CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representativ
g g g g g g g g
(2023) - Materials from HFMA g g g g
Studygonlinegatghttps://quizlet.com/_dowhqe
1. In what situation(s) should a provider NOT use a modifier?: -
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CPT already indicates 2-4 lesions
g g g g g
- CPT indicates multiple extremities
g g g
2. What are other names for Three-Day Payment Window?: ALL OF THE ABOVE
g g g g g g g g g g g
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
g g g g g g g g g g g
3. What happens during the post-
g g g g
service stage?: Final coding, preparation and submission of claims, payment proce
g g g g g g g g g g
ssing, balance billing and resolution.
g g g g
4. What are the below tasks part of?
g g g g g g
- Educate patients g
- Coordinate to avoid duplicate patient contacts g g g g g
- Be consistent in key aspects of account resolution
g g g g g g g
- Follow best practices for communication: Best practices created by the Medical D
g g g g g g g g g g g
ebt Task Force
g g
5. Which option is NOT a main HFMA Healthcare Dollars & Sense revenue c
g g g g g g g g g g g g
ycle initiative?: Process Compliance
g g g
6. Which option is NOT a continuum of care provider?
g g g g g g g g
A. Physician
B. Health Plan Contracting g g
C. Hospice
D. Skilled Nursing Facility: B. Health Plan Contracting
g g g g g g
7. What is "implied certification"?: When it is implied that a provider met all co
g g g g g g g g g g g g g
mpliance standards before submitting a claim
g g g g g
8. Which of the following are essential elements of an effective compliance p
g g g g g g g g g g g
rogram?
A. Established compliance standards and procedures. g g g g
B. Designation of a compliance officer employed within the Billing Depart- g g g g g g g g g
gment.
C. Oversight of personnel by high-level personnel. g g g g g
D. Automatic dismissal of any employee excluded from participation in a f
g g g g g g g g g g
ederal healthcare program.
g g
E. Reasonable methods to achieve compliance with standards, including g g g g g g g g
monitoring systems and hotlines.: A. Established compliance standards and p
g g g g g g g g g
rocedures.
C. Oversight of personnel by high-level personnel.
g g g g g g
1g/g52
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representativ
g g g g g g g g
(2023) - Materials from HFMA g g g g
Studygonlinegatghttps://quizlet.com/_dowhqe
E. Reasonable methods to achieve compliance with standards, including monitoring sy
g g g g g g g g g g
tems and hotlines. g g
9. When was Health Information Technology for Economic and Clinical Health (
g g g g g g g g g g
HITECH) Act signed into law?: FEB 17, 2009 g g g g g g g
10. When did HITECH Act become effective?: 2013 g g g g g g
11. Annually, the OIG publishes a work plan of compliance issues and ob- g g g g g g g g g g g
gjectives that will be focused on throughout the following year. Identify which o
g g g g g g g g g g g g
ption is NOT a work plan task mentioned in this course.
g g g g g g g g g g
A. Payments to Physicians for Co-Surgery Procedures g g g g g
B. Denials and Appeals in Medicare Part D g g g g g g
C. Medicare Hospital Payments for Claims Involving the Acute- g g g g g g g
and Post-Acute-Care Transfer Policies
g g g g
D. Standard Unique Employer Identifier: D. Standard Unique Employer Identifier
g g g g g g g g
12. What Plan are the tasks below a part of? g g g g g g g g
- Medicare Payments Made Outside of the Hospice Benefit g g g g g g g
- Denials and Appeals in Medicare Part C and Part D g g g g g g g g g
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
g g g g g g g g g
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits: The 2
g g g g g g g g g g g g g g
020 OIG Work Plan
g g g
13. When was the Preservation of Access to Care for Medicare Beneficiaries a
g g g g g g g g g g g
nd Pension Relief Act signed into law?: JUNE 25 2010
g g g g g g g g g
14. What is the Medicare DRG Three- g g g g g
Day Payment Window?: All Diagnostic services provided to a Medicare patient by a
g g g g g g g g g g g g
hospital on the Date of the patient's Inpatient admission or during the 3 calendar days (
g g g g g g g g g g g g g g g
or in the case of a non-IPPS hos-
g g g g g g g
gpital: 1 calendar day) immediately BEFORE the Date of Admission are REQUIRED to
g g g g g g g g g g g g
gbe included on the bill for the IP stay (unless there is no Part A coverage)
g g g g g g g g g g g g g g g
15. Do Outpatient Non- g g
Diagnostic Services qualify for separate payments if provided with the Three
g g g g g g g g g g
-Day Payment Window?: Nog g g
16. What is modifier 59?: Used to identify CPTs OTHER THAN E&M services, NOT no
g g g g g g g g g g g g g
rmally reported together, but are appropriate under the circumstances.
