CRCR Certification Exam

CRCR Certification
m m




Exam 2023 m


Overallmaggregatempaymentsmmademtomamhospicemaremsubjectmtomamcomputedm"capmamo
unt"mcalculatedmbym-mANS-
ThemMedicaremAdministrativemContractorm(MAC)matmthemendmofmthemhospicemcapmperiod

WhichmofmthemfollowingmismrequiredmformparticipationminmMedicaidm-mANS-
MeetmIncomemandmAssetsmRequirements

Inmchoosingmamsettingmformpatientmfinancialmdiscussions,morganizationsmshouldmfirstmandmf
oremostm-mANS-Respectmthempatientsmprivacy

Amnightlymroommchargemwillmbemincorrectmifmthempatient'sm-mANS-
TransfermfrommICUm(intensivemcaremunit)mtomthemMedical/Surgical
floormismnotmreflectedminmthemregistrationmsystem

ThemAffordablemCaremActmlegislatedmthemdevelopmentmofmHealthmInsurancemExchange
s,mwheremindividualsmandmsmallmbusinessesmcanm-mANS-
Purchasemqualifiedmhealthmbenefitmplansmregardlessmofminsured's
healthmstatus

AmportionmofmthemaccountsmreceivableminventorymwhichmhasmNOTmqualifiedmformbillingmincl
udes:m-mANS-Charitablempledges

WhatmismrequiredmformthemUB-04/837-
I,musedmbymRuralmHealthmClinicsmtomgeneratempaymentmfrommMedicare?m-mANS-
Revenuemcodes

Thismdirectivemwasmdevelopedmtompromotemandmensuremhealthcaremqualitymandmvaluemandm
alsomtomprotectmconsumersmandmworkersminmthemhealthcaremsystem.mThismdirectivemismcalled
-mANS-Patientmbillmofmrights

Themactivitymwhichmresultsminmthemaccuratemrecordingmofmpatientmbedmandmlevelmofmcarema
ssessment,mpatientmtransfermandmpatientmdischargemstatusmonmamreal-
timembasismismknownmasm-mANS-Casemmanagement

WhichmstatementmismanmEMTALAm(EmergencymMedicalmTreatmentmandmActivemLabormAc
t)mviolation?m-mANS-
Registrationmstaffmmaymroutinelymcontactmmanagedmaremplansmformpriormauthorizationsmb
eforemthempatientmismseenmbymthemon-dutymphysician

HIPAAmhadmadoptedmEmployermIdentificationmNumbersm(EIN)mtombemusedminmstandardmtra
nsactionsmtomidentifymthememployermofmanmindividualmdescribedminmamtransactionmEIN'smarem
assignedmbym-mANS-ThemInternalmRevenuemService

,Checksmreceivedmthroughmmail,mcashmreceivedmthroughmmail,mandmlockmboxmaremallmexam
plesmofm-mANS-Controlmpointsmformcashmposting

Whatmaremsomemcoremelementsmifmamboard-approvedmfinancialmassistancempolicy?m-
mANS-m
Eligibility,mapplicationmprocess,mandmnonpaymentmcollectionmactivities

Amrecurring/seriesmregistrationmismcharacterizedmbym-mANS-
Themcreationmofmonemregistrationmrecordmformmultiplemdaysmofmservice

WithmthemadventmofmthemAffordablemCaremActmHealthmInsurancemMarketplacesmandmthem
expansionmofmMedicaidminmsomemstates,mitmismmoremimportantmthanmevermformhospitalsmt
om-mANS-
Assistmpatientsminmunderstandingmtheirminsurancemcoveragemandmtheirmfinancialmobligat
ion

Thempurposemofmamfinancialmreportmismto:m-mANS-
Presentmfinancialminformationmtomdecisionmmakers

Patientmfinancialmcommunicationsmbestmpracticesmproducemcommunicationsmthatmare
m-m
ANS-Consistent,mclearmandmtransparent

MedicaremhasmestablishedmguidelinesmcalledmthemLocalmCoveragemDeterminationsm(LC
D)mandmNationalmCoveragemDeterminationsm(NCD)mthatmestablishm-mANS-
WhatmservicesmormhealthcaremitemsmaremcoveredmundermMedicare

