CRCR STUDY QUESTIONS AND ANSWERS 100% PASS

CRCR STUDY QUESTIONS AND ANSWERS 100% PASS code of conduct - ANSWER -hospital establish compliance standards Purpose of OIG work plan? - ANSWER -communicate 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? - ANSWER - Dx services and related charges provided on the W,R, and F before adm. What does modifier allow a provider to do? - ANSWER -Report 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 - ANSWER -combined with the in pt. bill and paid under the MS-DRG system Why is OIG pursuing the medicare Secondary Payer - ANSWER -reviews 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? - ANSWER -one reg. record is created for multi days of service Nonemergency pt. who comes for service w/out prior notif. to the provider called? - ANSWER - unscheduled pt. stmnts apply to observ. pt. type - ANSWER -used to evaluate the need for an in pt. adm. 2 | P a g e Created by Grace Amelia © 2025, All Rights Reserved. which services are hospice programs required to provide on an around the clock basis - ANSWER - physician, nursing, pharmacy purpose of initial step in put pt. testing scheduling process - ANSWER -identifying 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? - ANSWER -complete 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? - ANSWER -documentation of the medical necessity for the test advantage of pre reg. program? - ANSWER -reduces processing times at the time of serivce what data are required to est. a new MPI entry? - ANSWER -pts. name, DOB, sex Which HIPAA trans. set provides electronic processing of ins, verif requests and responses? - ANSWER -the 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 - ANSWER - mothers true about third party payers? - ANSWER -payments received by the provider from the payer respon. for reimbursing the provider for the pts. covered services co-payment? - ANSWER -fixed 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 - ANSWER -700 3 | P a g e Created by Grace Amelia © 2025, All Rights Reserved. type of plan that allows the subscriber to pay lower premium costs in return for a higher deductible? - ANSWER -consumer directed health plan characteristic of a managed care contracted methodology - ANSWER -prospectively set rates for in pt. and out pt. services which provision protects the pt. from medical expenses that exceed a pre set level - ANSWER -stop 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? - ANSWER -referral activities are completed when a scheduled, pre reg pt. arrives for service? - ANSWER -activating 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 - ANSWER -medical screening and stabilizing treatment collecting pt liability dollars after service leads to what - ANSWER -increased efforts by pt acct staff to resolve these balanaces