Certified Revenue Cycle Representative –
CRCR Study Guide Questions And Answers
Verified 100% Correct
Which statement includes the required components of an accurate pricing
determination? - ANSWER -Insurance coverage and benefits, service or test
involved, diagnosis and procedure codes, total estimated charges, adjudication
calculations based on the patient's benefit package.
The value of a robust scheduling and pre-registration process includes all of the
following except: - ANSWER -Identification of patients who are likely to be "no
shows".
Which patients are considered scheduled? - ANSWER -A. Observation Patients
B. Emergency Department Patients
**C. Recurring/Series Patients
D. Hospice Care
Name the guideline that Medicare established to determine which diagnoses,
signs, or symptoms are payable. - ANSWER -A. Patient Identifiers
**B. Local Coverage Determinations
C. Advance Beneficiary Notice
D. Scheduling Instructions
What is the purpose of insurance verification? - ANSWER -A. To identify
information that does not have to be collected from the patient.
**B. To ensure accuracy of the health plan information.
C. To effectively complete the MSP screening process.
D. To complete guarantor information if the guarantor is not the patient.
Which option is a federally-aided, state-operated program to provide health and
long-term care coverage? - ANSWER -A. Medicare
**B. Medicaid
C. Self-Insured Plans
,D. Liability Coverage
Which option is NOT a specific managed care requirement? - ANSWER -A.
Referrals
B. Notification
**C. Preferred Provider Organization
D. Discharge Planning
What is the first component of a pricing determination? - ANSWER -A. Identify
the service or test involved
**B. Verification of the patient's insurance eligibility and benefits
C. Inform the patient that physician services are or are not included
D. Use a worksheet or other tool for guidance in determining an estimate
The correct sequential order of the financial counseling steps for an uninsured
patient's surgery case are: - ANSWER -Greet patient and give your name
Explain organization's financial care approach and patient's financial responsibility
Review patient's health plan benefits and status
Review anticipated charges and patient's anticipated liability
Ask patient to resolve liability by reviewing payment options
For uninsured, explain financial assistance options
What is the purpose of financial counseling? - ANSWER -A. To address the most
appropriate ways to conduct financial interactions at every point
B. To train staff on how to request payment and conduct conversations
**C. To educate the patient on his/her health plan coverage and financial
responsibility for healthcare services
D. To help the patient understand exactly how a contracted health plan will resolve
their benefit package
, EMTALA prohibits inquiries about health plan or liability payer information if the
inquiry will delay examination or treatment. What other requirements apply to the
Emergency Department registration work? - ANSWER -ALL of the above
Typical activities which much be performed when an unscheduled patient arrives
for service include: - ANSWER -Identification of patient in the MPI or initiation of
a new MPI record, insurance verification of eligibility and benefits, managed care
screening, medical necessity screening, price estimation and financial counseling
to achieve the appropriate account resolution.
Case managers are involved from admission with the discharge planning process.
The purpose of discharge planning is: - ANSWER -To estimate how long the
patient will be in the hospital, identify the expected outcome of the hospitalization
and initiate any special requirements for services at or after the time of discharge.
The chargemaster is basically a list of services, procedures, room
accommodations, supplies, drugs, tests, etc. typically associated with the billing for
services rendered to patients. Challenges typically associated with the billing for
services rendered to patients. Challenges typically associated with the
chargemaster include: - ANSWER -Omission of charges, obsolete or invalid codes,
and the omission of required modifiers.
Ultimately, the services provided in the healthcare system are reduced to standard
codes. The primary types of coding systems currently used in healthcare are: -
ANSWER -ICD-10-CM/ICD-10-PCS; CPT/HCPCS codes
There are four code sets that provide health plans with additional information as
they process claims. Those code sets are: - ANSWER -Condition codes, occurrence
codes, occurrence span codes and value codes
Each type of service has unique billing rules which come into play during the
provision of service. For the skilled nursing facility, care is covered if which of the
following factors are present: - ANSWER -The patient required skilled services on
a daily basis and those services can only be provided on an inpatient basis in a
SNF.
