CRCR STUDY QUESTIONS
code of conduct - answerhospital establish compliance standards
Purpose of OIG work plan? - answercommunicate issues that will be reviewed during
the year for compliance with Medicare regulations
Medicare pt. admitted on Friday, what services fall within the three day window rule? -
answerDx services and related charges provided on the W,R, and F before adm.
What does modifier allow a provider to do? - answerReport a specific circumstance that
affected a procedure or service without changing the code or its definition
Out pt. dx services provided within 3 days of adm. of a medicare benef. to an IPPS
hospt, what must happen to these charges - answercombined with the in pt. bill and
paid under the MS-DRG system
Why is OIG pursuing the medicare Secondary Payer - answerreviews 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
Recurring or series registration? - answerone reg. record is created for multi days of
service
Nonemergency pt. who comes for service w/out prior notif. to the provider called? -
answerunscheduled pt.
stmnts apply to observ. pt. type - answerused to evaluate the need for an in pt. adm.
which services are hospice programs required to provide on an around the clock basis -
answerphysician, nursing, pharmacy
purpose of initial step in put pt. testing scheduling process - answeridentifying the
correct pt. in the providers database or add the pt. to the database
, scheduler instructions are used to prompt the scheduler to do what? - answercomplete
the scheduling process correctly based on service requested
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? -
answerdocumentation of the medical necessity for the test
advantage of pre reg. program? - answerreduces processing times at the time of
serivce
what data are required to est. a new MPI entry? - answerpts. name, DOB, sex
Which HIPAA trans. set provides electronic processing of ins, verif requests and
responses? - answerthe 270-271 set
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 - answermothers
true about third party payers? - answerpayments received by the provider from the
payer respon. for reimbursing the provider for the pts. covered services
co-payment? - answerfixed amt. that is due for a specific service
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 - answer700
type of plan that allows the subscriber to pay lower premium costs in return for a higher
deductible? - answerconsumer directed health plan
characteristic of a managed care contracted methodology - answerprospectively set
rates for in pt. and out pt. services
which provision protects the pt. from medical expenses that exceed a pre set level -
answerstop loss
what document must a primary care phys. send to an HMO pt. to authorize a visit to a
specialist for add. testing or care? - answerreferral
activities are completed when a scheduled, pre reg pt. arrives for service? -
answeractivating the record, obtaining signatures, and finalizing financial issues
under EMTALA reg., the provider may not ask about a pts. ins. info if it would delay
what - answermedical screening and stabilizing treatment
code of conduct - answerhospital establish compliance standards
Purpose of OIG work plan? - answercommunicate issues that will be reviewed during
the year for compliance with Medicare regulations
Medicare pt. admitted on Friday, what services fall within the three day window rule? -
answerDx services and related charges provided on the W,R, and F before adm.
What does modifier allow a provider to do? - answerReport a specific circumstance that
affected a procedure or service without changing the code or its definition
Out pt. dx services provided within 3 days of adm. of a medicare benef. to an IPPS
hospt, what must happen to these charges - answercombined with the in pt. bill and
paid under the MS-DRG system
Why is OIG pursuing the medicare Secondary Payer - answerreviews 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
Recurring or series registration? - answerone reg. record is created for multi days of
service
Nonemergency pt. who comes for service w/out prior notif. to the provider called? -
answerunscheduled pt.
stmnts apply to observ. pt. type - answerused to evaluate the need for an in pt. adm.
which services are hospice programs required to provide on an around the clock basis -
answerphysician, nursing, pharmacy
purpose of initial step in put pt. testing scheduling process - answeridentifying the
correct pt. in the providers database or add the pt. to the database
, scheduler instructions are used to prompt the scheduler to do what? - answercomplete
the scheduling process correctly based on service requested
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? -
answerdocumentation of the medical necessity for the test
advantage of pre reg. program? - answerreduces processing times at the time of
serivce
what data are required to est. a new MPI entry? - answerpts. name, DOB, sex
Which HIPAA trans. set provides electronic processing of ins, verif requests and
responses? - answerthe 270-271 set
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 - answermothers
true about third party payers? - answerpayments received by the provider from the
payer respon. for reimbursing the provider for the pts. covered services
co-payment? - answerfixed amt. that is due for a specific service
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 - answer700
type of plan that allows the subscriber to pay lower premium costs in return for a higher
deductible? - answerconsumer directed health plan
characteristic of a managed care contracted methodology - answerprospectively set
rates for in pt. and out pt. services
which provision protects the pt. from medical expenses that exceed a pre set level -
answerstop loss
what document must a primary care phys. send to an HMO pt. to authorize a visit to a
specialist for add. testing or care? - answerreferral
activities are completed when a scheduled, pre reg pt. arrives for service? -
answeractivating the record, obtaining signatures, and finalizing financial issues
under EMTALA reg., the provider may not ask about a pts. ins. info if it would delay
what - answermedical screening and stabilizing treatment