Anymprovidermthatmhasmfiledmamtimelymcostmreportmmaymappealmanmadversemfinalmdecision
mreceivedmfrommthemMedicaremAdministrativemContractorm(MAC).mThismappealmmaymbemfil

edmwithm-mANS-ThemProvidermReimbursementmReviewmBoard

Concurrentmreviewmandmdischargemplanningm-mANS-Occursmduringmservice

Duplicatempaymentsmoccur:m-mANS-Whenmprovidersmre-
billmclaimsmbasedmonmnonpaymentmfrommtheminitialmbillmsubmission

AnmindividualmenrolledminmMedicaremwhomismdissatisfiedmwithmthemgovernment'smclaimmdet
erminationmismentitledmtomreconsiderationmofmthemdecision.mThismtypemofmappealmismknownma
sm-mANS-Ambeneficiarymappeal

Insurancemverificationmresultsminmwhichmofmthemfollowingm-mANS-
Themaccuratemidentificationmofmthempatient'smeligibilitymandmbenefits

ThemMedicaremfee-
formservicemappealmprocessmformbothmbeneficiariesmandmprovidersmincludesmallmofmthemfoll
owingmlevelsmEXCEPT:m-mANS-Judicialmreviewmbymamfederalmdistrictmcourt

, UndermEMTALAm(EmergencymMedicalmTreatmentmandmLabormAct)mregulations,mthempr
ovidermaymnotmaskmaboutmampatient'sminsuranceminformationmifmitmwouldmdelaymwhat?m-
ANS-Medicalmscreeningmandmstabilizingmtreatment
m




Ambulancemservicesmarembilledmdirectlymtomthemhealthmplanmform-mANS-
Servicesmprovidedmbeforemampatientmismadmittedmandmformambulancemridesmarrangedmto
mpickmupmthempatientmfrommthemhospitalmaftermdischargemtomtakemhim/hermhomemormtoman

othermfacility

Keymperformancemindicatorsm(KPIs)msetmstandardsmformaccountsmreceivablesm(A/R)man
dm-mANS-ProvidemammethodmofmmeasuringmthemcollectionmandmcontrolmofmA/R

hempatientmdischargemprocessmbeginsmwhenm-mANS-
Themphysicianmwritesmthemdischargemorders

Themnightlymroommchargemwillmbemincorrectmifmthempatient'sm-mANS-
TransfermfrommICUmtomthemMedical/Surgicalmfloormismnotmreflectedminmthemregistrationmsyst
em.

Themsoftmcostmofmamdissatisfiedmcustomermism-mANS-
Themcustomermpassingmonminfomaboutmtheirmnegativemexperiencemtompotentialmptsmormthr
oughmsocialmmediamchannels

Anmadvantagemofmampre-registrationmprogrammism-mANS-
Themopportunitymtomreducemthemcorporatemcompliancemfailuresmwithinmthemregistration
mprocess




Itmismimportantmtomhavemhighmregistrationmqualitymstandardsmbecausem-mANS-
Inaccuratemormincompletempatientmdatamwillmdelaympaymentmormcausemdenials

Telemedmseeksmtomimprovemampatient'smhealthmbym-mANS-Permittingm2-
waymrealmtimeminteractivemcommunicationmbetweenmthempatientmandmthemclinicalmpr
ofessional

Anymhealthcareminsurancemplanmthatmprovidesmormensuresmcomprehensivemhealthmmaint
enancemandmtreatmentmservicesmformanmenrolledmgroupmofmpersonsmbasedmonmammonthlym
feemismknownmasmam -mANS-HMO

Identifyingmthempatient,minmthemMPI,mcreatingmthemregistrationmrecord,mcompletingmmedical
mnecessitymscreening,mdeterminingminsurancemeligibilitymandmbenefitsmresolvingmmanaged

mcare,mrequirementsmandm completingmfinancialmeducation/resolutionmaremallm-mANS-

Themdatamcollectionmstepsmformschedulingmandmpre-registeringmampatient

MedicaremPartmBmhasmanmannualmdeductible,mandmthembeneficiarymismresponsiblemform-
mANS-m
Amco-insurancempaymentmformallmPartmBmcoveredmservices

Themstandardmclaimmformmusedmformbillingmbymhospitals,mnursingmfacilities,mandmotherminpa
tientm-mANS-UB-04

Chargesmaremthembasismform-mANS-
Separationmofmfiscalmresponsibilitiesmbetweenmthempatientmandmthemhealthmplan