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sh
ne
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CRCR EXAM TEST BANK LATEST 2023-2024
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sh
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WITH 400+ QUESTIONS AND CORRECT
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la
ANSWERS (VERIFIED ANSWERS) 100%
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sh
Sp
COMPLETE
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la
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When does a hospital add ambulance charges to the Medicare inpatient claim? -
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ANSWER- If the patient requires ambulance transportation to a skilled nursing
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facility
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How should a provider resolve a late-charge credit posted after an account is
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billed? - ANSWER- Post a late-charge adjustment to the account
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Sp
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an increase in the dollars aged greater than 90 days from date of service indicate
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what about accounts - ANSWER- They are not being processed in a timely manner
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sh
Sp
What is an advantage of a preregistration program? - ANSWER- It reduces
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processing times at the time of service
la
tz
sh
Sp
What are the two statutory exclusions from hospice coverage? - ANSWER-
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Medically unnecessary services and custodial care
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tz
sh
What core financial activities are resolved within patient access? - ANSWER-
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Scheduling, insurance verification, discharge processing, and payment of point-of-
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service receipts
la
tz
sh
Sp
What statement applies to the scheduled outpatient? - ANSWER- The services do
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not involve an overnight stay
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How is a mis-posted contractual allowance resolved? - ANSWER- Comparing the
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contract reimbursement rates with the contract on the admittance advice to identify
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the correct amount
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What type of patient status is used to evaluate the patient's need for inpatient care?
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- ANSWER- Observation
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, ne
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sh
ne
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Coverage rules for Medicare beneficiaries receiving skilled nursing care require
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that the beneficiary has received what? - ANSWER- Medically necessary inpatient
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hospital services for at least 3 consecutive days before the skilled nursing care
admission ne
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tz
sh
Sp
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? -
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ANSWER- When the patient is the insured
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What are non-emergency patients who come for service without prior notification
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to the provider called? - ANSWER- Unscheduled patients
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la
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If the insurance verification response reports that a subscriber has a single policy,
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what is the status of the subscriber's spouse? - ANSWER- Neither enrolled not
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entitled to benefits
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tz
sh
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
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Lending Act, establishes what? - ANSWER- Disclosure rules for consumer credit
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sales and consumer loans
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tz
sh
Sp
What is a principal diagnosis? - ANSWER- Primary reason for the patient's
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admission
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tz
sh
Collecting patient liability dollars after service leads to what? - ANSWER- Lower
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accounts receivable levels
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la
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What is the daily out-of-pocket amount for each lifetime reserve day used? -
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ANSWER- 50% of the current deductible amount
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What service provided to a Medicare beneficiary in a rural health clinic (RHC) is
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not billable as an RHC services? - ANSWER- Inpatient care
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What code indicates the disposition of the patient at the conclusion of service? -
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ANSWER- Patient discharge status code
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Sp
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What are hospitals required to do for Medicare credit balance accounts? -
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ANSWER- They result in lost reimbursement and additional cost to collect
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sh
Sp
When an undue delay of payment results from a dispute between the patient and
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the third party payer, who is responsible for payment? - ANSWER- Patient
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Sp
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Sp
, ne
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sh
ne
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Medicare guidelines require that when a test is ordered for a LCD or NCD exists,
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the information provided on the order must include: - ANSWER- A valid CPT or
