CRCR CERTIFICATION EXAM 2024
ACTUAL EXAM COMPLETE 200
QUESTIONS WITH DETAILED
VERIFIED ANSWERS (100% CORRECT
ANSWERS) / ALREADY GRADED A+
If further treatment can only be provided in a hospital
setting, the patient's condition cannot be evaluated and/or
treated within 24 hours, or if there is not an anticipation of
improvement in the patient's condition with 24 hours, the
patient - ....ANSWER...Will be admitted as an inpatient
The benefit of Medicare Advantage Plan is -
....ANSWER...Patients generally have their Medicare-
coverage healthcare through the plan and do not need to
worry about "part a" or "part b" benefits
The process of creating the pre-registration record ensures
- ....ANSWER...Accurate billing
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Claims with dates of service received later than one
calendar year beyond the date of service, will be -
....ANSWER...Denied by Medicare
A portion of the accounts receivable inventory which has
NOT qualified for billing includes -
....ANSWER...Charitable pledges
The standard claim form used for billing by hospitals,
nursing facilities, and other in-patient - ....ANSWER...UB-
04
Once the price is estimated in the pre-service stage, a
provider's financial best practice is to -
....ANSWER...Explain to the patient their financial
responsibility and to determine the plan for payment
Internal controls addressing coding and reimbursement
changes are put in place to guard against -
....ANSWER...Compliance fraud by upcoding
Health Plan Contracting Departments do all of the
following EXCEPT - ....ANSWER...Establish a global
reimbursement rate to use with all third-party payer
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For routine scenarios, such as patients with insurance
coverage or a known ability to pay, financial discussions: -
....ANSWER...Should take place between the patient or
guarantor and properly trained provider representatives
What type of account adjustment results from the patient's
unwillingness to pay a self-pay balance? -
....ANSWER...Bad debt adjustment
Most major health plans including Medicare and Medicaid,
offer - ....ANSWER...Electronic and/or web portal
verification
The important Message from Medicare provides
beneficiaries information concerning their -
....ANSWER...Right to appeal a discharge decision if the
patient disagrees with the plan
Under EMTALA (Emergency Medical Treatment and
Labor Act) regulations, the provider may not ask about a
patient's insurance information if it would delay what? -
....ANSWER...Medical screening and stabilizing treatment
Before classifying and subsequently writing off an account
to financial assistance or bad debt, the hospital must
Medicare will only pay for tests and services that -
....ANSWER...Medicare determines are "reasonable and
necessary"
The physician who wrote the order for an inpatient service
and is in charge of the patients - ....ANSWER...The
attending physician
When primary payment is received, the actual
reimbursement - ....ANSWER...Is compared to the
expected reimbursement, the remaining contractual
adjustments are posted, and secondary claims are
submitted
The ICD-10 codes set and CPT/HCPCS code sets
combines provide - ....ANSWER...The specificity and
coding needed to support reimbursement claims
In a self-insured (or self-funded) plan, the costs of medical
care are - ....ANSWER...Borne by the employer on a pay-
as-you-go basis
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