Page 1 of 27
CRCR STUDY GUIDE LATEST VERSIONS (VERSION A, B
& C) NEWEST 2025/2026 ACTUAL EXAM COMPLETE
300 QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
Through what document does a hospital establish compliance
standards? ......ANSWER........Code of Conduct
What is the purpose of the OIG work plan?
......ANSWER........Communicate Issues that will be reviewed
during the year for compliance with Medicare Regulations
If a Medicare patient is admitted on Friday, what services fall
within the three-day DRG window rule?
......ANSWER........Diagnostic services and related charges
provided on Wednesday, Thursday and Friday before
admission.
What does a modifier allow a provider to do?
......ANSWER........Report a specific circumstance that affected a
procedure or service without changing the code or its definition
If outpatient diagnostic services are provided within three days
of the admission of a Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to
these charges? ......ANSWER........They must be combined with the
inpatient bill and paid under the MS-DRG (diagnosis related
group) system.
If outpatient diagnostic services are provided within three days
of the admission of a Medicare beneficiary to an IPPS (Inpatient
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Prospective Payment System) hospital, what must happen to
these charges? ......ANSWER........It reviews Medicare payments
for beneficiaries who have other insurance and assesses the
effectiveness of procedures in preventing inappropriate
Medicare payments for beneficiaries with other insurance
coverage.
What is a recurring or series registration? ......ANSWER........One
registration record is created for multiple days of service.
What are nonemergency patients who come for service without
prior notification to the provider called?
......ANSWER........Unscheduled Patients
Which of the following statements apply to the observation
patient type? ......ANSWER........It is used to evaluate the need for
an inpatient admission.
Which services are hospice programs required to provide on an
around-the-clock basis? ......ANSWER........Physician, nursing and
pharmacy
What is the purpose of the initial step in the outpatient testing
scheduling process? ......ANSWER........Identify the correct patient
on the providers database or add the patient to the database
Scheduler instructions are used to prompt the scheduler to do
what? ......ANSWER........Complete the scheduling process correctly
based on service requested.
, Page 3 of 27
The time needed to prepare the patient before service is the
difference between the patient's arrival time and which of the
following? ......ANSWER........Procedure time
Medicare guidelines require that when a test is ordered for
which as LCD (local coverage determination) or NCD (national
coverage determination) exist, the information provided on the
order must include which of the following?
......ANSWER........Documentation of the medical necessity of the
test.
What is an advantage of a preregistration program?
......ANSWER........It reduces processing times at the time of service
What data are required to establish a new MPI (master patient
index) entry? ......ANSWER........The patients full legal name, date
of birth and sex
Which HIPAA transition set provides electronic processing of
insurance verification requests and responses?
......ANSWER........The 270-271 Set
A mother and father both cover their 16-year-old child as a
dependent on their health insurance plans, which both follow the
birthday rule. The mothers date of birth is January 19, 1968; the
father's date of birth is July 19, 1967. Whose plan is the
primary payer? ......ANSWER........The Mothers Plan
What is a co-payment? ......ANSWER........The fixed amount that is
due for a specific service
CRCR STUDY GUIDE LATEST VERSIONS (VERSION A, B
& C) NEWEST 2025/2026 ACTUAL EXAM COMPLETE
300 QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
Through what document does a hospital establish compliance
standards? ......ANSWER........Code of Conduct
What is the purpose of the OIG work plan?
......ANSWER........Communicate Issues that will be reviewed
during the year for compliance with Medicare Regulations
If a Medicare patient is admitted on Friday, what services fall
within the three-day DRG window rule?
......ANSWER........Diagnostic services and related charges
provided on Wednesday, Thursday and Friday before
admission.
What does a modifier allow a provider to do?
......ANSWER........Report a specific circumstance that affected a
procedure or service without changing the code or its definition
If outpatient diagnostic services are provided within three days
of the admission of a Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to
these charges? ......ANSWER........They must be combined with the
inpatient bill and paid under the MS-DRG (diagnosis related
group) system.
If outpatient diagnostic services are provided within three days
of the admission of a Medicare beneficiary to an IPPS (Inpatient
,Page 2 of 27
Prospective Payment System) hospital, what must happen to
these charges? ......ANSWER........It reviews Medicare payments
for beneficiaries who have other insurance and assesses the
effectiveness of procedures in preventing inappropriate
Medicare payments for beneficiaries with other insurance
coverage.
What is a recurring or series registration? ......ANSWER........One
registration record is created for multiple days of service.
What are nonemergency patients who come for service without
prior notification to the provider called?
......ANSWER........Unscheduled Patients
Which of the following statements apply to the observation
patient type? ......ANSWER........It is used to evaluate the need for
an inpatient admission.
Which services are hospice programs required to provide on an
around-the-clock basis? ......ANSWER........Physician, nursing and
pharmacy
What is the purpose of the initial step in the outpatient testing
scheduling process? ......ANSWER........Identify the correct patient
on the providers database or add the patient to the database
Scheduler instructions are used to prompt the scheduler to do
what? ......ANSWER........Complete the scheduling process correctly
based on service requested.
, Page 3 of 27
The time needed to prepare the patient before service is the
difference between the patient's arrival time and which of the
following? ......ANSWER........Procedure time
Medicare guidelines require that when a test is ordered for
which as LCD (local coverage determination) or NCD (national
coverage determination) exist, the information provided on the
order must include which of the following?
......ANSWER........Documentation of the medical necessity of the
test.
What is an advantage of a preregistration program?
......ANSWER........It reduces processing times at the time of service
What data are required to establish a new MPI (master patient
index) entry? ......ANSWER........The patients full legal name, date
of birth and sex
Which HIPAA transition set provides electronic processing of
insurance verification requests and responses?
......ANSWER........The 270-271 Set
A mother and father both cover their 16-year-old child as a
dependent on their health insurance plans, which both follow the
birthday rule. The mothers date of birth is January 19, 1968; the
father's date of birth is July 19, 1967. Whose plan is the
primary payer? ......ANSWER........The Mothers Plan
What is a co-payment? ......ANSWER........The fixed amount that is
due for a specific service
