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CRCR STUDY GUIDE REVIEW 2024 LATEST EXAM (QUESTIONS AND CORRECT DETAILED ANSWERS) GRADED A +
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CRCR STUDY GUIDE REVIEW 2024 LATEST EXAM (QUESTIONS AND CORRECT DETAILED ANSWERS) GRADED A +
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CRCR STUDY GUIDE REVIEW 2024 LATESTEXAM (QUESTIONS AND CORRECT
DETAILED ANSWERS) GRADED A +
Medicare guidelines require that when a test is ordered for which as LCD (local coverage
determination) or NCD (national coverage determination) exist, the information provided
on the order must include which of the following?
✓ Documentation of the medical necessity of the test.
What is an advantage of a preregistration program?
✓ It reduces processing times at the time of service
What data are required to establish a new MPI (master patient index) entry?
✓ The patients full legal name, date of birth and sex
Which HIPAA transition set provides electronic processing of insurance verification
requests and responses?
✓ The 270-271 Set
A mother and father both cover their 16-year-old child as a dependent on their health
insurance plans, which both follow the birthday rule. The mothers date of birth is January
19, 1968; the father's date of birth is July 19, 1967. Whose plan is the primary payer?
✓ The Mothers Plan
What is a co-payment?
✓ The fixed amount that is due for a specific service
A patient's annual out-of-pocket limitation is $3000, excluding the deductible. To date this
calendar year, the patient has satisfied the $500 deductible and has paid $2300 in
coinsurance to various providers. For the balance of the calendar year, what is the
maximum amount of coinsurance the patient will owe?
✓ $3000 - $2300 = $700
,What type of plan allows the subscriber to pay lower premium costs in return for a higher
deductible?
✓ Consumer Directed Health Plan
What is a characteristic of a managed care contracting methodology?
✓ Prospectively set rates for inpatient and outpatient services.
Which provision protects the patient from Medical expenses that exceed a preset level?
✓ Stop Loss
What document must a primary care physician send to an HMO (health maintenance
organization) patient to authorize a visit to a specialist for additional testing or care?
✓ Referral
What activities are completed when a scheduled, pre-registered patient arrives for
service?
✓ Activating the record, obtaining signatures, and finalizing financial issues.
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
✓ Medical Screening and Stabilizing Treatment
Collecting patient liability dollars after service leads to what?
✓ Increased efforts by patient accounting staff to resolve these balances.
The important Message from Medicare (IM) provides beneficiaries with information
concerning what?
✓ Right to appeal discharge decision if the patient disagrees with the plan.
What circumstances would result in an incorrect nightly room charge?
✓ If the patient's transfer from the ICU (intensive care unit) to the medical/surgical
floor is not reflected in the registration system
Which of the following is a step in the discharge process?
, ✓ Have case management services complete the discharge plan
Which of the following statements describes the goal of financial counseling services?
✓ To help the patient understand insurance coverage, including what the patient will
owe for the current services
The hospital has an APC (ambulatory payment classification)-based contract for the
payment of outpatient services. Total anticipated charges for the visit are $2.380. The
approved APC payment rate is $780. Where will the patient's benefit package be applied?
✓ To the approved APC payment rate
A patient has met the $200 individual deductible and $900 of the $1000 coinsurance
responsibility. The coinsurance rate is 20%. The estimated insurance plan responsibility is
$1,975. What amount of coinsurance is due from the patient?
✓ $100
Which of the following items are considered valid proof of income documents?
✓ Copies of paycheck stubs from the most recent three months
When is a patient considered to be medically indigent
✓ The patient's outstanding medical bills exceed a defined dollar amount or
percentage of assets
What patient assets are considered in the financial assistance application?
✓ Sources of readily available finds, such as vehicles, campers, boats, and savings
accounts
If patient cannot agree to payment arrangements, what is the next option?
✓ Initiate Medicaid eligibility and financial assistance screenings
What are numbered receipts used for?
✓ To ensure that all payments are properly accounted for and deposited
What is an effective tool to help staff collect payments at time of service?
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