CRCR Study Questions and Answers 2023-2024
Through what document does a hospital establish compliance standards? -ANS- Code of Conduct
What is the purpose of the OIG work plan? -ANS- Communicate Issues that will be reviewed during the
year for compliance with Medicare Regulations
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? -
ANS- Diagnostic services and related charges provided on Wednesday, Thursday and Friday before
admission.
What does a modifier allow a provider to do? -ANS- Report a specific circumstance that affected a
procedure or service without changing the code or its definition
If outpatient diagnostic services are provided within three days of the admission of a Medicare
beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these
charges? -ANS- They must be combined with the inpatient bill and paid under the MS-DRG (diagnosis
related group) system.
If outpatient diagnostic services are provided within three days of the admission of a Medicare
beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these
charges? -ANS- It reviews Medicare payments for beneficiaries who have other insurance and assesses
the effectiveness of procedures in preventing inappropriate Medicare payments for beneficiaries with
other insurance coverage.
What is a recurring or series registration? -ANS- One registration record is created for multiple days of
service.
What are nonemergency patients who come for service without prior notification to the provider called?
-ANS- Unscheduled Patients
Which of the following statements apply to the observation patient type? -ANS- It is used to evaluate
the need for an inpatient admission.
,Which services are hospice programs required to provide on an around-the-clock basis? -ANS- Physician,
nursing and pharmacy
What is the purpose of the initial step in the outpatient testing scheduling process? -ANS- Identify the
correct patient on the providers database or add the patient to the database
Scheduler instructions are used to prompt the scheduler to do what? -ANS- Complete the scheduling
process correctly based on service requested.
The time needed to prepare the patient before service is the difference between the patient's arrival
time and which of the following? -ANS- Procedure time
Medicare guidelines require that when a test is ordered for which as LCD (local coverage determination)
or NCD (national coverage determination) exist, the information provided on the order must include
which of the following? -ANS- Documentation of the medical necessity of the test.
What is an advantage of a preregistration program? -ANS- It reduces processing times at the time of
service
What data are required to establish a new MPI (master patient index) entry? -ANS- The patients full legal
name, date of birth and sex
Which HIPAA transition set provides electronic processing of insurance verification requests and
responses? -ANS- The 270-271 Set
A mother and father both cover their 16-year-old child as a dependent on their health insurance plans,
which both follow the birthday rule. The mothers date of birth is January 19, 1968; the father's date of
birth is July 19, 1967. Whose plan is the primary payer? -ANS- The Mothers Plan
What is a co-payment? -ANS- The fixed amount that is due for a specific service
A patient's annual out-of-pocket limitation is $3000, excluding the deductible. To date this calendar
year, the patient has satisfied the $500 deductible and has paid $2300 in coinsurance to various
, providers. For the balance of the calendar year, what is the maximum amount of coinsurance the
patient will owe? -ANS- $3000 - $2300 = $700
What type of plan allows the subscriber to pay lower premium costs in return for a higher deductible? -
ANS- Consumer Directed Health Plan
What is a characteristic of a managed care contracting methodology? -ANS- Prospectively set rates for
inpatient and outpatient services.
Which provision protects the patient from Medical expenses that exceed a preset level? -ANS- Stop Loss
What document must a primary care physician send to an HMO (health maintenance organization)
patient to authorize a visit to a specialist for additional testing or care? -ANS- Referral
What activities are completed when a scheduled, pre-registered patient arrives for service? -ANS-
Activating the record, obtaining signatures, and finalizing financial issues.
Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the provider may not ask
about a patient's insurance information if it would delay what -ANS- Medical Screening and Stabilizing
Treatment
Collecting patient liability dollars after service leads to what? -ANS- Increased efforts by patient
accounting staff to resolve these balances.
The important Message from Medicare (IM) provides beneficiaries with information concerning what? -
ANS- Right to appeal discharge decision if the patient disagrees with the plan.
