CRCR EXAM PREP QUESTION AND ANSWERS
LATEST VERSION VERIFIED RATIONALE GRADED
A+
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims after what
happens? - ans120 days passes, but the claim then be withdrawn from the liability carrier
Access - ansAn individual's ability to obtain medical services on a timely and financially acceptable level
According to the Department of Health and Human Services guidelines, what is NOT considered income?
- ansSale of property, house, or car
Administrative Services Only (ASO) - ansUsually contracted administrative services to a self-insured
health plan
an increase in the dollars aged greater than 90 days from date of service indicate what about accounts -
ansThey are not being processed in a timely manner
At the end of each shift, what must happen to cash, checks, and credit card transaction documents? -
ansThey must be balanced
Care purchaser - ansIndividual or entity that contributes to the purchase of healthcare services
Case management - ansThe process whereby all health-related components of a case are managed by a
designated health professional. Intended to ensure continuity of healthcare accessibility and services
Charge - ansThe dollar amount a provider sets for services rendered before negotiating any discounts.
The charge can be different from the amount paid
Claim - ansA demand by an insured person for the benefits provided by the group contract
,CRCR EXAM PREP QUESTION AND ANSWERS
LATEST VERSION VERIFIED RATIONALE GRADED
A+
Collecting patient liability dollars after service leads to what? - ansLower accounts receivable levels
Coordination of benefits (COB) - ansa typical insurance provision that determines the responsibility for
primary payment when the patient is covered by more than one employer-sponsored health benefit
program
Cost - ansThe definition of cost varies by party incurring the expense
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has
received what? - ansMedically necessary inpatient hospital services for at least 3 consecutive days before
the skilled nursing care admission
Discounted fee-for-service - ansA reimbursement methodology whereby a provider agrees to provide
service on a fee for service basis, but the fees are discounted by certain packages
Eligibility - ansPatient status regarding coverage for healthcare insurance benefits
ESRD - ansEnd-stage renal disease. The patient has permanent kidney failure, is covered by a GHP, and
has not yet completed the 30-month coordination period
Every patient who is new to the healthcare provider must be offered what? - ansA printed copy of the
provider's privacy notice
FERA - ansFraud Enforcement and Recovery act
First dollar coverage - ansA healthcare insurance policy that has no deductible and covers the first dollar
of an insured's expenses
, CRCR EXAM PREP QUESTION AND ANSWERS
LATEST VERSION VERIFIED RATIONALE GRADED
A+
Gatekeeping - ansA concept wherein the primary care physician provides all primary patient care and
coordinates all diagnostic testing and specialty referrals required for a patient's medical care
Health plan - ansan insurance company that provides for the delivery or payment of healthcare services
How are disputes with nongovernmental payers resolved? - ansAppeal conditions specified in the
individual payer's contract
how are HCPCS codes and the appropriate modifiers used? - ansTo report the level 1, 2, or 3 code that
correctly describes the service provided
How are patient reminder calls used? - ansTo make sure the patient follows the prep instructions and
arrives at the scheduled time for service
How does utilization review staff use correct insurance information? - ansTo obtain approval for inpatient
days and coordinate services
How is a mis-posted contractual allowance resolved? - ansComparing the contract reimbursement rates
with the contract on the admittance advice to identify the correct amount
How may a collection agency demonstrate its performance? - ansCalculate the rate of recovery
How must providers handle credit balances? - ansComply with state statutes concerning reporting credit
balance
LATEST VERSION VERIFIED RATIONALE GRADED
A+
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims after what
happens? - ans120 days passes, but the claim then be withdrawn from the liability carrier
Access - ansAn individual's ability to obtain medical services on a timely and financially acceptable level
According to the Department of Health and Human Services guidelines, what is NOT considered income?
- ansSale of property, house, or car
Administrative Services Only (ASO) - ansUsually contracted administrative services to a self-insured
health plan
an increase in the dollars aged greater than 90 days from date of service indicate what about accounts -
ansThey are not being processed in a timely manner
At the end of each shift, what must happen to cash, checks, and credit card transaction documents? -
ansThey must be balanced
Care purchaser - ansIndividual or entity that contributes to the purchase of healthcare services
Case management - ansThe process whereby all health-related components of a case are managed by a
designated health professional. Intended to ensure continuity of healthcare accessibility and services
Charge - ansThe dollar amount a provider sets for services rendered before negotiating any discounts.
The charge can be different from the amount paid
Claim - ansA demand by an insured person for the benefits provided by the group contract
,CRCR EXAM PREP QUESTION AND ANSWERS
LATEST VERSION VERIFIED RATIONALE GRADED
A+
Collecting patient liability dollars after service leads to what? - ansLower accounts receivable levels
Coordination of benefits (COB) - ansa typical insurance provision that determines the responsibility for
primary payment when the patient is covered by more than one employer-sponsored health benefit
program
Cost - ansThe definition of cost varies by party incurring the expense
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has
received what? - ansMedically necessary inpatient hospital services for at least 3 consecutive days before
the skilled nursing care admission
Discounted fee-for-service - ansA reimbursement methodology whereby a provider agrees to provide
service on a fee for service basis, but the fees are discounted by certain packages
Eligibility - ansPatient status regarding coverage for healthcare insurance benefits
ESRD - ansEnd-stage renal disease. The patient has permanent kidney failure, is covered by a GHP, and
has not yet completed the 30-month coordination period
Every patient who is new to the healthcare provider must be offered what? - ansA printed copy of the
provider's privacy notice
FERA - ansFraud Enforcement and Recovery act
First dollar coverage - ansA healthcare insurance policy that has no deductible and covers the first dollar
of an insured's expenses
, CRCR EXAM PREP QUESTION AND ANSWERS
LATEST VERSION VERIFIED RATIONALE GRADED
A+
Gatekeeping - ansA concept wherein the primary care physician provides all primary patient care and
coordinates all diagnostic testing and specialty referrals required for a patient's medical care
Health plan - ansan insurance company that provides for the delivery or payment of healthcare services
How are disputes with nongovernmental payers resolved? - ansAppeal conditions specified in the
individual payer's contract
how are HCPCS codes and the appropriate modifiers used? - ansTo report the level 1, 2, or 3 code that
correctly describes the service provided
How are patient reminder calls used? - ansTo make sure the patient follows the prep instructions and
arrives at the scheduled time for service
How does utilization review staff use correct insurance information? - ansTo obtain approval for inpatient
days and coordinate services
How is a mis-posted contractual allowance resolved? - ansComparing the contract reimbursement rates
with the contract on the admittance advice to identify the correct amount
How may a collection agency demonstrate its performance? - ansCalculate the rate of recovery
How must providers handle credit balances? - ansComply with state statutes concerning reporting credit
balance
