CRCR Certification Exam 2024 Questions and Answers (Verified Answers by Expert)

1 / 15 CRCR Certification Exam 2024 Questions and Answers (Verified Answers by Expert) 1. Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by The Medicare Administrative Contractor (MAC) atthe end of the hospice cap period 2. Which of the following is required for participation in Medicaid Meet In-come and Assets Requirements 3. In choosing a setting for patient financial discussions, organizations should first and foremost Respect the patients privacy 4. A nightly room charge will be incorrect if the patient's Trfer from ICU(intensive care unit) to the Medical/Surgical floor is not reflected in the registration system 5. The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can Purchase qualifiedhealth benefit pl regardless of insured's2 / 15 health status 6. A portion of the accounts receivable inventory which has NOT qualified for billing includes Charitable pledges 7. What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? Revenue codes 8. This directive was developed to promote and ensure healthcare quality and value and also to protect consumers and workers in the healthcare system.This directive is called Patient bill of rights 9. The activity which results in the accurate recording of patient bed and level of care assessment, patient trfer and patient discharge status on areal-time basis is known as Case management 10. Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? Registration staff may routinely contact managed arepl for prior authorizations before the patient is seen by the onduty physician3 / 15 11. HIPAA had adopted Employer Identification Numbers (EIN) to be used in standard tractions to identify the employer of an individual described ina traction EIN's are assigned by The Internal Revenue Service 12. Checks received through mail, cash received through mail, and lock box are all examples of Control points for cash posting 13. What are some core elements if a board-approved financial assistance policy? Eligibility, application process, and nonpayment collection activities4 / 15 14. A recurring/series registration is characterized by The creation of oneregistration record for multiple days of service 15. With the advent of the Affordable Care Act Health Insurance Marketplaces and the expion of Medicaid in some states, it is more important than everfor hospitals to Assist patients in understanding their insurance coverage and their financial obligation 16. The purpose of a financial report is to Present financial information todecision makers 17. Patient financial communications best practices produce communications that are Consistent, clear and trparent 18. Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish -What services or healthcare items are covered under Medicare 19. Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor (MAC). This appeal may be filed with The Provider Reimbursement Review5 / 15 Board 20. Concurrent review and discharge planning Occurs during service 21. Duplicate payments occur When providers re-bill claims based on nonpay-ment from the initial bill submission 22. An individual enrolled in Medicare who is dissatisfied with the government's claim determination is entitled to reconsideration of the decision.This type of appeal is known as A beneficiary appeal 23. Insurance verification results in which of the following The accurateidentification of the patient's eligibility and benefits 24. The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT Judicial review by afederal district court 25. Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the providermay not ask about a patient's insurance information if it would delay what? Medical screening and stabilizing treatment 26. Ambulance services are billed directly to the health plan for Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or to anotherfacility6 / 15 27. Key performance indicators (KPIs) set standards for accounts receivables (A/R) and Provide a method of measuring the collection and control of A/R 28. he patient discharge process begins when The physician writes the dis-charge orders 29. The nightly room charge will be incorrect if the patient's Trfer from ICUto the Medical/Surgical floor is not reflected in the registration system. 30. The soft cost of a dissatisfied customer is The customer passing on info about their negative experience to potential pts or through social media channels 31. An advantage of a pre-registration program is The opportunity to reducethe corporate compliance failures within the registration process 32. It is important to have high registration quality standards because Inac-curate or incomplete patient data will delay payment or cause denials 33. Telemed seeks to improve a patient's health by Permitting 2-way real timeinteractive communication between the patient and the clinical professional 34. Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a monthly fee is known as a HMO 35. Identifying the patient, in the MPI, creating the registration record, completing medical necessity screening, determining insurance eligibility and7 / 15 benefits resolving managed care, requirements and completing financial education/resolution are all The data collection steps for scheduling and pre-reg-istering a patient 36. Medicare Part B has an annual deductible, and the beneficiary is responsible for A co-insurance payment for all Part B covered services 37. The standard claim form used for billing by hospitals, nursing facilities, and other inpatient UB-04 38. Charges are the basis for Separation of fiscal responsibilities between thepatient and the health plan 39. All of the following are forms of hospital payment contracting EXCEPT - Contracted Rebating 40. The most common resolution methods for credit balances include all of the following EXCEPT Designate the overpayment for charity care 41. Ambulance services are billed directly to the health