g g g g g g g g
Documentation must support a different session, different procedure or surgery, differ g g g g g g g g g g
nt site or organ system, separate.
g g g g g
17. What is condition code 51?: Code noted on the separate UB-
g g g g g g g g g g
04 OP claim, thus indicating the charge is unrelated to the admission.
g g g g g g g g g g g
2g/g52
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representativ
g g g g g g g g
(2023) - Materials from HFMA
g g g g
Studygonlinegatghttps://quizlet.com/_dowhqe
18. What kind of hospitals are the following:
g g g g g g
3g/g52
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representativ
g g g g g g g g
(2023) - Materials from HFMA g g g g
Studygonlinegatghttps://quizlet.com/_dowhqe
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's ho
g g g g g g g g g
pitals for examples: Non-IPPS hospitals
g g g g
19. What are the 3 types of medical necessity screenings and noncoverage not
g g g g g g g g g g g
ifications required in the Medicare program?: 1. Advanced Beneficiary Notice of No
g g g g g g g g g g g
ncoverage (ABN) for Part B services. g g g g g
2. SNF ABN for Part A SNF services.
g g g g g g
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
g g g g g g g
20. What is Medicare Part B ABN?: Used to explain to a Medicare patient that the or
g g g g g g g g g g g g g g g
dered test or services probably WILL NOT be covered by the Medicare b/c the DX info
g g g g g g g g g g g g g g g g
provided by the Dr. does NOT support the need for these services.
g g g g g g g g g g g
****May also be used for voluntary notifications, in place of the Notice of Exclusion for
g g g g g g g g g g g g g g g
Medicare Benefits (NEMB). g g
21. What is the Two- g g g
Midnight Rule?: Hospital admissions spanning 2 midnights would be considered a
g g g g g g g g g g
ppropriate for payment under the IPPS rule g g g g g g
22. What are some MSP claims that require additional review by the OIG to e
g g g g g g g g g g g g g
nsure compliance?: - W/C g g g
- Black Lung Program services g g g
- Veterans Affairs (VA) services g g g
- Federal grant programs g g
- Public Health Service programs (i.e Medicaid)
g g g g g
23. What are some cases where Medicare is the Secondary Payer?: -
g g g g g g g g g g
Working Aged (commercial insurance is Primary)
g g g g g g
- Accident or other liability (car/tort) g g g g
- End-Stage Renal Disease (ESRD) g g g
- Disability
24. What code must be provided on UB- g g g g g g
04 when billing Medicare as Primary for accident or injury?: Occurrence Code
g g g g g g g g g g g g
05 - ACCIDENT / NO MEDICAL OR LIABILITY COVERAGE
g g g g g g g g
25. How long should a provider wait to bill Medicare after billing liability in
g g g g g g g g g g g g
surance(s)?: 120 days g g
After 120 days, the provider has the option to CX liability claim and bill Medicare. Medi
g g g g g g g g g g g g g g g
are will process the claim under IPPS rules and recover payment from the liability hea
g g g g g g g g g g g g g g
h plan. g
26. What is the Correct Coding Initiative (CCI)?: The CCI ensures that the most co
g g g g g g g g g g g g g
4g/g52
g g g g g g g g
(2023) - Materials from HFMA g g g g
Studygonlinegatghttps://quizlet.com/_dowhqe
1. In what situation(s) should a provider NOT use a modifier?: -
g g g g g g g g g g
CPT already indicates 2-4 lesions
g g g g g
- CPT indicates multiple extremities
g g g
2. What are other names for Three-Day Payment Window?: ALL OF THE ABOVE
g g g g g g g g g g g
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
g g g g g g g g g g g
3. What happens during the post-
g g g g
service stage?: Final coding, preparation and submission of claims, payment proce
g g g g g g g g g g
ssing, balance billing and resolution.
