CRCR STUDY QUESTIONS AND ANSWERS 2023
100% PASS
1.code of conduct – Ans hospital establish compliance standards
2.Purpose of OIG work plan? – Ans communicate issues that will be reviewed during the year
for compliance with Medicare regulations
3.Medicare pt. admitted on Friday, what services fall within the three day window rule? – Ans
Dx services and related charges provided on the W,R, and F before adm.
4.What does modifier allow a provider to do? – Ans Report a specific circumstance that affected
a procedure or service without changing the code or its definition
5.Out pt. dx services provided within 3 days of adm. of a medicare benef. to an IPPS hospt, what
must happen to these charges – Ans combined with the in pt. bill and paid under the MS-DRG
system
6.Why is OIG pursuing the medicare Secondary Payer – Ans reviews medicare payments for
beneficiaries who have other insurance and assesses the effect. of procedures in preventing
inappro. medcare payments for benef. with other ins. coverage
7.Recurring or series registration? – Ans one reg. record is created for multi days of service
8. Nonemergency pt. who comes for service w/out prior notif. to the provider called? – Ans
unscheduled pt.
9. stmnts apply to observ. pt. type – Ans used to evaluate the need for an in pt. adm.
10.which services are hospice programs required to provide on an around the clock basis – Ans
physician, nursing, pharmacy
11. purpose of initial step in put pt. testing scheduling process – Ans identifying the correct pt. in
the providers database or add the pt. to the database
12.scheduler instructions are used to prompt the scheduler to do what? – Ans complete the
scheduling process correctly based on service requested
13. medicare guidelines require that when a test is ordered for which an LCD or NCD exists, the
info provided on the order must include which of the following? – Ans documentation of the
medical necessity for the test
14.advantage of pre reg. program? – Ans reduces processing times at the time of serivce
15.what data are required to est. a new MPI entry? – Ans pts. name, DOB, sex
, 16. Which HIPAA trans. set provides electronic processing of ins, verif requests and responses?
– Ans the 270-271 set
17. a mother and father both cover their 16 yo child as a dep. on their health ins, plans, which
both follow the bday rule. mothers dob is 1-19-68 and fathers dob is 7-19-67; whose plan is
primary – Ans mothers
18. true about third party payers? – Ans payments received by the provider from the payer
respon. for reimbursing the provider for the pts. covered services
19. co-payment? – Ans fixed amt. that is due for a specific service
20. pts annual out of pocket limitation is 3000, excluding deduct. to date this cal. year the pt has
satisfied the 500 deduct. and has paid 2300 in co insurance to various providers. max amount of
coinsurance the pt will owe – Ans 700
21. type of plan that allows the subscriber to pay lower premium costs in return for a higher
deductible? – Ans consumer directed health plan
22. characteristic of a managed care contracted methodology – Ans prospectively set rates for in
pt. and out pt. services
23. which provision protects the pt. from medical expenses that exceed a pre set level – Ans stop
loss
24. what document must a primary care phys. send to an HMO pt. to authorize a visit to a
specialist for add. testing or care? – Ans referral
25. activities are completed when a scheduled, pre reg pt. arrives for service? – Ans activating
the record, obtaining signatures, and finalizing financial issues
26. under EMTALA reg., the provider may not ask about a pts. ins. info if it would delay what –
Ans medical screening and stabilizing treatment
27. collecting pt liability dollars after service leads to what – Ans increased efforts by pt acct
staff to resolve these balanaces
28. important message from medicare provides beneficiaries with info concerning what? – Ans
right to appeal a discharge decision if the pt disagrees with the plan
29. which of the following is a step in the discharge process? – Ans have case management
services complete the discharge plan
30. what curcumstances would result in an incorrect nightly room charge? - Ansif pt. transfer
from the ICU to medical/surgical floor is not reflected in the reg system
100% PASS
1.code of conduct – Ans hospital establish compliance standards
2.Purpose of OIG work plan? – Ans communicate issues that will be reviewed during the year
for compliance with Medicare regulations
3.Medicare pt. admitted on Friday, what services fall within the three day window rule? – Ans
Dx services and related charges provided on the W,R, and F before adm.
4.What does modifier allow a provider to do? – Ans Report a specific circumstance that affected
a procedure or service without changing the code or its definition
5.Out pt. dx services provided within 3 days of adm. of a medicare benef. to an IPPS hospt, what
must happen to these charges – Ans combined with the in pt. bill and paid under the MS-DRG
system
6.Why is OIG pursuing the medicare Secondary Payer – Ans reviews medicare payments for
beneficiaries who have other insurance and assesses the effect. of procedures in preventing
inappro. medcare payments for benef. with other ins. coverage
7.Recurring or series registration? – Ans one reg. record is created for multi days of service
8. Nonemergency pt. who comes for service w/out prior notif. to the provider called? – Ans
unscheduled pt.
9. stmnts apply to observ. pt. type – Ans used to evaluate the need for an in pt. adm.
10.which services are hospice programs required to provide on an around the clock basis – Ans
physician, nursing, pharmacy
11. purpose of initial step in put pt. testing scheduling process – Ans identifying the correct pt. in
the providers database or add the pt. to the database
12.scheduler instructions are used to prompt the scheduler to do what? – Ans complete the
scheduling process correctly based on service requested
13. medicare guidelines require that when a test is ordered for which an LCD or NCD exists, the
info provided on the order must include which of the following? – Ans documentation of the
medical necessity for the test
14.advantage of pre reg. program? – Ans reduces processing times at the time of serivce
15.what data are required to est. a new MPI entry? – Ans pts. name, DOB, sex
, 16. Which HIPAA trans. set provides electronic processing of ins, verif requests and responses?
– Ans the 270-271 set
17. a mother and father both cover their 16 yo child as a dep. on their health ins, plans, which
both follow the bday rule. mothers dob is 1-19-68 and fathers dob is 7-19-67; whose plan is
primary – Ans mothers
18. true about third party payers? – Ans payments received by the provider from the payer
respon. for reimbursing the provider for the pts. covered services
19. co-payment? – Ans fixed amt. that is due for a specific service
20. pts annual out of pocket limitation is 3000, excluding deduct. to date this cal. year the pt has
satisfied the 500 deduct. and has paid 2300 in co insurance to various providers. max amount of
coinsurance the pt will owe – Ans 700
21. type of plan that allows the subscriber to pay lower premium costs in return for a higher
deductible? – Ans consumer directed health plan
22. characteristic of a managed care contracted methodology – Ans prospectively set rates for in
pt. and out pt. services
23. which provision protects the pt. from medical expenses that exceed a pre set level – Ans stop
loss
24. what document must a primary care phys. send to an HMO pt. to authorize a visit to a
specialist for add. testing or care? – Ans referral
25. activities are completed when a scheduled, pre reg pt. arrives for service? – Ans activating
the record, obtaining signatures, and finalizing financial issues
26. under EMTALA reg., the provider may not ask about a pts. ins. info if it would delay what –
Ans medical screening and stabilizing treatment
27. collecting pt liability dollars after service leads to what – Ans increased efforts by pt acct
staff to resolve these balanaces
28. important message from medicare provides beneficiaries with info concerning what? – Ans
right to appeal a discharge decision if the pt disagrees with the plan
29. which of the following is a step in the discharge process? – Ans have case management
services complete the discharge plan
30. what curcumstances would result in an incorrect nightly room charge? - Ansif pt. transfer
from the ICU to medical/surgical floor is not reflected in the reg system
