CRCR Study Guide Review
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
Which of the following statements describes the goal of financial counseling services? -
ANS-To help the patient understand insurance coverage, including what the patient will
owe for the current services
The hospital has an APC (ambulatory payment classification)-based contract for the
payment of outpatient services. Total anticipated charges for the visit are $2.380. The
approved APC payment rate is $780. Where will the patient's benefit package be
applied? - ANS-To the approved APC payment rate
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
Which of the following statements describes the goal of financial counseling services? -
ANS-To help the patient understand insurance coverage, including what the patient will
owe for the current services
The hospital has an APC (ambulatory payment classification)-based contract for the
payment of outpatient services. Total anticipated charges for the visit are $2.380. The
approved APC payment rate is $780. Where will the patient's benefit package be
applied? - ANS-To the approved APC payment rate
