claims based on a % of charges. How are patients out of pocket costs calculated?

certain % of charges ate4r patient meets policy annual deductible - indemnity plans usually reimburse what?

quality assurance - dept that need to be included in Charge master3 Maintenance include all EXCEPT what?

submit a standardized transaction to any of the health plans with which it conducts business - using HIPPA standardized transaction sets allow providers to what?

cost of services - which of the following is NOT included in the standardized quality measures?

encourage new ACOs to form in rural and underserved areas - the ACO investment model will test the use of per-paid shared savings to do what?

HMO - this type of ins plan provides comprehensive health maintenance and treatment services for an enrolled group of persons on a monthly fee

services provided before admission and for the rides to take them home after discharge or to transfer to another facility. - EMS services are billed directly to the health plan for what?

the provider reimbursement review board - any provider that files a timely cost report may appeal in an adverse final decision recited from the Medicare Admin Contractor (MAC), the appeal may be filed with what?

obtaining or updating pt and guarantor info - for SCHEDULED payments, important rev cycle activities in the time-of=service state DO NOT include what?

the hospital UR committee determines before the pt is d/c and prior to billing that an obsveration setting would be more appropriate - hospital can only convert an inpatient case to observation if what?

used only designated software platforms to secure pt date - HIPAA privacy rules require covered entities to take all, of the following EXCEPT what?

send a demand letter to provider to recover the over payment - when recovery audit contractors (RAC) identify payments as overpayments, the claims processing contractor must do what?

270-271 set - Which HIPAA transaction set provides electronic processing of ins verification requests and responses?

support that choice, inform that the discussion does not interfere with patient care or disrupt patient flow - across all care settings if a pt consents to a financial discussion during a medial encounter to expedite discharge, the HFMA best practice is to make sure what is informed?

complete registration and ins approval before service - a SCHEDULED inpatient represents an opportunity for the provider to do what?

align incentives b/w hospitals, physicians, and non-physician providers in-order to better coordinate pt care - the Medicare Bundled Payments for Care Initiative (BCP) is designed to for what?

tracked and shared to improve customer experience - to maximize the value derived from customer complaints, all consumer complaints should be..?

an estimated price - applying the contracted payment methodology to the total charges yields what?

primary source for clinical data required for reimbursement by health plans and liability payers - the importance of MR maintained by HIM is that the pt records:

obtaining or updating pt and guarantor info - important rev cycle activities in the pre-service state include what?

amount the pt may be expected to pay after ins - in the pre-service stage, all cost of the schedule services is identified and the patient plan and benefits are used to calculate what?

reduces internal staffing costs and a reliance on outsourced staff - the disadvantage of outsourcing includes all of the following EXCEPT what?

case management - maintaining routine contract with health plan or liability payer, making sure all required info is provided and all needed approvals are obtained is the responsibility of who?

the submitted claim does not have the physician signature - a claim can be denied for the following reasons EXCEPT for?

all emergency and medically necessary care - all hospitals are required to est. a written financial assistance policy that applies to what?

seeking payment options for self-pay - examples of ethics violation that impact the rev cycle include all of the following except what?

given to "qualified" staff as defined in hospitals policies and procedures - verbal orders from a physician for services are acceptable when?

what services or healthcare items are covered under medicare - Medicare has est. guidelines called Local coverage determination and National coverage determination that est what?

obtaining cash, check, credit or debit card payment from that day - what is the first step of the daily cash reconciliation process?

Medicare and Medicaid payments - The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to what?

edits that are implemented within providers claim processing sys. - the correct coding initiative program consist of what?

purchase health benefits plans regardless of insured's health status - the Affordable Health Care Act legislated the development of Health insurance exchange, where individuals and small businesses can do what?

monitor compliance - before classifying and subsequently writing off an account to financial assistance or bad debit, the hospital must est policy define appropriate criteria, implement procedures for identifying accounts and:

a standardized for providers 3rd party payment details to providers - the Electronic Remittance Advice (ERA) data sets are what?

verifying the pt identification - the first and most critical step in registering a pt, whether scheduled or unscheduled is what?

revenue codes - a 4-digit number code est by national uniform billing committee that categorizes a line in the charge master is known as what?

compliance fraud by "upcoding" - internal controls addressing coding and reimbursement charges are put in place to guard against what?

complete a community needs assessment and develop a discount program for pt balances after ins payment - the 501 (R) regulations require non-for-profit providers (501) (3) organizations to do which of the following activities?

pt full legal name and DOB or the pt SSN - During pre-reg, a search for the pt MRI number is initiated using which of the following data sets:

tracked and shared to improve the customer experience - to maximize the value derived from customer complaints, all consumer complaints should be what?

the principles and standards by which organizations operate - the Business ethics, or organizational ethics represent what?

third-party payers - provides are advised that it is best to est pt financial responsibility and assistance policies and make sure they are followed internally and by whom?

providers pay pennies on each dollar collected (false) - the advantage to using 3rd party collection agencies includes all of the following EXCEPT what?

which dx, signs, or symptoms are reimbursable - LCD and NCD are Medicare guidelines used to determine what?

denied by Medicare - claims with the DOS received later than one calendar year beyond the DOS will be what?

pre-auth is obtained - in the pre-service stage, the requested service is screened for medically necessity, health plan cvg, and benefits are verified and what is obtained?

claim edits - these are rules developed to verify the accuracy of claims based on each health plans polices

provider scheduling - who is typically responsible for obtaining the auth?

during service - when does concurrent review and discharge planning occur?

check if pt is a health plan beneficiary and what is their cvg - what is the first thing a health plan does when processing a claim?

no pt financial discussion should occur before a pt is screened and stabilized - EMTLA and HFMA best practices specify that in an ER setting

provide a standardized method for evaluation pt perspective on hospital care - the HCCAHPS (hospital consumer assessment of healthcare providers and sys) initiative was launched to provide what?

can be demonstrated as necessary - medicare will only pay for tests and services that are what?

Joint commission for acceleration of Health Care Organizations (JCAHO) safety standards - this was developed to promote and ensure healthcare quality and value and also to protect consumers and workers in the healthcare sys. This directive is called what?

Explicit price concessions and implicit price consessions - What is the new terminology now employed in the calculation of net patient service revenues.