CRCR Study Guide Questions And Answers
Verified 100% Correct
Which statement includes the required components of an accurate pricing
determination? - ANSWER -Insurance coverage and benefits, service or test
involved, diagnosis and procedure codes, total estimated charges, adjudication
calculations based on the patient's benefit package.
The value of a robust scheduling and pre-registration process includes all of the
following except: - ANSWER -Identification of patients who are likely to be "no
shows".
Which patients are considered scheduled? - ANSWER -A. Observation Patients
B. Emergency Department Patients
**C. Recurring/Series Patients
D. Hospice Care
Name the guideline that Medicare established to determine which diagnoses,
signs, or symptoms are payable. - ANSWER -A. Patient Identifiers
**B. Local Coverage Determinations
C. Advance Beneficiary Notice
D. Scheduling Instructions
What is the purpose of insurance verification? - ANSWER -A. To identify
information that does not have to be collected from the patient.
**B. To ensure accuracy of the health plan information.
C. To effectively complete the MSP screening process.
D. To complete guarantor information if the guarantor is not the patient.
Which option is a federally-aided, state-operated program to provide health and
long-term care coverage? - ANSWER -A. Medicare
**B. Medicaid
C. Self-Insured Plans
,D. Liability Coverage
Which option is NOT a specific managed care requirement? - ANSWER -A.
Referrals
B. Notification
**C. Preferred Provider Organization
D. Discharge Planning
What is the first component of a pricing determination? - ANSWER -A. Identify
the service or test involved
**B. Verification of the patient's insurance eligibility and benefits
C. Inform the patient that physician services are or are not included
D. Use a worksheet or other tool for guidance in determining an estimate
The correct sequential order of the financial counseling steps for an uninsured
patient's surgery case are: - ANSWER -Greet patient and give your name
Explain organization's financial care approach and patient's financial responsibility
Review patient's health plan benefits and status
Review anticipated charges and patient's anticipated liability
Ask patient to resolve liability by reviewing payment options
For uninsured, explain financial assistance options
What is the purpose of financial counseling? - ANSWER -A. To address the most
appropriate ways to conduct financial interactions at every point
B. To train staff on how to request payment and conduct conversations
**C. To educate the patient on his/her health plan coverage and financial
responsibility for healthcare services
D. To help the patient understand exactly how a contracted health plan will resolve
their benefit package
, EMTALA prohibits inquiries about health plan or liability payer information if the
inquiry will delay examination or treatment. What other requirements apply to the
Emergency Department registration work? - ANSWER -ALL of the above
Typical activities which much be performed when an unscheduled patient arrives
for service include: - ANSWER -Identification of patient in the MPI or initiation of
a new MPI record, insurance verification of eligibility and benefits, managed care
screening, medical necessity screening, price estimation and financial counseling
to achieve the appropriate account resolution.
Case managers are involved from admission with the discharge planning process.
The purpose of discharge planning is: - ANSWER -To estimate how long the
patient will be in the hospital, identify the expected outcome of the hospitalization
and initiate any special requirements for services at or after the time of discharge.
The chargemaster is basically a list of services, procedures, room
accommodations, supplies, drugs, tests, etc. typically associated with the billing for
services rendered to patients. Challenges typically associated with the billing for
services rendered to patients. Challenges typically associated with the
chargemaster include: - ANSWER -Omission of charges, obsolete or invalid codes,
and the omission of required modifiers.
Ultimately, the services provided in the healthcare system are reduced to standard
codes. The primary types of coding systems currently used in healthcare are: -
ANSWER -ICD-10-CM/ICD-10-PCS; CPT/HCPCS codes
There are four code sets that provide health plans with additional information as
they process claims. Those code sets are: - ANSWER -Condition codes, occurrence
codes, occurrence span codes and value codes
Each type of service has unique billing rules which come into play during the
provision of service. For the skilled nursing facility, care is covered if which of the
following factors are present: - ANSWER -The patient required skilled services on
a daily basis and those services can only be provided on an inpatient basis in a
SNF.
