CRCR EXAM MULTIPLE CHOICE CRCR
Exam Prep Certified Revenue Cycle
Representative CRCR 2021)
What are collection agency fees based on? - answersA percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? - answersBirthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - answersCase rates
What customer service improvements might improve the patient accounts department?
- answersHolding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
answersInform a Medicare beneficiary that Medicare may not pay for the order or
service
What type of account adjustment results from the patient's unwillingness to pay for a
self-pay balance? - answersBad debt adjustment
What is the initial hospice benefit? - answersTwo 90-day periods and an unlimited
number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -
answersIf the patient requires ambulance transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account is billed? -
answersPost a late-charge adjustment to the account
,an increase in the dollars aged greater than 90 days from date of service indicate what
about accounts - answersThey are not being processed in a timely manner
What is an advantage of a preregistration program? - answersIt reduces processing
times at the time of service
What are the two statutory exclusions from hospice coverage? - answersMedically
unnecessary services and custodial care
What core financial activities are resolved within patient access? - answersScheduling,
insurance verification, discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - answersThe services do not
involve an overnight stay
How is a mis-posted contractual allowance resolved? - answersComparing the contract
reimbursement rates with the contract on the admittance advice to identify the correct
amount
What type of patient status is used to evaluate the patient's need for inpatient care? -
answersObservation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - answersMedically necessary inpatient hospital
services for at least 3 consecutive days before the skilled nursing care admission
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? -
answersWhen the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - answersUnscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what
is the status of the subscriber's spouse? - answersNeither enrolled not entitled to
benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - answersDisclosure rules for consumer credit sales and
consumer loans
What is a principal diagnosis? - answersPrimary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - answersLower accounts
receivable levels
,What is the daily out-of-pocket amount for each lifetime reserve day used? -
answers50% of the current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not
billable as an RHC services? - answersInpatient care
What code indicates the disposition of the patient at the conclusion of service? -
answersPatient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - answersThey
result in lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient and the
third party payer, who is responsible for payment? - answersPatient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - answersA valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - answersAccess their information and perform
functions on-line
What date is required on all CMS 1500 claim forms? - answersonset date of current
illness
What does scheduling allow provider staff to do - answersReview appropriateness of
the service request
What code is used to report the provider's most common semiprivate room rate? -
answersCondition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: - answers2012
What is a primary responsibility of the Recover Audit Contractor? - answersTo correctly
identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - answersComply with state statutes
concerning reporting credit balance
Insurance verification results in what? - answersThe accurate identification of the
patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - answersCMS 1500
, What activities are completed when a scheduled pre-registered patient arrives for
service? - answersRegistering the patient and directing the patient to the service area
In addition to being supported by information found in the patient's chart, a CMS 1500
claim must be coded using what? - answersHCPCS (Healthcare Common Procedure
Coding system)
What results from a denied claim? - answersThe provider incurs rework and appeal
costs
Why does the financial counselor need pricing for services? - answersTo calculate the
patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - answersHospital-
based mammography centers
How are disputes with nongovernmental payers resolved? - answersAppeal conditions
specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - answersRight to appeal a discharge decision if the patient disagrees
with the services
Why do managed care plans have agreements with hospitals, physicians, and other
healthcare providers to offer a range of services to plan members? - answersTo
improve access to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30
days, what is the SNF permitted to do? - answersSubmit interim bills to the Medicare
program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - answers120 days passes, but the claim then be withdrawn
from the liability carrier
What data are required to establish a new MPI entry? - answersThe patient's full legal
name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as primary? -
answersDetermine the correct payer and notify the incorrect payer of the processing
error
What do EMTALA regulations require on-call physicians to do? - answersPersonally
appear in the emergency department and attend to the patient within a reasonable time
Exam Prep Certified Revenue Cycle
Representative CRCR 2021)
What are collection agency fees based on? - answersA percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? - answersBirthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - answersCase rates
What customer service improvements might improve the patient accounts department?
- answersHolding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
answersInform a Medicare beneficiary that Medicare may not pay for the order or
service
What type of account adjustment results from the patient's unwillingness to pay for a
self-pay balance? - answersBad debt adjustment
What is the initial hospice benefit? - answersTwo 90-day periods and an unlimited
number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -
answersIf the patient requires ambulance transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account is billed? -
answersPost a late-charge adjustment to the account
,an increase in the dollars aged greater than 90 days from date of service indicate what
about accounts - answersThey are not being processed in a timely manner
What is an advantage of a preregistration program? - answersIt reduces processing
times at the time of service
What are the two statutory exclusions from hospice coverage? - answersMedically
unnecessary services and custodial care
What core financial activities are resolved within patient access? - answersScheduling,
insurance verification, discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - answersThe services do not
involve an overnight stay
How is a mis-posted contractual allowance resolved? - answersComparing the contract
reimbursement rates with the contract on the admittance advice to identify the correct
amount
What type of patient status is used to evaluate the patient's need for inpatient care? -
answersObservation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - answersMedically necessary inpatient hospital
services for at least 3 consecutive days before the skilled nursing care admission
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? -
answersWhen the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - answersUnscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what
is the status of the subscriber's spouse? - answersNeither enrolled not entitled to
benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - answersDisclosure rules for consumer credit sales and
consumer loans
What is a principal diagnosis? - answersPrimary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - answersLower accounts
receivable levels
,What is the daily out-of-pocket amount for each lifetime reserve day used? -
answers50% of the current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not
billable as an RHC services? - answersInpatient care
What code indicates the disposition of the patient at the conclusion of service? -
answersPatient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - answersThey
result in lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient and the
third party payer, who is responsible for payment? - answersPatient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - answersA valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - answersAccess their information and perform
functions on-line
What date is required on all CMS 1500 claim forms? - answersonset date of current
illness
What does scheduling allow provider staff to do - answersReview appropriateness of
the service request
What code is used to report the provider's most common semiprivate room rate? -
answersCondition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: - answers2012
What is a primary responsibility of the Recover Audit Contractor? - answersTo correctly
identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - answersComply with state statutes
concerning reporting credit balance
Insurance verification results in what? - answersThe accurate identification of the
patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - answersCMS 1500
, What activities are completed when a scheduled pre-registered patient arrives for
service? - answersRegistering the patient and directing the patient to the service area
In addition to being supported by information found in the patient's chart, a CMS 1500
claim must be coded using what? - answersHCPCS (Healthcare Common Procedure
Coding system)
What results from a denied claim? - answersThe provider incurs rework and appeal
costs
Why does the financial counselor need pricing for services? - answersTo calculate the
patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - answersHospital-
based mammography centers
How are disputes with nongovernmental payers resolved? - answersAppeal conditions
specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - answersRight to appeal a discharge decision if the patient disagrees
with the services
Why do managed care plans have agreements with hospitals, physicians, and other
healthcare providers to offer a range of services to plan members? - answersTo
improve access to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30
days, what is the SNF permitted to do? - answersSubmit interim bills to the Medicare
program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - answers120 days passes, but the claim then be withdrawn
from the liability carrier
What data are required to establish a new MPI entry? - answersThe patient's full legal
name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as primary? -
answersDetermine the correct payer and notify the incorrect payer of the processing
error
What do EMTALA regulations require on-call physicians to do? - answersPersonally
appear in the emergency department and attend to the patient within a reasonable time