What circumstances would result in an incorrect nightly room charge? -ANS- If the patient's transfer
from the ICU (intensive care unit) to the medical/surgical floor is not reflected in the registration system
Which of the following is a step in the discharge process? -ANS- Have case management services
complete the discharge plan
Through what document does a hospital establish compliance standards? -ANS- Code of Conduct
What is the purpose of the OIG work plan? -ANS- Communicate Issues that will be reviewed during the
year for compliance with Medicare Regulations
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? -
ANS- Diagnostic services and related charges provided on Wednesday, Thursday and Friday before
admission.
What does a modifier allow a provider to do? -ANS- Report a specific circumstance that affected a
procedure or service without changing the code or its definition
If outpatient diagnostic services are provided within three days of the admission of a Medicare
beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these
charges? -ANS- They must be combined with the inpatient bill and paid under the MS-DRG (diagnosis
related group) system.
If outpatient diagnostic services are provided within three days of the admission of a Medicare
beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these
charges? -ANS- It reviews Medicare payments for beneficiaries who have other insurance and assesses
the effectiveness of procedures in preventing inappropriate Medicare payments for beneficiaries with
other insurance coverage.
What is a recurring or series registration? -ANS- One registration record is created for multiple days of
service.
What are nonemergency patients who come for service without prior notification to the provider called?
-ANS- Unscheduled Patients
Which of the following statements apply to the observation patient type? -ANS- It is used to evaluate
the need for an inpatient admission.
,Which services are hospice programs required to provide on an around-the-clock basis? -ANS- Physician,
nursing and pharmacy
What is the purpose of the initial step in the outpatient testing scheduling process? -ANS- Identify the
correct patient on the providers database or add the patient to the database
Scheduler instructions are used to prompt the scheduler to do what? -ANS- Complete the scheduling
process correctly based on service requested.
The time needed to prepare the patient before service is the difference between the patient's arrival
time and which of the following? -ANS- Procedure time
Medicare guidelines require that when a test is ordered for which as LCD (local coverage determination)
or NCD (national coverage determination) exist, the information provided on the order must include
which of the following? -ANS- Documentation of the medical necessity of the test.
What is an advantage of a preregistration program? -ANS- It reduces processing times at the time of
service
What data are required to establish a new MPI (master patient index) entry? -ANS- The patients full legal
name, date of birth and sex
Which HIPAA transition set provides electronic processing of insurance verification requests and
responses? -ANS- The 270-271 Set
A mother and father both cover their 16-year-old child as a dependent on their health insurance plans,
which both follow the birthday rule. The mothers date of birth is January 19, 1968; the father's date of
birth is July 19, 1967. Whose plan is the primary payer? -ANS- The Mothers Plan
What is a co-payment? -ANS- The fixed amount that is due for a specific service
A patient's annual out-of-pocket limitation is $3000, excluding the deductible. To date this calendar
year, the patient has satisfied the $500 deductible and has paid $2300 in coinsurance to various
, providers. For the balance of the calendar year, what is the maximum amount of coinsurance the
patient will owe? -ANS- $3000 - $2300 = $700
What type of plan allows the subscriber to pay lower premium costs in return for a higher deductible? -
ANS- Consumer Directed Health Plan
What is a characteristic of a managed care contracting methodology? -ANS- Prospectively set rates for
inpatient and outpatient services.
Which provision protects the patient from Medical expenses that exceed a preset level? -ANS- Stop Loss
What document must a primary care physician send to an HMO (health maintenance organization)
patient to authorize a visit to a specialist for additional testing or care? -ANS- Referral
What activities are completed when a scheduled, pre-registered patient arrives for service? -ANS-
Activating the record, obtaining signatures, and finalizing financial issues.
Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the provider may not ask
about a patient's insurance information if it would delay what -ANS- Medical Screening and Stabilizing
Treatment
Collecting patient liability dollars after service leads to what? -ANS- Increased efforts by patient
accounting staff to resolve these balances.
The important Message from Medicare (IM) provides beneficiaries with information concerning what? -
ANS- Right to appeal discharge decision if the patient disagrees with the plan.
What circumstances would result in an incorrect nightly room charge? -ANS- If the patient's transfer
from the ICU (intensive care unit) to the medical/surgical floor is not reflected in the registration system
Which of the following is a step in the discharge process? -ANS- Have case management services
complete the discharge plan
