What are collection agency fees based on? - ANS A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - ANS Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated between ...
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CERTIFIED REVENUE
CYCLE REPRESENTATIVE -
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CRCR (2021) QUESTIONS
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,What are collection agency fees based on? - ANS A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other
rule? - ANS Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated between
the payer and some or all providers? - ANS Case rates
What customer service improvements might improve the patient accounts department? - ANS
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? - ANS Inform
a Medicare beneficiary that Medicare may not pay for the order or service
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What type of account adjustment results from the patient's unwillingness to pay for a self-pay
balance? - ANS Bad debt adjustment
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What is the initial hospice benefit? - ANS Two 90-day periods and an unlimited number of
subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - ANS If the
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patient requires ambulance transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account is billed? - ANS
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
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accounts - ANS They are not being processed in a timely manner
What is an advantage of a preregistration program? - ANS It reduces processing times at the
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time of service
What are the two statutory exclusions from hospice coverage? - ANS Medically unnecessary
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services and custodial care
What core financial activities are resolved within patient access? - ANS Scheduling, insurance
verification, discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - ANS The services do not involve an
overnight stay
How is a mis-posted contractual allowance resolved? - ANS 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? - ANS
Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - ANS 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$? - ANS When the
patient is the insured
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What are non-emergency patients who come for service without prior notification to the provider
called? - ANS Unscheduled patients
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If the insurance verification response reports that a subscriber has a single policy, what is the
status of the subscriber's spouse? - ANS Neither enrolled not entitled to benefits
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Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act,
establishes what? - ANS Disclosure rules for consumer credit sales and consumer loans
What is a principal diagnosis? - ANS Primary reason for the patient's admission
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Collecting patient liability dollars after service leads to what? - ANS Lower accounts receivable
levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - ANS 50% of the
current deductible amount
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What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as
an RHC services? - ANS Inpatient care
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What code indicates the disposition of the patient at the conclusion of service? - ANS Patient
discharge status code
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What are hospitals required to do for Medicare credit balance accounts? - ANS 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? - ANS Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: - ANS A valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are expanding to
allow patients to do what? - ANS Access their information and perform functions on-line
, What date is required on all CMS 1500 claim forms? - ANS onset date of current illness
What does scheduling allow provider staff to do - ANS Review appropriateness of the service
request
What code is used to report the provider's most common semiprivate room rate? - ANS
Condition code
Regulations and requirements for coding accountable care organizations, which allows
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providers to begin creating these organizations, were finalized in: - ANS 2012
What is a primary responsibility of the Recover Audit Contractor? - ANS To correctly identify
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proper payments for Medicare Part A & B claims
How must providers handle credit balances? - ANS Comply with state statutes concerning
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reporting credit balance
Insurance verification results in what? - ANS The accurate identification of the patient's
eligibility and benefits
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What form is used to bill Medicare for rural health clinics? - ANS CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for service? -
ANS 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
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must be coded using what? - ANS HCPCS (Healthcare Common Procedure Coding system)
What results from a denied claim? - ANS The provider incurs rework and appeal costs
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Why does the financial counselor need pricing for services? - ANS To calculate the patient's
financial responsibility
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What type of provider bills third-party payers using CMS 1500 form - ANS Hospital-based
mammography centers
How are disputes with nongovernmental payers resolved? - ANS Appeal conditions specified
in the individual payer's contract
The important message from Medicare provides beneficiaries with information concerning what?
- ANS Right to appeal a discharge decision if the patient disagrees with the services
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