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HCPCS code
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la
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With advances in internet security and encryption, revenue-cycle processes are
sh
Sp
expanding to allow patients to do what? - ANSWER- Access their information and
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perform functions on-line
la
tz
sh
What date is required on all CMS 1500 claim forms? - ANSWER- onset date of
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current illness
ne
la
tz
What does scheduling allow provider staff to do - ANSWER- Review
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appropriateness of the service request
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What code is used to report the provider's most common semiprivate room rate? -
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ANSWER- Condition code
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Regulations and requirements for coding accountable care organizations, which
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allows providers to begin creating these organizations, were finalized in: -
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ANSWER- 2012
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What is a primary responsibility of the Recover Audit Contractor? - ANSWER- To
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correctly identify proper payments for Medicare Part A & B claims
sh
Sp
ne
How must providers handle credit balances? - ANSWER- Comply with state
la
statutes concerning reporting credit balance
tz
sh
Sp
ne
Insurance verification results in what? - ANSWER- The accurate identification of
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the patient's eligibility and benefits
tz
sh
Sp
What form is used to bill Medicare for rural health clinics? - ANSWER- CMS
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1500
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tz
sh
Sp
What activities are completed when a scheduled pre-registered patient arrives for
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service? - ANSWER- Registering the patient and directing the patient to the
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service area
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sh
Sp
ne
la
sh
Sp
la
Sp
, ne
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sh
ne
In addition to being supported by information found in the patient's chart, a CMS
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1500 claim must be coded using what? - ANSWER- HCPCS (Healthcare Common
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sh
Procedure Coding system)
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ne
What results from a denied claim? - ANSWER- The provider incurs rework and
la
tz
appeal costs
sh
Sp
ne
Why does the financial counselor need pricing for services? - ANSWER- To
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calculate the patient's financial responsibility
tz
sh
Sp
What type of provider bills third-party payers using CMS 1500 form - ANSWER-
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Hospital-based mammography centers
la
tz
sh
Sp
How are disputes with nongovernmental payers resolved? - ANSWER- Appeal
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conditions specified in the individual payer's contract
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tz
sh
The important message from Medicare provides beneficiaries with information
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concerning what? - ANSWER- Right to appeal a discharge decision if the patient
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disagrees with the services
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tz
sh
Sp
Why do managed care plans have agreements with hospitals, physicians, and other
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healthcare providers to offer a range of services to plan members? - ANSWER- To
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improve access to quality healthcare
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Sp
If a patient remains an inpatient of an SNF (skilled nursing facility for more than
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30 days, what is the SNF permitted to do? - ANSWER- Submit interim bills to the
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Medicare program.
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sh
Sp
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90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for
la
liability claims after what happens? - ANSWER- 120 days passes, but the claim
tz
sh
then be withdrawn from the liability carrier
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ne
What data are required to establish a new MPI entry? - ANSWER- The patient's
la
tz
full legal name, date of birth, and sex
sh
Sp
ne
What should the provider do if both of the patient's insurance plans pay as
la
primary? - ANSWER- Determine the correct payer and notify the incorrect payer
tz
of the processing error
sh
Sp
ne
la
sh
Sp
la
Sp
tz
sh
ne
la
CRCR EXAM TEST BANK LATEST 2023-2024
tz
sh
Sp
WITH 400+ QUESTIONS AND CORRECT
ne
la
ANSWERS (VERIFIED ANSWERS) 100%
tz
sh
Sp
COMPLETE
ne
la
tz
sh
Sp
ne
When does a hospital add ambulance charges to the Medicare inpatient claim? -
la
ANSWER- If the patient requires ambulance transportation to a skilled nursing
tz
sh
facility
Sp
ne
How should a provider resolve a late-charge credit posted after an account is
la
tz
billed? - ANSWER- Post a late-charge adjustment to the account
sh
Sp
ne
an increase in the dollars aged greater than 90 days from date of service indicate
la
what about accounts - ANSWER- They are not being processed in a timely manner
tz
sh
Sp
What is an advantage of a preregistration program? - ANSWER- It reduces
ne
processing times at the time of service
la
tz
sh
Sp
What are the two statutory exclusions from hospice coverage? - ANSWER-
ne
Medically unnecessary services and custodial care
la
tz
sh
What core financial activities are resolved within patient access? - ANSWER-
Sp
Scheduling, insurance verification, discharge processing, and payment of point-of-
ne
service receipts
la
tz
sh
Sp
What statement applies to the scheduled outpatient? - ANSWER- The services do
ne
not involve an overnight stay
la
tz
sh
How is a mis-posted contractual allowance resolved? - ANSWER- Comparing the
Sp
contract reimbursement rates with the contract on the admittance advice to identify
ne
the correct amount
la
tz
sh
Sp
What type of patient status is used to evaluate the patient's need for inpatient care?
