CRCR Exam Prep/ 146 Qs & Ans/ Updated . Terms like:
The OIG has issued compliance guidance/model compliance plans for all of the following entities: - Answer: hospices. physician practices. ambulance providers
Providers who are found to be in violation of CMS regulations are subject to: - An...
The OIG has issued compliance guidance/model compliance plans for all of the
following entities: - Answer: hospices. physician practices. ambulance providers
Providers who are found to be in violation of CMS regulations are subject to: -
Answer: Corporate integrity agreements
In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers? - Answer: Case rates
What customer service improvements might improve the patient accounts
department? - Answer: Holding staff accountable for customer service during
performance reviews
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,What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
Answer: 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? - Answer: Bad debt adjustment
What are collection agency fees based on? - Answer: A percentage of dollars
collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule
or what other rule? - Answer: Birthday
What is the initial hospice benefit? - Answer: Two 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -
Answer: 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? - Answer: 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 - Answer: They are not being processed in a timely manner
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, What is an advantage of a preregistration program? - Answer: It reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? - Answer:
Medically unnecessary services and custodial care
What core financial activities are resolved within patient access? - Answer:
Scheduling, insurance verification, discharge processing, and payment of point-of-
service receipts
What statement applies to the scheduled outpatient? - Answer: The services do
not involve an overnight stay
How is a mis-posted contractual allowance resolved? - Answer: 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? - Answer: Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require
that the beneficiary has received what? - Answer: Medically necessary inpatient
hospital services for at least 3 consecutive days before the skilled nursing care
admission
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