plan for The portionof the bill outside of the patient's self-pay8 / 15 42. A claim for reimbursement submitted to a third-party payer that has all the information and documentation required for the payer to make a decision on it is known as A clean claim 43. The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to Medicareand Medicaid payments 44. The Correct Coding Initiative Program consists of Edits that are imple-mented within providers' claim processing systems 45. To provide a patient with information that is meaningful to them, all of the following factors must be included EXCEPT The actual physician reimburse-ment 46. Which department supports/collaborates with the revenue cycle? Infor-mation Technology 47. Medicare Part B has an annual deductible and the beneficiary is responsible for a co-insurance payment for all Part B covered services 48. The two types of claims denial appeals are Beneficiary and Provider 49. Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) Registration staff members routinely contact man- aged care pl for prior authorizations before the patient is seen by the on duty physician 50. Rural Health Clinics (RHC) personnel can provide services in all of the following locations, EXCEPT Providing inpatient services in the RHC9 / 15 51. The patient discharge process begins when The physician writes the dis-charge order 52. Departments that need to be included in charge master maintenance include all of the following EXCEPT Quality Assurance 53. The first thing a health plan does when processing a claim is Check if thepatient is a health plan beneficiary and what is the coverage 54. Vital to accurate calculations of a patient's self-pay amount is 55. The most accurate way to validate patient information is to require clinicalstaff to verify information at each treatment encounter 56. In order for Regulation Z to apply, a hospital must 57. All of the following are minimum requirements for new patients with no MPI number EXCEPT Address10 / 15 58. A typical routine patient financial discussion would include Explainingthe benefits identified through verifying the patients insurance 59. Components of financial education include informing the patient of the hospital's financial policies, assessing the patient's ability to pay and Re-viewing payment alternatives with the patient so appropriate resolution of the health care financial obligation is achieved 60. HFMA best practices indicate that the technology evaluation is conducted to Continually align technology with processes rather than technology dictatingprocesses 61. Scheduler instructions are used to prompt the scheduler to Complete thescheduling process correctly based on service requested 62. When billing Rural Health Clinic services on a UB-04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521). Although codes are collapsed into a single revenue code, it is still important to list the appropriate CPT codes as part These codes will be used to determine medicalnecessity and useful in determining what happened during the encounter 63. What is likely to occur if credit balances are not identified separately from debit balances in accounts receivable? The accounts receivable level would beunderstated 64. The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as insurance verification and reimbursable charges 65. Unless the patient encounter is an emergency, it is more efficient and11 / 15 effective to Collect all information after the patient has been discharged 66. Applying the contracted payment amount to the amount of total charges yields A pricing agreement 67. "Hard-coded" is the term used to refer to Codes for services, procedures,and drugs automatically assigned by the charge master 68. The advantages to using a third-party collection agency include all of the following EXCEPT Providers pay pennies on each dollar collected 69. Which of the following is usually covered on a Conditions of Admission form Release of information 70. The 501(r) regulations require not-for-profit providers (501(c)(3) organizations) to do which of the following activities. Complete a community needs12 / 15 assessment and develop a discount program for patient balances after insurance payment 71. To be eligible for Medicaid, an individual must meet income and assetrequirements 72. Eliminating mail time and reducing data entry time, electronically monitoring the receipt of claims and online claim adjudication, more prompt payment are all benefits achieved by The electronic submission of claims usingelectronic trfers 73. There are unique billing requirements based on The provider type 74. The unscheduled "direct" admission represents a patient who Is admit-ted from a physician's office on an urgent basis 75. In resolving medical accounts, a law firm may be used as A substitute fora collection agency 76. The legal authority to request and analyze provider claim documentation to ensure that The Office of the U.S. Inspector General (OIG) 77. The office of inspector general (OIG) publishes a compliance work plan- Annually 78. Room and bed charges are typically posted From the midnight census 79. All of the following information should be reviewed as part of schedule finalization EXCEPT The results of any and all test 80. Revenue cycle activities occurring at the point-of-service include all of the following EXCEPT Providing charges to the third-party payer as they13 / 15 areincurred 81. HFMA's patient financial communications best practices specify that pts should be told about the The service providers that typically participate in the service, e.g. radiologists ,pathologists, etc. 82. The core financial activities resolved within patient access include - Scheduling, pre-registration, insurance verification and managed care processing 83. A decision on whether a patient should be admitted as an inpatient or become about patient observation patient requires medical judgments based on all of the following