ne
- ANSWER- Observation
la
sh
Sp
la
Sp
, ne
tz
sh
ne
la
Coverage rules for Medicare beneficiaries receiving skilled nursing care require
tz
sh
that the beneficiary has received what? - ANSWER- Medically necessary inpatient
Sp
hospital services for at least 3 consecutive days before the skilled nursing care
admission ne
la
tz
sh
Sp
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? -
ne
ANSWER- When the patient is the insured
la
tz
sh
What are non-emergency patients who come for service without prior notification
Sp
to the provider called? - ANSWER- Unscheduled patients
ne
la
tz
If the insurance verification response reports that a subscriber has a single policy,
sh
Sp
what is the status of the subscriber's spouse? - ANSWER- Neither enrolled not
ne
entitled to benefits
la
tz
sh
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
Sp
Lending Act, establishes what? - ANSWER- Disclosure rules for consumer credit
ne
sales and consumer loans
la
tz
sh
Sp
What is a principal diagnosis? - ANSWER- Primary reason for the patient's
ne
admission
la
tz
sh
Collecting patient liability dollars after service leads to what? - ANSWER- Lower
Sp
accounts receivable levels
ne
la
tz
What is the daily out-of-pocket amount for each lifetime reserve day used? -
sh
Sp
ANSWER- 50% of the current deductible amount
ne
la
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is
tz
sh
not billable as an RHC services? - ANSWER- Inpatient care
Sp
ne
What code indicates the disposition of the patient at the conclusion of service? -
la
tz
ANSWER- Patient discharge status code
sh
Sp
ne
What are hospitals required to do for Medicare credit balance accounts? -
la
ANSWER- They result in lost reimbursement and additional cost to collect
tz
sh
Sp
When an undue delay of payment results from a dispute between the patient and
ne
the third party payer, who is responsible for payment? - ANSWER- Patient
la
sh
Sp
la
Sp
, ne
tz
sh
ne
la
Medicare guidelines require that when a test is ordered for a LCD or NCD exists,
tz
sh
the information provided on the order must include: - ANSWER- A valid CPT or
Sp
HCPCS code
ne
la
tz
With advances in internet security and encryption, revenue-cycle processes are
sh
Sp
expanding to allow patients to do what? - ANSWER- Access their information and
ne
perform functions on-line
la
tz
sh
What date is required on all CMS 1500 claim forms? - ANSWER- onset date of
Sp
current illness
ne
la
tz
What does scheduling allow provider staff to do - ANSWER- Review
sh
Sp
appropriateness of the service request
ne
la
What code is used to report the provider's most common semiprivate room rate? -
tz
sh
ANSWER- Condition code
Sp
ne
Regulations and requirements for coding accountable care organizations, which
la
tz
allows providers to begin creating these organizations, were finalized in: -
sh
Sp
ANSWER- 2012
ne
la
What is a primary responsibility of the Recover Audit Contractor? - ANSWER- To
tz
correctly identify proper payments for Medicare Part A & B claims
sh
Sp
ne
How must providers handle credit balances? - ANSWER- Comply with state
la
statutes concerning reporting credit balance
tz
sh
Sp
ne
Insurance verification results in what? - ANSWER- The accurate identification of
la
the patient's eligibility and benefits
tz
sh
Sp
What form is used to bill Medicare for rural health clinics? - ANSWER- CMS
ne
1500
la
tz
sh
Sp
What activities are completed when a scheduled pre-registered patient arrives for
ne
service? - ANSWER- Registering the patient and directing the patient to the
la
service area
tz
sh
Sp
ne
la
sh
Sp
la
Sp
, ne
tz
sh
ne
In addition to being supported by information found in the patient's chart, a CMS
la
1500 claim must be coded using what? - ANSWER- HCPCS (Healthcare Common
tz
sh
Procedure Coding system)
Sp
ne
What results from a denied claim? - ANSWER- The provider incurs rework and
la
tz
appeal costs
sh
Sp
ne
Why does the financial counselor need pricing for services? - ANSWER- To
la
calculate the patient's financial responsibility
tz
sh
Sp
What type of provider bills third-party payers using CMS 1500 form - ANSWER-
ne
Hospital-based mammography centers
la
tz
sh
Sp
How are disputes with nongovernmental payers resolved? - ANSWER- Appeal
ne
conditions specified in the individual payer's contract
la
tz
sh
The important message from Medicare provides beneficiaries with information
Sp
concerning what? - ANSWER- Right to appeal a discharge decision if the patient
ne
disagrees with the services
la
tz
sh
Sp
Why do managed care plans have agreements with hospitals, physicians, and other
ne
healthcare providers to offer a range of services to plan members? - ANSWER- To
la
improve access to quality healthcare
tz
sh
Sp
If a patient remains an inpatient of an SNF (skilled nursing facility for more than
ne
30 days, what is the SNF permitted to do? - ANSWER- Submit interim bills to the
la
Medicare program.
tz
sh
Sp
ne
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for
la
liability claims after what happens? - ANSWER- 120 days passes, but the claim
tz
sh
then be withdrawn from the liability carrier
Sp
ne
What data are required to establish a new MPI entry? - ANSWER- The patient's
la
tz
full legal name, date of birth, and sex
sh
Sp
ne
What should the provider do if both of the patient's insurance plans pay as
la
primary? - ANSWER- Determine the correct payer and notify the incorrect payer
tz
of the processing error
sh
Sp
ne
la
sh
Sp
la
Sp
