CRCR Certification
10. Case Management calls for that a case supervisor be assigned
a) To sufferers of any doctor requesting case management
b) To a choose affected person organization
c) To each affected person
d) To precise instances certain through 0.33 party contractual settlement - ANS-b) To a
select patient organization
14. The core monetary activities resolved within affected person access include:
a) Scheduling, pre-registration, coverage verification and managed
care processing
b) Scheduling, insurance verification, clinical discharge processing
and price posting of point of provider receipts
c) Scheduling, registration, charge access and controlled care
processing
d) Scheduling, pre-registration, registration, clinical necessity screening and affected person
refunds - ANS-a) Scheduling, pre-registration, coverage verification and managed care
processing
15. Which of the subsequent is NOT contained in a collection enterprise settlement?
A) A clear understanding that the provider keeps possession of any
outsourced activities
b) Specific language as to who pays legal charges, if wished
c) An annual renewal clause
d) A mutual hold-harmless clause - ANS-d) A mutual maintain-harmless clause
16. Maintaining recurring touch with the fitness plan or legal responsibility payer, ensuring all
required information is furnished and all wanted approvals are received is the
duty of:
a) Patient Accounts
b) Managed Care Contract Staff
c) HIM group of workers
d) Case Management - ANS-d) Case Management
sixty one. Which of the subsequent statements is true of internal inpatient transfers? -
ANS-Transfers are coordinated by using the mattress-placement coordinator and aren't
recorded in the system until affected person is moved to the receiving unit an mattress
A declare is denied for the following reasons EXCEPT: - ANS-The submitted declare does
not have the physician signature
A declare is denied for the subsequent reasons, EXCEPT:
a) The health plan can not become aware of the subscriber
,b) The frequency of provider turned into out of doors the coverage timeline
c) The submitted declare does not have the physicians signature
d) The subscriber become no longer enrolled at the time of service - ANS-c) The submitted
claim does now not have the physicians signature
A common billing trouble with health facility-based doctor's is - ANS-They are not contracted
with the patient's fitness plan to offer offerings
A complete "Compliance Program" is described as
a) Annual prison audit and overview for adherence to guidelines
b) Educating group of workers on regulations
c) Systematic processes to make certain that the provisions of guidelines imposed via a
central authority
agency are being met
d) The improvement of operational regulations that correspond to regulations - ANS-c)
Systematic methods to ensure that the provisions of regulations imposed via a central
authority
A choice on whether a affected person must be admitted as an inpatient or emerge as an
outpatient commentary affected person requires medical judgement primarily based on all
the following EXCEPT: - ANS-The affected person's domestic care coverage
A decision on whether or not a affected person need to be admitted as an inpatient or turn
out to be an outpatient remark patient calls for medical judgement basement on all of the
following EXCEPT: - ANS-The affected person's domestic care insurance
A selection on whether a patient ought to be admitted as an inpatient or end up an outpatient
statement affected person calls for medical judgments based totally on all the following
EXCEPT:
a) The patient's domestic care insurance
b) Current clinical desires
c) The probability of an damaging occasion occurring to the affected person
d) The affected person's scientific history - ANS-a) The affected person's home care
insurance
A 4-digit number code established via the National Uniform Billing Committee (NUBC) that
categorizes/classifies a line inside the price master is known as: - ANS-Revenue codes
A 4-digit wide variety code hooked up with the aid of the National Uniform Billing Committee
(NUBC) that categorizes/classifies a line item in the price grasp is called
a) HCPCs codes
b) ICD-10 Procedural codes
c) CPT codes
d) Revenue codes - ANS-d) Revenue codes
A massive number of credit balances are not the result of overpayments however of
a) Posting mistakes inside the affected person accounting gadget
b) Incorrect declare submissions
,c) Inadequate team of workers training
d) Banking transaction mistakes - ANS-a) Posting errors within the affected person
accounting machine
A Medicare Part A benefit length starts:
a) With admission as an inpatient
b) The first day in which an man or woman has not been a sanatorium inpatient not in a
professional nursing facility for the previous 60 days
c) Upon the day the insurance premium is paid
d) Immediately once authorization for remedy is provided by means of the health plan -
ANS-a) With admission as an inpatient
A dad and mom both cover their 16-yr-vintage baby as a dependent on their medical
insurance plans, which each observe the birthday rule. The mothers date of start is
1/19/1968; and the fathers date of birth is 7/19/1967. Whose plan is the primary payer? -
ANS-The moms plan