EXCEPT The patient's home care coverage 84. Which option is a benefit of pre-registering a patient for services Thepatient arrival process is expedited, reducing wait times and delays14 / 15 85. Days in A/R is calculated based on the value of The total accounts receiv-able on a specific date 86. Case Management requires that a case manager be assigned To a selectpatient group 87. Which of the following is required for participation in Medicaid? Meetincome and assets requirements 88. All of the following are steps in safeguarding collections EXCEPT Issuingreceipts 89. The Electronic Remittance Advice (ERA) data set is A standardized formthat provides third party payment details to providers 90. All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT Services and procedures that are custodial in nature 91. Medicare beneficiaries remain in the same "benefit period" Until the ben-eficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days 92. It is important to calculate reserves to ensure Stable financial operationsand accurate financial reporting 93. A claim is denied for the following reasons, EXCEPT The submitted claimdoes not have the physici signature 94. HFMA best practices call for patient financial discussions to be reinforced By changing policies to programs15 / 15 95. Patients should be informed that costs presented in a price estimate may Vary from estimates, depending on the actual services performed 96. The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physici to do all of the following EXCEPT Obtainhigher compensation for physici 97. Charges as the most appropriate measurement of utilization enables Ac-curacy of expense and cost capture 98. Once the EMTALA requirements are satisfied The remaining registrationprocessing is initiated at the bedside or in a registration area 99. Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite discharge, the HFMA best practice16 / 15 is to Support that choice, providing that the discussion does not interfere withpatient care or disrupt patient flow 100. In Chapter 7 straight bankruptcy filling The court liquidates the debtor'snonexempt property, pays creditors, and discharges the debtor from the debt 101. Chapter 13 Bankruptcy, debtor rehabilitation is a court proceeding Thatreorganizes a debtor's holdings and instructs creditors to look to the debtors' futureearnings for payment 102. This concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits Claims processing 103. The importance of Medical records being maintained by HIM is that the patient records Are the primary source for clinical data required for reimburse-ment 104. When there is a request for service, the scheduling staff member must confirm the patient's unique identification information to Ensure that she/heaccesses the correct information in the historical database 105. Maintaining routine contact with the health plan or liability payer, making sure all required information is provided and all needed approvals are obtained is the responsibility of Case Management 106. Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and Provide a method of measuring the collection and control of A/R17 / 15 107. With any remaining open balances, after insurance payments have been posted, the account financial liability is Potentially trferred to the patient 108. Pricing trparency is defined as readily available information on the price of healthcare services, that together with other information, help definethe value of those services and enable consumers to Identify, compare, andchoose providers that offer the desired level of value 109. All of the following are potential causes of credit balances EXCEPT Apatient's choice to build up a credit against future medical bills 110. A comprehensive "Compliance Program" is defined as Systematic pro-cedures to ensure that the provisions of regulations imposed by a government agency are being met 111. An originating site is The location of the patient at the time the service isprovided18 / 15 112. Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare established guideline(s) used to determine - Which diagnoses, signs, or symptoms are reimbursable 113. If further treatment can only be provided in a hospital setting, the patient's condition cannot be evaluated and/or treated within 24 hours, or if there is not an anticipation of improvement in the patient's condition with 24 hours, the patient Will be admitted as an inpatient 114. The benefit of Medicare Advantage Plan is Patients generally have theirMedicare-coverage healthcare through the plan and do not need to worry about"part a" or "part b" benefits 115. The process of creating the pre-registration record ensures Accuratebilling 116. Claims with dates of service received later than one calendar year beyond the date of service, will be Denied by Medicare 117. A portion of the accounts receivable inventory which has NOT qualified for billing includes Charitable pledges 118. The standard claim form used for billing by hospitals, nursing facilities, and other in-patient UB-04 119. Once the price is estimated in the pre-service stage, a provider's financial best practice is to Explain to the patient their financial responsibility and todetermine the plan for payment 120. Internal controls addressing coding and reimbursement changes are19 / 15 put in place to guard against Compliance fraud by upcoding 121. Health Plan Contracting Departments do all of the following EXCEPT - Establish a global reimbursement rate to use with all third-party payer 122. For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions Should take place between thepatient or guarantor and properly trained provider representatives 123. What type of account adjustment results from the patient's unwillingness to pay a self-pay balance? Bad debt adjustment 124. Most major health pl including Medicare and Medicaid, offer Elec-tronic and/or web portal verification 125. The important Message from Medicare provides beneficiaries information concerning their Right to appeal a discharge decision if the patient dis- agrees with the plan20 / 15 126. 