CRCR EXAM MULTIPLE CHOICE, CRCR
Exam Prep, Certified Revenue Cycle
Representative - CRCR (2021) – Q’s and
A’s
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
-What is an advantage of a preregistration program? - -It reduces
processing times at the time of service
, -What are the two statutory exclusions from hospice coverage? - -Medically
unnecessary services and custodial care
-What core financial activities are resolved within patient access? - -
Scheduling, insurance verification, discharge processing, and payment of
point-of-service receipts
-What statement applies to the scheduled outpatient? - -The services do not
involve an overnight stay
-How is a mis-posted contractual allowance resolved? - -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? - -Observation
-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
-When an undue delay of payment results from a dispute between the
patient and the third party payer, who is responsible for payment? - -Patient
-Medicare guidelines require that when a test is ordered for a LCD or NCD
exists, the information provided on the order must include: - -A valid CPT or
HCPCS code
-With advances in internet security and encryption, revenue-cycle processes
are expanding to allow patients to do what? - -Access their information and
perform functions on-line
-What date is required on all CMS 1500 claim forms? - -onset date of current
illness
-What does scheduling allow provider staff to do - -Review appropriateness
of the service request
-What code is used to report the provider's most common semiprivate room
rate? - -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
-The important message from Medicare provides beneficiaries with
information concerning what? - -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?
- -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? - -Submit interim bills to the
Medicare program.
-90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare
for liability claims after what happens? - -120 days passes, but the claim
then be withdrawn from the liability carrier
-What data are required to establish a new MPI entry? - -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? - -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
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