A nightly room rate might be incorrect if the patient's
a) Discharge for the next day has now not been charted
b) Condition has now not been discussed throughout the shift change document meeting
c) Pharmacy orders to the ICU have no longer been entered inside the pharmacy gadget
d) Transfer from ICU (intensive care unit) to the Medical/Surgical ground isn't always
pondered within the registration system - ANS-d) Transfer from ICU (intensive care unit) to
the Medical/Surgical ground isn't contemplated inside the registration device
A patient has met the $200 person deductible and $900 of the $1000 co-coverage
responsibility. The co-insurance rate is 20%. The estimated insurance plan responsibility is
$1975.00. What amount of coinsurance is due from the affected person? - ANS-$one
hundred
A affected person's annual out-of-pocket obstacle is $3,000 apart from deductible. To date
this calendar year the affected person has happy the $500 deductible and has paid $2300 in
coinsurance to coinsurance to diverse companies. For the balance of the calendar yr, what is
the maximum amount of coinsurance the affected person will owe? - ANS-$700.00
A part of the accounts receivable stock which has NOT certified for billing
includes:
a) Charitable pledges
b) Accounts created for the duration of pre-registration but no longer activated
c) Accounts coded however held inside the suspense length
d) Accounts assigned to a pre-collection organisation - ANS-a) Charitable pledges
A part of the money owed receivable inventory which has NOT certified for billing consists of
a) Charitable pledges
b) Accounts assigned to a pre-series employer
c) Accounts coded however held in the suspense duration
d) Accounts created all through pre-registration however no longer activated - ANS-a)
Charitable pledges
, A portion of the accounts receivable inventory which has NOT certified for billing consists of:
- ANS-Accounts created in the course of pre-registration but now not activated
A recurring/collection registration is characterized by
a) A advent of more than one registrations for multiple offerings
b) The creation of one registration file for multiple days of carrier
c) The creation of more than one affected person types for one date of provider
d) The advent of 1 registration record according to diagnosis consistent with go to - ANS-b)
The creation of 1 registration file for a couple of days of provider
A ordinary/series registration is characterized by
a) The introduction of 1 registration file for a couple of days of carrier
b) The creation of multiple registrations for a couple of services
c) The creation of one registration document per diagnosis in step with visits
d) The advent of multiple affected person kinds for one date of service - ANS-a) The creation
of 1 registration file for multiple days of carrier
A scheduled inpatient represents an possibility for the issuer to do which of the following?
A) Refer the patient to every other region with the health gadget
b) Comply with EMTALA (Emergency Medical Treatment and Labor Act) necessities earlier
than
provider
c) Complete registration and insurance approval earlier than service
d) Register the patient after he or she is positioned in a bed on that provider unit. - ANS-c)
Complete registration and insurance approval before service
A scheduled inpatient represents an opportunity for the provider to do which of the
subsequent? - ANS-Complete registration and insurance approval before service
A a hit Medicare pay-for-performance initiative will probably result in what? - ANS-Higher
payments even as protecting sicker beneficiaries
According to the Department of Health and Human Services recommendations, which of the
subsequent isn't always considered income? - ANS-Sale of property, residence or
automobile
Account Receivable (A/R) ageing reviews - ANS-Identify overdue debts probably to end up
terrible debit
Across all care settings, if a affected person concurs to a financial dialogue all through a
clinical
encounter to expedite discharge, the HFMA high-quality exercise is to:
a) Make positive that the attending group of workers can solution questions and
help in acquiring required affected person financial records
b) Have a patient obligations package ready for the affected person,
containing all of the required registration forms and instructions
c) Support that choice, offering that the dialogue does no longer
10. Case Management calls for that a case supervisor be assigned
a) To sufferers of any doctor requesting case management
b) To a choose affected person organization
c) To each affected person
d) To precise instances certain through 0.33 party contractual settlement - ANS-b) To a
select patient organization
14. The core monetary activities resolved within affected person access include:
a) Scheduling, pre-registration, coverage verification and managed
care processing
b) Scheduling, insurance verification, clinical discharge processing
and price posting of point of provider receipts
c) Scheduling, registration, charge access and controlled care
processing
d) Scheduling, pre-registration, registration, clinical necessity screening and affected person
refunds - ANS-a) Scheduling, pre-registration, coverage verification and managed care
