CRS PA BOARD EVALUATION SCRIPT 2026
QUESTIONS WITH SOLUTIONS GRADED A+
⩥ Why does the financial counselor need pricing for services? Answer:
To calculate the patient's financial responsibility
⩥ What type of provider bills third-party payers using CMS 1500 form
Answer: Hospital-based mammography centers
⩥ How are disputes with nongovernmental payers resolved? Answer:
Appeal conditions specified in the individual payer's contract
⩥ The important message from Medicare provides beneficiaries with
information concerning what? Answer: Right to appeal a discharge
decision if the patient disagrees with the services
⩥ Why do managed care plans have agreements with hospitals,
physicians, and other healthcare providers to offer a range of services to
plan members? Answer: To improve access to quality healthcare
⩥ If a patient remains an inpatient of an SNF (skilled nursing facility for
more than 30 days, what is the SNF permitted to do? Answer: Submit
interim bills to the Medicare program.
,⩥ 90. MSP (Medicare Secondary Payer) rules allow providers to bill
Medicare for liability claims after what happens? Answer: 120 days
passes, but the claim then be withdrawn from the liability carrier
⩥ What data are required to establish a new MPI entry? Answer: The
patient's full legal name, date of birth, and sex
⩥ What should the provider do if both of the patient's insurance plans
pay as primary? Answer: Determine the correct payer and notify the
incorrect payer of the processing error
⩥ What do EMTALA regulations require on-call physicians to do?
Answer: Personally appear in the emergency department and attend to
the patient within a reasonable time
⩥ At the end of each shift, what must happen to cash, checks, and credit
card transaction documents? Answer: They must be balanced
⩥ What will cause a CMS 1500 claim to be rejected? Answer: The
provider is billing with a future date of service
⩥ Under Medicare regulations, which of the following is not included on
a valid physician's order for services? Answer: The cost of the test
, ⩥ how are HCPCS codes and the appropriate modifiers used? Answer:
To report the level 1, 2, or 3 code that correctly describes the service
provided
⩥ If a Medicare patient is admitted on Friday, what services fall within
the three-day DRG window rule? Answer: Diagnostic and clinically-
related non-diagnostic charges provided on the Tuesday, Wednesday,
Thursday, and Friday before admission
⩥ What is a benefit of pre-registering patient's for service? Answer:
Patient arrival processing is expedited, reducing wait times and delays
⩥ What is a characteristic of a managed contracting methodology?
Answer: Prospectively set rates for inpatient and outpatient services
⩥ What do the MSP disability rules require? Answer: That the patient's
spouse's employer must have less than 20 employees in the group health
plan
⩥ what organization originated the concept of insuring prepaid health
care services? Answer: Blue Cross and blue Shield
⩥ What is true about screening a beneficiary for possible MSP
situations? Answer: It is acceptable to complete the screening form after
QUESTIONS WITH SOLUTIONS GRADED A+
⩥ Why does the financial counselor need pricing for services? Answer:
To calculate the patient's financial responsibility
⩥ What type of provider bills third-party payers using CMS 1500 form
Answer: Hospital-based mammography centers
⩥ How are disputes with nongovernmental payers resolved? Answer:
Appeal conditions specified in the individual payer's contract
⩥ The important message from Medicare provides beneficiaries with
information concerning what? Answer: Right to appeal a discharge
decision if the patient disagrees with the services
⩥ Why do managed care plans have agreements with hospitals,
physicians, and other healthcare providers to offer a range of services to
plan members? Answer: To improve access to quality healthcare
⩥ If a patient remains an inpatient of an SNF (skilled nursing facility for
more than 30 days, what is the SNF permitted to do? Answer: Submit
interim bills to the Medicare program.
,⩥ 90. MSP (Medicare Secondary Payer) rules allow providers to bill
Medicare for liability claims after what happens? Answer: 120 days
passes, but the claim then be withdrawn from the liability carrier
⩥ What data are required to establish a new MPI entry? Answer: The
patient's full legal name, date of birth, and sex
⩥ What should the provider do if both of the patient's insurance plans
pay as primary? Answer: Determine the correct payer and notify the
incorrect payer of the processing error
⩥ What do EMTALA regulations require on-call physicians to do?
Answer: Personally appear in the emergency department and attend to
the patient within a reasonable time
⩥ At the end of each shift, what must happen to cash, checks, and credit
card transaction documents? Answer: They must be balanced
⩥ What will cause a CMS 1500 claim to be rejected? Answer: The
provider is billing with a future date of service
⩥ Under Medicare regulations, which of the following is not included on
a valid physician's order for services? Answer: The cost of the test
, ⩥ how are HCPCS codes and the appropriate modifiers used? Answer:
To report the level 1, 2, or 3 code that correctly describes the service
provided
⩥ If a Medicare patient is admitted on Friday, what services fall within
the three-day DRG window rule? Answer: Diagnostic and clinically-
related non-diagnostic charges provided on the Tuesday, Wednesday,
Thursday, and Friday before admission
⩥ What is a benefit of pre-registering patient's for service? Answer:
Patient arrival processing is expedited, reducing wait times and delays
⩥ What is a characteristic of a managed contracting methodology?
Answer: Prospectively set rates for inpatient and outpatient services
⩥ What do the MSP disability rules require? Answer: That the patient's
spouse's employer must have less than 20 employees in the group health
plan
⩥ what organization originated the concept of insuring prepaid health
care services? Answer: Blue Cross and blue Shield
⩥ What is true about screening a beneficiary for possible MSP
situations? Answer: It is acceptable to complete the screening form after
