CRCR Exam Prep, Multiple Choice,
Certified Revenue Cycle Representative
(2023) - Materials from HFMA
In what situation(s) should a provider NOT use a modifier? - ANS - CPT already indicates 2-4 lesions
- CPT indicates multiple extremities
What are other names for Three-Day Payment Window? - ANS ALL OF THE ABOVE
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
What happens during the post-service stage? - ANS Final coding, preparation and submission of claims,
payment processing, balance billing and resolution.
What are the below tasks part of?
- Educate patients
- Coordinate to avoid duplicate patient contacts
- Be consistent in key aspects of account resolution
- Follow best practices for communication - ANS Best practices created by the Medical Debt Task Force
Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle initiative? - ANS Process
Compliance
Which option is NOT a continuum of care provider?
A. Physician
,B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility - ANS B. Health Plan Contracting
What is "implied certification"? - ANS When it is implied that a provider met all compliance standards
before submitting a claim
Which of the following are essential elements of an effective compliance program?
A. Established compliance standards and procedures.
B. Designation of a compliance officer employed within the Billing Department.
C. Oversight of personnel by high-level personnel.
D. Automatic dismissal of any employee excluded from participation in a federal healthcare program.
E. Reasonable methods to achieve compliance with standards, including monitoring systems and
hotlines. - ANS A. Established compliance standards and procedures.
C. Oversight of personnel by high-level personnel.
E. Reasonable methods to achieve compliance with standards, including monitoring systems and
hotlines.
When was Health Information Technology for Economic and Clinical Health (HITECH) Act signed into
law? - ANS FEB 17, 2009
When did HITECH Act become effective? - ANS 2013
,Annually, the OIG publishes a work plan of compliance issues and objectives that will be focused on
throughout the following year. Identify which option is NOT a work plan task mentioned in this course.
A. Payments to PhysiciANS for Co-Surgery Procedures
B. Denials and Appeals in Medicare Part D
C. Medicare Hospital Payments for Claims Involving the Acute- and Post-Acute-Care Transfer Policies
D. Standard Unique Employer Identifier - ANS D. Standard Unique Employer Identifier
What Plan are the tasks below a part of?
- Medicare Payments Made Outside of the Hospice Benefit
- Denials and Appeals in Medicare Part C and Part D
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits - ANS The 2020 OIG Work Plan
When was the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act signed
into law? - ANS JUNE 25 2010
What is the Medicare DRG Three-Day Payment Window? - ANS All Diagnostic services provided to a
Medicare patient by a hospital on the Date of the patient's Inpatient admission or during the 3 calendar
days (or in the case of a non-IPPS hospital: 1 calendar day) immediately BEFORE the Date of Admission
are REQUIRED to be included on the bill for the IP stay (unless there is no Part A coverage)
Do Outpatient Non-Diagnostic Services qualify for separate payments if provided with the Three-Day
Payment Window? - ANS No
What is modifier 59? - ANS Used to identify CPTs OTHER THAN E&M services, NOT normally reported
together, but are appropriate under the circumstances.
, Documentation must support a different session, different procedure or surgery, different site or organ
system, separate.
What is condition code 51? - ANS Code noted on the separate UB-04 OP claim, thus indicating the
charge is unrelated to the admission.
What kind of hospitals are the following:
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's hospitals for examples - ANS
Non-IPPS hospitals
What are the 3 types of medical necessity screenings and noncoverage notifications required in the
Medicare program? - ANS 1. Advanced Beneficiary Notice of Noncoverage (ABN) for Part B services.
2. SNF ABN for Part A SNF services.
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
What is Medicare Part B ABN? - ANS Used to explain to a Medicare patient that the ordered test or
services probably WILL NOT be covered by the Medicare b/c the DX info provided by the Dr. does NOT
support the need for these services.
****May also be used for voluntary notifications, in place of the Notice of Exclusion for Medicare
Benefits (NEMB).
What is the Two-Midnight Rule? - ANS Hospital admissions spanning 2 midnights would be considered
appropriate for payment under the IPPS rule
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