CRCR Exam Prep, Multiple Choice,
Certified Revenue Cycle
Representative - Materials from
HFMA
In what scenario(s) need to a issuer NOT use a modifier?
- CPT already suggests 2-four lesions
- CPT shows more than one extremities
three a couple of preference alternatives
What are other names for Three-Day Payment Window?
ALL OF THE ABOVE
seventy two-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
three more than one choice alternatives
What happens during the submit-service level?
Final coding, preparation and submission of claims, charge processing, stability billing and
resolution.
3 a couple of desire alternatives
What are the under obligations a part of?
- Educate sufferers
- Coordinate to keep away from replica affected person contacts
- Be consistent in key factors of account resolution
- Follow nice practices for communique
Best practices created by using the Medical Debt Task Force
3 more than one preference options
Which choice is NOT a prime HFMA Healthcare Dollars & Sense® sales cycle initiative?
Process Compliance
three a couple of choice alternatives
Which choice is NOT a continuum of care issuer?
,A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility
B. Health Plan Contracting
three more than one choice alternatives
What is "implied certification"?
When it's miles implied that a company met all compliance standards earlier than filing a
declare
three more than one choice options
Which of the following are vital factors of an powerful compliance software?
A. Established compliance requirements and methods.
B. Designation of a compliance officer hired inside the Billing Department.
C. Oversight of personnel through excessive-degree personnel.
D. Automatic dismissal of any worker excluded from participation in a federal healthcare
program.
E. Reasonable methods to attain compliance with requirements, which include tracking
systems and hotlines.
A. Established compliance requirements and procedures.
C. Oversight of personnel by using high-degree personnel.
E. Reasonable methods to attain compliance with requirements, including monitoring
systems and hotlines.
3 a couple of choice alternatives
When was Health Information Technology for Economic and Clinical Health (HITECH) Act
signed into regulation?
FEB 17, 2009
three multiple desire alternatives
When did HITECH Act come to be effective?
2013
three more than one desire alternatives
Annually, the OIG publishes a work plan of compliance issues and objectives so that it will
be focused on during the following year. Identify which choice is NOT a work plan project
referred to on this route.
,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
D. Standard Unique Employer Identifier
3 a couple of desire options
What Plan are the obligations 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 five to 10 Skilled Visits
The 2020 OIG Work Plan
3 more than one preference alternatives
When become the Preservation of Access to Care for Medicare Beneficiaries and Pension
Relief Act signed into law?
JUNE 25 2010
three a couple of preference alternatives
What is the Medicare DRG Three-Day Payment Window?
All Diagnostic offerings provided to a Medicare affected person through a clinic on the Date
of the patient's Inpatient admission or at some stage in the three calendar days (or in the
case of a non-IPPS medical institution: 1 calendar day) right away BEFORE the Date of
Admission are REQUIRED to be covered on the invoice for the IP live (unless there is no
Part A insurance)
three a couple of choice options
Do Outpatient Non-Diagnostic Services qualify for separate bills if provided with the
Three-Day Payment Window?
No
What is modifier 59?
Used to pick out CPTs OTHER THAN E&M offerings, NOT generally stated collectively, but
are suitable under the situations.
Documentation have to aid a specific consultation, distinctive process or surgical procedure,
distinct web site or organ system, separate.
3 more than one choice options
, What is circumstance code 51?
Code referred to at the separate UB-04 OP claim, for that reason indicating the price is
unrelated to the admission.
Three multiple choice options
What sort of hospitals are the subsequent:
Cancer treatment centers, psychiatric, IP rehabilitation, LTC and kid's hospitals for examples
Non-IPPS hospitals
three more than one choice alternatives
What are the three styles of scientific necessity screenings and noncoverage notifications
required in the Medicare application?
1. Advanced Beneficiary Notice of Noncoverage (ABN) for Part B offerings.
2. SNF ABN for Part A SNF offerings.
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
What is Medicare Part B ABN?
Used to provide an explanation for to a Medicare patient that the ordered test or offerings
probably WILL NOT be blanketed through the Medicare b/c the DX information supplied with
the aid of the Dr. Does NOT support the want for these offerings.
****May additionally be used for voluntary notifications, in location of the Notice of Exclusion
for Medicare Benefits (NEMB).
What is the Two-Midnight Rule?
Hospital admissions spanning 2 hours of darkness would be taken into consideration
suitable for charge under the IPPS rule
3 a couple of desire alternatives
What are some MSP claims that require extra review by means of the OIG to ensure
compliance?
- W/C
- Black Lung Program offerings
- Veterans Affairs (VA) services
- Federal supply applications
- Public Health Service applications (i.E Medicaid)
What are a few cases where Medicare is the Secondary Payer?