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? Medical screening and stabilizing treatment 127. Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implement Monitor compliance 128. Medicare will only pay for tests and services that Medicare determinesare "reasonable and necessary" 129. The physician who wrote the order for an inpatient service and is in charge of the patients The attending physician 130. When primary payment is received, the actual reimbursement Is com- pared to the expected reimbursement, the remaining contractual adjustments areposted, and secondary claims are submitted 131. The ICD-10 codes set and CPT/HCPCS code sets combines provide Thespecificity and coding needed to support reimbursement claims 132. In a self-insured (or self-funded) plan, the costs of medical care are - Borne by the employer on a pay-as-you-go basis 133. Indemnity pl usually reimburse A certain percentage of the chargesafter the patient meets the policy's annual deductible 134. The first and most critical step in registering a patient, whether scheduled or unscheduled, is Verifying the patient's identification21 / 15 135. When Recovery Audit Contractors (RAC) identify improper payments as over payments, the Send a demand letter to the provider to recover the over payment amount 136. Across all care settings, if a patient consents to a financial discussion during a medical encounter Support that choice, providing that the discussiondoes not interfere with patient care or disrupt patient flow 137. Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by Each state's Medicaid plan 138. Medicare patients are NOT required to produce a physician order to receive which of these services Screening Mammography, flu vaccine or pneu-monia vaccine 139. EFT (electronic funds trfer) is An electronic trfer of funds from payerto payee22 / 15 140. The importance of medical records being maintained by HIM is that the patient records Are the primary source for clinical data required for reimburse- ment by health pl and liability payers 141. Days in A/R is calculated based on the value of The time it takes to collectanticipated revenue 142. To maximize the value derived from customer complaints, all consumer complaints should be Responded to within two business days 143. A scheduled inpatient represents an opportunity for the provider to do which of the following? Complete registration and insurance approval before service 144. In the pre-service stage, the requested service is screened for medical necessity, health Pre-authorization are obtained 145. Hospitals need which of the following information sets to assess a patient's financial status Patient and guarantor's income, expenses and assets 146. Patients are contacting hospitals to proactively inquire about costs and fees prior to The fact that charge master lists the total charge, not net charges that reflect charges after a payer's contractual adjustment 147. HIPAA had adopted Employer Identification Numbers (EIN) to be used in standard tractions to identify the employer of an individual describedin a traction EIN's are assigned by The Internal Revenue Service23 / 15 148. The HCAHPS (hospital consumer assessment of healthcare providers and systems) initiative Provide a standardized method for evaluating patient'sperspective on hospital care. 149. A large number of credit balances are not the result of overpayments but of Posting errors in the patient accounting system 150. A Medicare Part A benefit period begins With admission as an inpatient 151. Chapter 13 Bankruptcy, debtor rehabilitation, is a court proceeding Thatreorganizes a debtor's holdings and instructs creditors to look to the debtor's futureearnings for payment 152. Which of the following in NOT included in the Standardized Quality Measures Cost of services 153. The disadvantages of outsourcing include all of the following EXCEPT - Reduced internal staffing costs and a reliance on outsourced staff24 / 15 154. Improving the overall patient experience requires revenue cycle leadership and staff to simultaneously be Clear on policies and consistent in applyingthe policies 155. Because 501(r) regulations focus on identifying potential eligible financial assistants patients hospitals must Hold financial conversations withpatients as soon as possible 156. Which of the following is NOT contained in a collection agency agreement? A mutual hold-harmless clause 157. HFMA best practices stipulate that a reasonable attempt should be made to have the financial As early as possible, before a financial obligationis incurred 158. Recognizing that health coverage is complicated and not all pts are able to navigate this terrain, HFMA best practices specify that Patients should be given the opportunity to request a patient advocate, family member or other designee to help them In these discussions 159. For scheduled patients, important revenue cycle activities In theTime of Service stage DO NOT INCLUDE Final bill is presented for payment 160. HFMA's patient financial communication best practices specify that patients should be told about the types of services provided and The serviceproviders that typically participate in the service, e.g., radiologists, pathologists, etc. 161. Successful account resolution begins with Collecting all25 / 15 deductibles andcopayments during the pre-service stage 162. Recognizing that health coverage is complicated and not all patients are able to navigate this terrain, HFMA best practices specify that Patientsshould be given the opportunity to request a patient advocate, family member, orother designee to help them in these discussions 163. In the balance resolution process, providers should Ask the patient if he or she would like to receive information about payment options and supportivefinancial assistance programs 164. Business ethics, or organizational ethics represent The principles andstandards by which organizations operate 165. Which option is a government-sponsored health care program that is financed through taxes and general revenue funds Medicare26 / 15 166. Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on; a monthly fee is known as a HMO 167. In a Chapter 7 Straight Bankruptcy filing The court liquidates the debtor'snonexempt property, pays creditors, and discharges the debtor from the debt 168. When there is a request for service the scheduling staff member must confirm the patient's Ensure that she/he accesses the correct information in thehistorical database 169. A four digit number code established by the National Uniform Billing Committee (NUBC)that categorizes/classifies a line item in the charge master is known as Revenue codes 170. Appropriate training for patient financial counseling staff must cover all of the following EXCEPT Documenting the conversation in the medical records 171. The ACO investment model will test the use of pre-paid shared savings to Encourage new ACOs to form in rural and underserved areas 172. When recovery audit contractors (RAC) identify improper payments as over payments the claims processing contractor must Send a demand letterto the provider to recover the over payment amount 173. The purpose of the ACA mandated Community Health Needs Assessment is To identify significant health needs, prioritize those needs and identifyresources to address them27 / 15 174. A balance sheet is A statement of assets, liabilities, and capital for anorganization at a specified point in time 175. Hospitals can only convert an inpatient case to observation if the hospital utilization review committee determines this status before the patient is discharged and Prior to billing, that an observation setting will be more appropriate 176. During pre-registration, a search for the patients MPI number is initiated using which of the following data sets? Patient's full legal name and date of birth or the patient's Social Security number 177. Because case managers document the clinical reasons for treatment, they are A good resource when developing written appeals of denials 178. TheTruth in Lending Act establishes Disclosure rules for consumer creditsales and consumer lo28 / 15 179. What is Continuum of Care? The coordination and linkage of resourcesneeded to avoid the duplication of services and the facilitation of a seamless movement among care settings 180. HIPAA privacy rules require covered entities to take all of the following actions EXCEPT Use only designated software platforms to secure patient data 181. TheTwo Midnight Rule allows hospitals to account for total hospital time when determining if an inpatient admission order should be written based on A beneficiary needing a minimum of 48 hours of care 182. Since passage of the Affordable Care Act Health Insurance Marketplaces and the expion of Medicaid in some states, it is more important than ever for hospitals to Assist patients in understanding their insurance cov-erage and their financial obligation 183. HFMA patient financial communications best practices call for annual training for all staff EXCEPT Nursing 184. The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as Insurance verification of reim-bursable charges 185. Net Accounts Receivable is The amount an entity is reasonably confidentof collecting from overall accounts receivable. 186. ED patients should be informed that their ability to pay Will not interferewith treatment of any emergency medical conditions29 / 15 187. Providers are advised that it is best to establish patient financial responsibility and assistance policies and make sure they are followed internally and by Business affiliates 188. Incorrect data gathering can cause all of the following EXCEPT Theinability to discuss quality with physici 189. All Hospitals are required to establish a written financial assistance policy that applies to All emergency and medically necessary care 190. All of the following are reference resources used to help guide in the application of business ethics EXCEPT Consumer satisfaction reports 191. Each patient is assigned a unique number, commonly called the MasterPatient Index (MPI) number 192. HIPAA contains all of the following goals EXCEPT To ensure propercoding across the continuum of care30 / 15 193. Which of the following is NOT included in the Standardized Quality Measures? 194. Account Receivable (A/R) Aging reports Divide accounts receivable into30, 60, 90 ,120 days past due categories 195. Patients expect value for their healthcare dollar, including greater tr-parency of Quality and price information 196. The impact of denials on the revenue cycle includes all of the following EXCEPT Patient outcomes 197. Examples of ethics violations that impact the revenue cycle include all of the following EXCEPT Seeking payment options for patient self-pay 198. Scheduled procedures routinely include Patient preparation instructions 199. ICD-10-CM and ICD-10-PCS codes sets are modifications of The Inter-national ICD-10 codes as developed by the WHO (World Health Organization) 200. The result of accurate census balancing on a daily basis is The correctrecording of room charges 201. All of the following are steps in verifying insurance EXCEPT The patientsigning the statement of financial responsibility 202. Health Information Management (HIM) is responsible for All patient med-ical records 203. This form contains major items, subdivided into a total of 55 detailed31 / 15 items, and is used by professional service providers and not hospitals for submitting claims for services to health pl this form is called The 1500 204. Which of the following is NOT a factor in self-pay follow-up? The type ofpatient (inpatient, out-patient) 205. The Office of Inspector General (OIG) was created Detect and preventfraud, waste, and abuse