CRCR Study Guide Review
Through what document does a hospital establish compliance standards? -
answerCode of Conduct
What is the purpose of the OIG work plan? - answerCommunicate 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? - answerDiagnostic services and related charges provided on
Wednesday, Thursday and Friday before admission.
What does a modifier allow a provider to do? - answerReport 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? - answerThey 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? - answerIt 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? - answerOne registration record is created for
multiple days of service.
What are nonemergency patients who come for service without prior notification to the
provider called? - answerUnscheduled Patients
Which of the following statements apply to the observation patient type? - answerIt is
used to evaluate the need for an inpatient admission.
, Which services are hospice programs required to provide on an around-the-clock basis?
- answerPhysician, nursing and pharmacy
What is the purpose of the initial step in the outpatient testing scheduling process? -
answerIdentify 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? - answerComplete
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? - answerProcedure 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? -
answerDocumentation of the medical necessity of the test.
What is an advantage of a preregistration program? - answerIt reduces processing
times at the time of service
What data are required to establish a new MPI (master patient index) entry? -
answerThe patients full legal name, date of birth and sex
Which HIPAA transition set provides electronic processing of insurance verification
requests and responses? - answerThe 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? - answerThe Mothers Plan
What is a co-payment? - answerThe 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? - answer$3000 - $2300 = $700
What type of plan allows the subscriber to pay lower premium costs in return for a
higher deductible? - answerConsumer Directed Health Plan
What is a characteristic of a managed care contracting methodology? -
answerProspectively set rates for inpatient and outpatient services.
Through what document does a hospital establish compliance standards? -
answerCode of Conduct
What is the purpose of the OIG work plan? - answerCommunicate 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? - answerDiagnostic services and related charges provided on
Wednesday, Thursday and Friday before admission.
What does a modifier allow a provider to do? - answerReport 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? - answerThey 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? - answerIt 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? - answerOne registration record is created for
multiple days of service.
What are nonemergency patients who come for service without prior notification to the
provider called? - answerUnscheduled Patients
Which of the following statements apply to the observation patient type? - answerIt is
used to evaluate the need for an inpatient admission.
, Which services are hospice programs required to provide on an around-the-clock basis?
- answerPhysician, nursing and pharmacy
What is the purpose of the initial step in the outpatient testing scheduling process? -
answerIdentify 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? - answerComplete
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? - answerProcedure 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? -
answerDocumentation of the medical necessity of the test.
What is an advantage of a preregistration program? - answerIt reduces processing
times at the time of service
What data are required to establish a new MPI (master patient index) entry? -
answerThe patients full legal name, date of birth and sex
Which HIPAA transition set provides electronic processing of insurance verification
requests and responses? - answerThe 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? - answerThe Mothers Plan
What is a co-payment? - answerThe 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? - answer$3000 - $2300 = $700
What type of plan allows the subscriber to pay lower premium costs in return for a
higher deductible? - answerConsumer Directed Health Plan
What is a characteristic of a managed care contracting methodology? -
answerProspectively set rates for inpatient and outpatient services.