processing
15. Which of the subsequent is NOT contained in a collection enterprise settlement?
A) A clear understanding that the provider keeps possession of any
outsourced activities
b) Specific language as to who pays legal charges, if wished
c) An annual renewal clause
d) A mutual hold-harmless clause - ANS-d) A mutual maintain-harmless clause
16. Maintaining recurring touch with the fitness plan or legal responsibility payer, ensuring all
required information is furnished and all wanted approvals are received is the
duty of:
a) Patient Accounts
b) Managed Care Contract Staff
c) HIM group of workers
d) Case Management - ANS-d) Case Management
sixty one. Which of the subsequent statements is true of internal inpatient transfers? -
ANS-Transfers are coordinated by using the mattress-placement coordinator and aren't
recorded in the system until affected person is moved to the receiving unit an mattress
A declare is denied for the following reasons EXCEPT: - ANS-The submitted declare does
not have the physician signature
A declare is denied for the subsequent reasons, EXCEPT:
a) The health plan can not become aware of the subscriber
,b) The frequency of provider turned into out of doors the coverage timeline
c) The submitted declare does not have the physicians signature
d) The subscriber become no longer enrolled at the time of service - ANS-c) The submitted
claim does now not have the physicians signature
A common billing trouble with health facility-based doctor's is - ANS-They are not contracted
with the patient's fitness plan to offer offerings
A complete "Compliance Program" is described as
a) Annual prison audit and overview for adherence to guidelines
b) Educating group of workers on regulations
c) Systematic processes to make certain that the provisions of guidelines imposed via a
central authority
agency are being met
d) The improvement of operational regulations that correspond to regulations - ANS-c)
Systematic methods to ensure that the provisions of regulations imposed via a central
authority
A choice on whether a affected person must be admitted as an inpatient or emerge as an
outpatient commentary affected person requires medical judgement primarily based on all
the following EXCEPT: - ANS-The affected person's domestic care coverage
A decision on whether or not a affected person need to be admitted as an inpatient or turn
out to be an outpatient remark patient calls for medical judgement basement on all of the
following EXCEPT: - ANS-The affected person's domestic care insurance
A selection on whether a patient ought to be admitted as an inpatient or end up an outpatient
statement affected person calls for medical judgments based totally on all the following
EXCEPT:
a) The patient's domestic care insurance
b) Current clinical desires
c) The probability of an damaging occasion occurring to the affected person
d) The affected person's scientific history - ANS-a) The affected person's home care
insurance
A 4-digit number code established via the National Uniform Billing Committee (NUBC) that
categorizes/classifies a line inside the price master is known as: - ANS-Revenue codes
A 4-digit wide variety code hooked up with the aid of the National Uniform Billing Committee
(NUBC) that categorizes/classifies a line item in the price grasp is called
a) HCPCs codes
b) ICD-10 Procedural codes
c) CPT codes
d) Revenue codes - ANS-d) Revenue codes
A massive number of credit balances are not the result of overpayments however of
a) Posting mistakes inside the affected person accounting gadget
b) Incorrect declare submissions
,c) Inadequate team of workers training
d) Banking transaction mistakes - ANS-a) Posting errors within the affected person
accounting machine
A Medicare Part A benefit length starts:
a) With admission as an inpatient
b) The first day in which an man or woman has not been a sanatorium inpatient not in a
professional nursing facility for the previous 60 days
c) Upon the day the insurance premium is paid
d) Immediately once authorization for remedy is provided by means of the health plan -
ANS-a) With admission as an inpatient
A dad and mom both cover their 16-yr-vintage baby as a dependent on their medical
insurance plans, which each observe the birthday rule. The mothers date of start is
1/19/1968; and the fathers date of birth is 7/19/1967. Whose plan is the primary payer? -
ANS-The moms plan