- Working Aged (commercial insurance is Primary)
Certified Revenue Cycle
Representative - Materials from
HFMA
In what scenario(s) need to a issuer NOT use a modifier?
- CPT already suggests 2-four lesions
- CPT shows more than one extremities
three a couple of preference alternatives
What are other names for Three-Day Payment Window?
ALL OF THE ABOVE
seventy two-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
three more than one choice alternatives
What happens during the submit-service level?
Final coding, preparation and submission of claims, charge processing, stability billing and
resolution.
3 a couple of desire alternatives
What are the under obligations a part of?
- Educate sufferers
- Coordinate to keep away from replica affected person contacts
- Be consistent in key factors of account resolution
- Follow nice practices for communique
Best practices created by using the Medical Debt Task Force
3 more than one preference options
Which choice is NOT a prime HFMA Healthcare Dollars & Sense® sales cycle initiative?
Process Compliance
three a couple of choice alternatives
Which choice is NOT a continuum of care issuer?
,A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility
B. Health Plan Contracting
three more than one choice alternatives
What is "implied certification"?
When it's miles implied that a company met all compliance standards earlier than filing a
declare
three more than one choice options
Which of the following are vital factors of an powerful compliance software?
A. Established compliance requirements and methods.
B. Designation of a compliance officer hired inside the Billing Department.
C. Oversight of personnel through excessive-degree personnel.
D. Automatic dismissal of any worker excluded from participation in a federal healthcare
program.
E. Reasonable methods to attain compliance with requirements, which include tracking
systems and hotlines.
A. Established compliance requirements and procedures.
C. Oversight of personnel by using high-degree personnel.
E. Reasonable methods to attain compliance with requirements, including monitoring
systems and hotlines.
3 a couple of choice alternatives
When was Health Information Technology for Economic and Clinical Health (HITECH) Act
signed into regulation?
FEB 17, 2009
three multiple desire alternatives
When did HITECH Act come to be effective?
2013
three more than one desire alternatives
Annually, the OIG publishes a work plan of compliance issues and objectives so that it will
be focused on during the following year. Identify which choice is NOT a work plan project
referred to on this route.
,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
D. Standard Unique Employer Identifier
3 a couple of desire options
What Plan are the obligations 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 five to 10 Skilled Visits
The 2020 OIG Work Plan
3 more than one preference alternatives
When become the Preservation of Access to Care for Medicare Beneficiaries and Pension
Relief Act signed into law?
JUNE 25 2010
three a couple of preference alternatives
What is the Medicare DRG Three-Day Payment Window?
All Diagnostic offerings provided to a Medicare affected person through a clinic on the Date
of the patient's Inpatient admission or at some stage in the three calendar days (or in the
case of a non-IPPS medical institution: 1 calendar day) right away BEFORE the Date of
Admission are REQUIRED to be covered on the invoice for the IP live (unless there is no
Part A insurance)
three a couple of choice options
Do Outpatient Non-Diagnostic Services qualify for separate bills if provided with the
Three-Day Payment Window?
No
What is modifier 59?
Used to pick out CPTs OTHER THAN E&M offerings, NOT generally stated collectively, but
are suitable under the situations.
Documentation have to aid a specific consultation, distinctive process or surgical procedure,
distinct web site or organ system, separate.
3 more than one choice options
, What is circumstance code 51?
Code referred to at the separate UB-04 OP claim, for that reason indicating the price is
unrelated to the admission.
Three multiple choice options
What sort of hospitals are the subsequent:
Cancer treatment centers, psychiatric, IP rehabilitation, LTC and kid's hospitals for examples
Non-IPPS hospitals
three more than one choice alternatives
What are the three styles of scientific necessity screenings and noncoverage notifications
required in the Medicare application?
1. Advanced Beneficiary Notice of Noncoverage (ABN) for Part B offerings.
2. SNF ABN for Part A SNF offerings.
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
What is Medicare Part B ABN?
Used to provide an explanation for to a Medicare patient that the ordered test or offerings
probably WILL NOT be blanketed through the Medicare b/c the DX information supplied with
the aid of the Dr. Does NOT support the want for these offerings.
****May additionally be used for voluntary notifications, in location of the Notice of Exclusion
for Medicare Benefits (NEMB).
What is the Two-Midnight Rule?
Hospital admissions spanning 2 hours of darkness would be taken into consideration
suitable for charge under the IPPS rule
3 a couple of desire alternatives
What are some MSP claims that require extra review by means of the OIG to ensure
compliance?
- W/C
- Black Lung Program offerings
- Veterans Affairs (VA) services
- Federal supply applications
- Public Health Service applications (i.E Medicaid)
What are a few cases where Medicare is the Secondary Payer?
- Working Aged (commercial insurance is Primary)