g g g g
4. What are the below tasks part of?
g g g g g g
- Educate patients g
- Coordinate to avoid duplicate patient contacts g g g g g
- Be consistent in key aspects of account resolution
g g g g g g g
- Follow best practices for communication: Best practices created by the Medical D
g g g g g g g g g g g
ebt Task Force
g g
5. Which option is NOT a main HFMA Healthcare Dollars & Sense revenue c
g g g g g g g g g g g g
ycle initiative?: Process Compliance
g g g
6. Which option is NOT a continuum of care provider?
g g g g g g g g
A. Physician
B. Health Plan Contracting g g
C. Hospice
D. Skilled Nursing Facility: B. Health Plan Contracting
g g g g g g
7. What is "implied certification"?: When it is implied that a provider met all co
g g g g g g g g g g g g g
mpliance standards before submitting a claim
g g g g g
8. Which of the following are essential elements of an effective compliance p
g g g g g g g g g g g
rogram?
A. Established compliance standards and procedures. g g g g
B. Designation of a compliance officer employed within the Billing Depart- g g g g g g g g g
gment.
C. Oversight of personnel by high-level personnel. g g g g g
D. Automatic dismissal of any employee excluded from participation in a f
g g g g g g g g g g
ederal healthcare program.
g g
E. Reasonable methods to achieve compliance with standards, including g g g g g g g g
monitoring systems and hotlines.: A. Established compliance standards and p
g g g g g g g g g
rocedures.
C. Oversight of personnel by high-level personnel.
g g g g g g
1g/g52
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representativ
g g g g g g g g
(2023) - Materials from HFMA g g g g
Studygonlinegatghttps://quizlet.com/_dowhqe
E. Reasonable methods to achieve compliance with standards, including monitoring sy
g g g g g g g g g g
tems and hotlines. g g
9. When was Health Information Technology for Economic and Clinical Health (
g g g g g g g g g g
HITECH) Act signed into law?: FEB 17, 2009 g g g g g g g
10. When did HITECH Act become effective?: 2013 g g g g g g
11. Annually, the OIG publishes a work plan of compliance issues and ob- g g g g g g g g g g g
gjectives that will be focused on throughout the following year. Identify which o
g g g g g g g g g g g g
ption is NOT a work plan task mentioned in this course.
g g g g g g g g g g
A. Payments to Physicians for Co-Surgery Procedures g g g g g
B. Denials and Appeals in Medicare Part D g g g g g g
C. Medicare Hospital Payments for Claims Involving the Acute- g g g g g g g
and Post-Acute-Care Transfer Policies
g g g g
D. Standard Unique Employer Identifier: D. Standard Unique Employer Identifier
g g g g g g g g
12. What Plan are the tasks below a part of? g g g g g g g g
- Medicare Payments Made Outside of the Hospice Benefit g g g g g g g
- Denials and Appeals in Medicare Part C and Part D g g g g g g g g g
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
g g g g g g g g g
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits: The 2
g g g g g g g g g g g g g g
020 OIG Work Plan
g g g
13. When was the Preservation of Access to Care for Medicare Beneficiaries a
g g g g g g g g g g g
nd Pension Relief Act signed into law?: JUNE 25 2010
g g g g g g g g g
14. What is the Medicare DRG Three- g g g g g
Day Payment Window?: All Diagnostic services provided to a Medicare patient by a
g g g g g g g g g g g g
hospital on the Date of the patient's Inpatient admission or during the 3 calendar days (
g g g g g g g g g g g g g g g
or in the case of a non-IPPS hos-
g g g g g g g
gpital: 1 calendar day) immediately BEFORE the Date of Admission are REQUIRED to
g g g g g g g g g g g g
gbe included on the bill for the IP stay (unless there is no Part A coverage)
g g g g g g g g g g g g g g g
15. Do Outpatient Non- g g
Diagnostic Services qualify for separate payments if provided with the Three
g g g g g g g g g g
-Day Payment Window?: Nog g g
16. What is modifier 59?: Used to identify CPTs OTHER THAN E&M services, NOT no
g g g g g g g g g g g g g
rmally reported together, but are appropriate under the circumstances.
