CRCR Part 4| 36 Questions with Answers 2023, Exams of Nursing

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CRCR Part 4| 36 Questions with Answers 2023

General Ledger Cash - CORRECT ANSWERSPetty cash used as payments for miscellaneous purchases Electronic Funds Transfer (EFT) - CORRECT ANSWERSThe transfer of funds from payer to payee through the banking system. It is considered the quickest way to move money because it is possible to transfer funds between banks on the same day. Electronic Remittance Advice (ERA) - CORRECT ANSWERSA standardized healthcare claim payment format used to electronically send third-party payment details to healthcare providers. ERA Level 1 - CORRECT ANSWERSElectronic receipt of 835 data only. An ERA is received, the info is printed, and the printout is processed the same as a paper remittance. ERA Level 2 - CORRECT ANSWERSElectronic receipt of 835 dataset and electronic data entry. ERA data is received and entered into the computer electronically, then viewed in a terminal. ERA Level 3 - CORRECT ANSWERSElectronic receipt, data entry, reconciliation, posting, and closing of 835 data. ERA Level 4 - CORRECT ANSWERSTotal automation of receipt, data entry, payment posting, and adjustment processing of 835 data. Includes all of level 3 and linking of banking information to allow reconciliation of payments received electronically though a non-bank network, with funds received electronically. Credit Balances - CORRECT ANSWERSWhen payments and contractual adjustments posted to an account exceed the overall total charges.

CMS-838 - CORRECT ANSWERSMedicare form used to report all Medicare credit- balance overpayment accounts on a quarterly basis. Technical Denials - CORRECT ANSWERSType of health plan denial based on missing or incomplete claim information. Clinical Denials - CORRECT ANSWERSType of health plan denial associated with the care or service provided. Underpayment denials - CORRECT ANSWERSWhen the health plan pays less than the agreed contract amount. Pre-service denials - CORRECT ANSWERSAssociated with Physicians, Patient Access, Financial Counselors, and Case Management. Examples include not obtaining pre-auth, insurance benefits not verified, incorrect data entry. Time-of-service Denials - CORRECT ANSWERSAssociated with Physicians, Patient Access, Case Management, Clinical Service departments, and HIM. Examples include New technology used without determining coverage, Charges bundled or unbundled incorrectly, Patient acuity level changes but the type of service not changed, admission notification not completed, or invalid coding Post-Service Denials - CORRECT ANSWERSAssociated with the Clinical Service departments, Patient Access, IT, and Patient Accounting Examples include late charges, duplicate claims, and untimely filing. Recovery Audit Contractors (RAC) - CORRECT ANSWERSMission is to protect Medicare from fraudulent and abusive billing. Beneficiary Appeal Type - CORRECT ANSWERSFiled by the Medicare beneficiary who is dissatisfied with the government's claim determination. Provider Appeal Type - CORRECT ANSWERSFiled by the provider. When the amount in question is between $1,000 and $10,000, a provider may request a hearing. If the amount is >$10k the provider may file the appeal with the Provider Reimbursement Review Board.

Medicare Waiver of Liability - CORRECT ANSWERSIf the beneficiary nor the provider knew or reasonably could know the services were not covered, Medicare is liable for paying the claim. Liens - CORRECT ANSWERSA claim against real or personal property that secures payment of a debt or performance of some other act. Agreement Liens - CORRECT ANSWERSA creditor can protect his/her security interest by filing a financing statement under the Uniform Commercial Code (UCC), usually at the Secretary of State's Office. When personal property is used as collateral, the agreement is called a security interest. When the secured property is real estate, the agreement is called a mortgage. Judicial Liens - CORRECT ANSWERSResults when the creditor cannot collect via reasonable "pressuring" techniques (as defined by the Fair Debt Collection Practices Act). Statute Liens - CORRECT ANSWERSFour common Types: Employee's Lien is placed on the employer's personal property to secure payment of back wages. Landlord's lien is placed on the tenant's property to secure payment of back rent. Materialman's or Mechanic's lien is placed to secure compensation of contractors, suppliers, or repair workers. Tax lien existing in favor of the state or municipality upon lands of a person charged with taxes. Difference between Bad Debt and Financial Assistance - CORRECT ANSWERSthe first is an unwillingness to pay the entire account or the balance of an account not paid by insurance. The second is an inability to pay (also called Charity Care). FAP Requirements - CORRECT ANSWERSThe ACA required the IRS to issue rules to implement this program. These regulations are known as the IRS 501® rules, and apply only to non-profit providers as designated by section 501(c)3 status. IRS Code 501(c)3 - CORRECT ANSWERSRegulations that must be met by all hospitals to legally qualify as non-profit under the ACA Community Health Needs Assessment - CORRECT ANSWERSMust be conducted in order to qualify as a 501(c)(3) tax-exempt facility. It must identify the

community's needs and must include input from community members. Must be made widely available to the public via a hospital facility's website Extraordinary Collections Actions (ECAs) - CORRECT ANSWERSMay not be pursued until after the hospital has taken reasonable efforts to determine the patient's eligibility for financial assistance. This section applies to hospitals as well as other entities, such as collection agencies, working on behalf of the hospital. Includes garnishments, liens, and selling debt to third parties. Consumer Credit Protection Act Title 1 - CORRECT ANSWERSTruth in Lending Act. If triggered, a hospital must disclose the details of a debt repayment plan with a patient. Consumer Credit Protection Act Title 3 - CORRECT ANSWERSRestrictions on Garnishment. Establishes maximum limits for wage garnishments, either 25% of a worker's disposable earnings per week, or the amount by which a worker's hourly wage exceeds 30x the federal minimum wage. Consumer Credit Protection Act Title 6 - CORRECT ANSWERSFair Credit Reporting Act. Affects those who "issue or use reports on consumers in connection with the approval of credit." This section limits the use of consumer credit reports. For example, collection accounts must be removed after seven years. Consumer Credit Protection Act Title 8 - CORRECT ANSWERSFair Debt Collection Practices Act (FDCPA). Governs the actions and practices a debt collector may take when pursuing a debtor. Chapter 7 Straight Bankruptcy - CORRECT ANSWERSA court proceeding that liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from his/her debt. Chapter 11 Debtor Reorganization - CORRECT ANSWERSPermits a debtor to work out a court-supervised plan with his/her creditor, usually in the nature of a composition (reduction in debt), an extension (more time to pay off the debt), or a receivership (involving the continuing management of the debtor's business or property.

Chapter 13 Debtor Rehabilitation - CORRECT ANSWERSCourt proceeding that does not liquidate property nor discharge debts. Rather, serves to reorganize a debtor's holdings and instruct creditors to look to the debtor's future earnings for payment. Garnishment is a form of debtor rehabilitation. Telephone Consumer Protection Act (TCPA) - CORRECT ANSWERSDesigned to restrict auto-callers and automated messages by telemarketers.