A nightly room rate might be incorrect if the patient's
a) Discharge for the next day has now not been charted
b) Condition has now not been discussed throughout the shift change document meeting
c) Pharmacy orders to the ICU have no longer been entered inside the pharmacy gadget
d) Transfer from ICU (intensive care unit) to the Medical/Surgical ground isn't always
pondered within the registration system - ANS-d) Transfer from ICU (intensive care unit) to
the Medical/Surgical ground isn't contemplated inside the registration device
A patient has met the $200 person deductible and $900 of the $1000 co-coverage
responsibility. The co-insurance rate is 20%. The estimated insurance plan responsibility is
$1975.00. What amount of coinsurance is due from the affected person? - ANS-$one
hundred
A affected person's annual out-of-pocket obstacle is $3,000 apart from deductible. To date
this calendar year the affected person has happy the $500 deductible and has paid $2300 in
coinsurance to coinsurance to diverse companies. For the balance of the calendar yr, what is
the maximum amount of coinsurance the affected person will owe? - ANS-$700.00
A part of the accounts receivable stock which has NOT certified for billing
includes:
a) Charitable pledges
b) Accounts created for the duration of pre-registration but no longer activated
c) Accounts coded however held inside the suspense length
d) Accounts assigned to a pre-collection organisation - ANS-a) Charitable pledges
A part of the money owed receivable inventory which has NOT certified for billing consists of
a) Charitable pledges
b) Accounts assigned to a pre-series employer
c) Accounts coded however held in the suspense duration
d) Accounts created all through pre-registration however no longer activated - ANS-a)
Charitable pledges
, A portion of the accounts receivable inventory which has NOT certified for billing consists of:
- ANS-Accounts created in the course of pre-registration but now not activated
A recurring/collection registration is characterized by
a) A advent of more than one registrations for multiple offerings
b) The creation of one registration file for multiple days of carrier
c) The creation of more than one affected person types for one date of provider
d) The advent of 1 registration record according to diagnosis consistent with go to - ANS-b)
The creation of 1 registration file for a couple of days of provider
A ordinary/series registration is characterized by
a) The introduction of 1 registration file for a couple of days of carrier
b) The creation of multiple registrations for a couple of services
c) The creation of one registration document per diagnosis in step with visits
d) The advent of multiple affected person kinds for one date of service - ANS-a) The creation
of 1 registration file for multiple days of carrier
A scheduled inpatient represents an possibility for the issuer to do which of the following?
A) Refer the patient to every other region with the health gadget
b) Comply with EMTALA (Emergency Medical Treatment and Labor Act) necessities earlier
than
provider
c) Complete registration and insurance approval earlier than service
d) Register the patient after he or she is positioned in a bed on that provider unit. - ANS-c)
Complete registration and insurance approval before service
A scheduled inpatient represents an opportunity for the provider to do which of the
subsequent? - ANS-Complete registration and insurance approval before service
A a hit Medicare pay-for-performance initiative will probably result in what? - ANS-Higher
payments even as protecting sicker beneficiaries
According to the Department of Health and Human Services recommendations, which of the
subsequent isn't always considered income? - ANS-Sale of property, residence or
automobile
Account Receivable (A/R) ageing reviews - ANS-Identify overdue debts probably to end up
terrible debit
Across all care settings, if a affected person concurs to a financial dialogue all through a
clinical
encounter to expedite discharge, the HFMA high-quality exercise is to:
a) Make positive that the attending group of workers can solution questions and
help in acquiring required affected person financial records
b) Have a patient obligations package ready for the affected person,
containing all of the required registration forms and instructions
c) Support that choice, offering that the dialogue does no longer