g g g g g g g g
Documentation must support a different session, different procedure or surgery, differ g g g g g g g g g g
nt site or organ system, separate.
g g g g g
17. What is condition code 51?: Code noted on the separate UB-
g g g g g g g g g g
04 OP claim, thus indicating the charge is unrelated to the admission.
g g g g g g g g g g g
2g/g52
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representativ
g g g g g g g g
(2023) - Materials from HFMA
g g g g
Studygonlinegatghttps://quizlet.com/_dowhqe
18. What kind of hospitals are the following:
g g g g g g
3g/g52
, CRCR Exam Prep, Multiple Choice, Certified Revenue Cycle Representativ
g g g g g g g g
(2023) - Materials from HFMA g g g g
Studygonlinegatghttps://quizlet.com/_dowhqe
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's ho
g g g g g g g g g
pitals for examples: Non-IPPS hospitals
g g g g
19. What are the 3 types of medical necessity screenings and noncoverage not
g g g g g g g g g g g
ifications required in the Medicare program?: 1. Advanced Beneficiary Notice of No
g g g g g g g g g g g
ncoverage (ABN) for Part B services. g g g g g
2. SNF ABN for Part A SNF services.
g g g g g g
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
g g g g g g g
20. What is Medicare Part B ABN?: Used to explain to a Medicare patient that the or
g g g g g g g g g g g g g g g
dered test or services probably WILL NOT be covered by the Medicare b/c the DX info
g g g g g g g g g g g g g g g g
provided by the Dr. does NOT support the need for these services.
g g g g g g g g g g g
****May also be used for voluntary notifications, in place of the Notice of Exclusion for
g g g g g g g g g g g g g g g
Medicare Benefits (NEMB). g g
21. What is the Two- g g g
Midnight Rule?: Hospital admissions spanning 2 midnights would be considered a
g g g g g g g g g g
ppropriate for payment under the IPPS rule g g g g g g
22. What are some MSP claims that require additional review by the OIG to e
g g g g g g g g g g g g g
nsure compliance?: - W/C g g g
- Black Lung Program services g g g
- Veterans Affairs (VA) services g g g
- Federal grant programs g g
- Public Health Service programs (i.e Medicaid)
g g g g g
23. What are some cases where Medicare is the Secondary Payer?: -
g g g g g g g g g g
Working Aged (commercial insurance is Primary)
g g g g g g
- Accident or other liability (car/tort) g g g g
- End-Stage Renal Disease (ESRD) g g g
- Disability
24. What code must be provided on UB- g g g g g g
04 when billing Medicare as Primary for accident or injury?: Occurrence Code
g g g g g g g g g g g g
05 - ACCIDENT / NO MEDICAL OR LIABILITY COVERAGE
g g g g g g g g
25. How long should a provider wait to bill Medicare after billing liability in
g g g g g g g g g g g g
surance(s)?: 120 days g g
After 120 days, the provider has the option to CX liability claim and bill Medicare. Medi
g g g g g g g g g g g g g g g
are will process the claim under IPPS rules and recover payment from the liability hea
g g g g g g g g g g g g g g
h plan. g
26. What is the Correct Coding Initiative (CCI)?: The CCI ensures that the most co
g g g g g g g g g g g g g
4g/g52
