CRCR Certification Exam Questions and Answers 2023-
2024 solved 100%
What are collection agency fees based on? -ANSA percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? -
ANSBirthday
In what type of payment methodology is a lump sum or bundled payment negotiated between the payer
and some or all providers? -ANSCase rates
What customer service improvements might improve the patient accounts department? -ANSHolding
staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -ANSInform a Medicare
beneficiary that Medicare may not pay for the order or service
What type of account adjustment results from the patient's unwillingness to pay for a self-pay balance? -
ANSBad debt adjustment
What is the initial hospice benefit? -ANSTwo 90-day periods and an unlimited number of subsequent
periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -ANSIf the patient
requires ambulance transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account is billed? -ANSPost a late-
charge adjustment to the account
an increase in the dollars aged greater than 90 days from date of service indicate what about accounts -
ANSThey are not being processed in a timely manner
,What is an advantage of a preregistration program? -ANSIt reduces processing times at the time of
service
What are the two statutory exclusions from hospice coverage? -ANSMedically unnecessary services and
custodial care
What core financial activities are resolved within patient access? -ANSScheduling, insurance verification,
discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? -ANSThe services do not involve an overnight stay
How is a mis-posted contractual allowance resolved? -ANSComparing the contract reimbursement rates
with the contract on the admittance advice to identify the correct amount
What type of patient status is used to evaluate the patient's need for inpatient care? -ANSObservation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has
received what? -ANSMedically necessary inpatient hospital services for at least 3 consecutive days
before the skilled nursing care admission
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? -ANSWhen the patient is
the insured
What are non-emergency patients who come for service without prior notification to the provider
called? -ANSUnscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what is the status of
the subscriber's spouse? -ANSNeither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act, establishes
what? -ANSDisclosure rules for consumer credit sales and consumer loans
,What is a principal diagnosis? -ANSPrimary reason for the patient's admission
Collecting patient liability dollars after service leads to what? -ANSLower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? -ANS50% of the current
deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as an RHC
services? -ANSInpatient care
What code indicates the disposition of the patient at the conclusion of service? -ANSPatient discharge
status code
What are hospitals required to do for Medicare credit balance accounts? -ANSThey result in lost
reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient and the third party payer,
who is responsible for payment? -ANSPatient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: -ANSA valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are expanding to allow
patients to do what? -ANSAccess their information and perform functions on-line
What date is required on all CMS 1500 claim forms? -ANSonset date of current illness
What does scheduling allow provider staff to do -ANSReview appropriateness of the service request
What code is used to report the provider's most common semiprivate room rate? -ANSCondition code
, Regulations and requirements for coding accountable care organizations, which allows providers to
begin creating these organizations, were finalized in: -ANS2012
What is a primary responsibility of the Recover Audit Contractor? -ANSTo correctly identify proper
payments for Medicare Part A & B claims
How must providers handle credit balances? -ANSComply with state statutes concerning reporting credit
balance
Insurance verification results in what? -ANSThe accurate identification of the patient's eligibility and
benefits
What form is used to bill Medicare for rural health clinics? -ANSCMS 1500
What activities are completed when a scheduled pre-registered patient arrives for service? -
ANSRegistering the patient and directing the patient to the service area
In addition to being supported by information found in the patient's chart, a CMS 1500 claim must be
coded using what? -ANSHCPCS (Healthcare Common Procedure Coding system)
What results from a denied claim? -ANSThe provider incurs rework and appeal costs
Why does the financial counselor need pricing for services? -ANSTo calculate the patient's financial
responsibility
What type of provider bills third-party payers using CMS 1500 form -ANSHospital-based mammography
centers
How are disputes with nongovernmental payers resolved? -ANSAppeal conditions specified in the
individual payer's contract
2024 solved 100%
What are collection agency fees based on? -ANSA percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? -
ANSBirthday
In what type of payment methodology is a lump sum or bundled payment negotiated between the payer
and some or all providers? -ANSCase rates
What customer service improvements might improve the patient accounts department? -ANSHolding
staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -ANSInform a Medicare
beneficiary that Medicare may not pay for the order or service
What type of account adjustment results from the patient's unwillingness to pay for a self-pay balance? -
ANSBad debt adjustment
What is the initial hospice benefit? -ANSTwo 90-day periods and an unlimited number of subsequent
periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -ANSIf the patient
requires ambulance transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account is billed? -ANSPost a late-
charge adjustment to the account
an increase in the dollars aged greater than 90 days from date of service indicate what about accounts -
ANSThey are not being processed in a timely manner
,What is an advantage of a preregistration program? -ANSIt reduces processing times at the time of
service
What are the two statutory exclusions from hospice coverage? -ANSMedically unnecessary services and
custodial care
What core financial activities are resolved within patient access? -ANSScheduling, insurance verification,
discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? -ANSThe services do not involve an overnight stay
How is a mis-posted contractual allowance resolved? -ANSComparing the contract reimbursement rates
with the contract on the admittance advice to identify the correct amount
What type of patient status is used to evaluate the patient's need for inpatient care? -ANSObservation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has
received what? -ANSMedically necessary inpatient hospital services for at least 3 consecutive days
before the skilled nursing care admission
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? -ANSWhen the patient is
the insured
What are non-emergency patients who come for service without prior notification to the provider
called? -ANSUnscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what is the status of
the subscriber's spouse? -ANSNeither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act, establishes
what? -ANSDisclosure rules for consumer credit sales and consumer loans
,What is a principal diagnosis? -ANSPrimary reason for the patient's admission
Collecting patient liability dollars after service leads to what? -ANSLower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? -ANS50% of the current
deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as an RHC
services? -ANSInpatient care
What code indicates the disposition of the patient at the conclusion of service? -ANSPatient discharge
status code
What are hospitals required to do for Medicare credit balance accounts? -ANSThey result in lost
reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient and the third party payer,
who is responsible for payment? -ANSPatient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: -ANSA valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are expanding to allow
patients to do what? -ANSAccess their information and perform functions on-line
What date is required on all CMS 1500 claim forms? -ANSonset date of current illness
What does scheduling allow provider staff to do -ANSReview appropriateness of the service request
What code is used to report the provider's most common semiprivate room rate? -ANSCondition code
, Regulations and requirements for coding accountable care organizations, which allows providers to
begin creating these organizations, were finalized in: -ANS2012
What is a primary responsibility of the Recover Audit Contractor? -ANSTo correctly identify proper
payments for Medicare Part A & B claims
How must providers handle credit balances? -ANSComply with state statutes concerning reporting credit
balance
Insurance verification results in what? -ANSThe accurate identification of the patient's eligibility and
benefits
What form is used to bill Medicare for rural health clinics? -ANSCMS 1500
What activities are completed when a scheduled pre-registered patient arrives for service? -
ANSRegistering the patient and directing the patient to the service area
In addition to being supported by information found in the patient's chart, a CMS 1500 claim must be
coded using what? -ANSHCPCS (Healthcare Common Procedure Coding system)
What results from a denied claim? -ANSThe provider incurs rework and appeal costs
Why does the financial counselor need pricing for services? -ANSTo calculate the patient's financial
responsibility
What type of provider bills third-party payers using CMS 1500 form -ANSHospital-based mammography
centers
How are disputes with nongovernmental payers resolved? -ANSAppeal conditions specified in the
individual payer's contract
