CRCR Certification Exam Review 2023 Questions and Answers, Exams of Nursing

Download CRCR Certification Exam Review 2023 Questions and Answers and more Exams Nursing in PDF only on Docsity! CRCR Certification exam review 2023 questions and answers Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by - correct answer The Medicare Administrative Contractor (MAC) at the end of the hospice cap period Which of the following is required for participation in Medicaid - correct answer Meet Income and Assets Requirements. In choosing a setting for patient financial discussions, organizations should first and foremost - correct answer Respect the patients privacy. A nightly room charge will be incorrect if the patient's - correct answer Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can - correct answer Purchase qualified health benefit plans regardless of insured's health status CRCR Certification exam review 2023 questions and answers A portion of the accounts receivable inventory which has NOT qualified for billing includes: - correct answer Charitable pledges What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare? - correct answer Revenue codes This directive was developed to promote and ensure healthcare quality and value and also to protect consumers and workers in the healthcare system. This directive is called - correct answer Patient bill of rights The activity which results in the accurate recording of patient bed and level of care assessment, patient transfer and patient discharge status on a real-time basis is known as - correct answer Case management Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation? - correct answer Registration staff may CRCR Certification exam review 2023 questions and answers (MAC). This appeal may be filed with - correct answer The Provider Reimbursement Review Board Concurrent review and discharge planning - correct answer Occurs during service Duplicate payments occur: - correct answer When providers re-bill claims based on nonpayment from the initial bill submission An individual enrolled in Medicare who is dissatisfied with the government's claim determination is entitled to reconsideration of the decision. This type of appeal is known as - correct answer A beneficiary appeal Insurance verification results in which of the following - correct answer The accurate identification of the patient's eligibility and benefits CRCR Certification exam review 2023 questions and answers The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: - correct answer Judicial review by a federal district court Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the providermay not ask about a patient's insurance information if it would delay what? - correct answer Medical screening and stabilizing treatment Ambulance services are billed directly to the health plan for - correct answer Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility Key performance indicators (KPIs) set standards for accounts receivables (A/R) and - correct answer Provide a method of measuring the collection and control of A/R CRCR Certification exam review 2023 questions and answers he patient discharge process begins when - correct answer The physician writes the discharge orders The nightly room charge will be incorrect if the patient's - correct answer Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system. The soft cost of a dissatisfied customer is - correct answer The customer passing on info about their negative experience to potential pts or through social media channels An advantage of a pre-registration program is - correct answer The opportunity to reduce the corporate compliance failures within the registration process It is important to have high registration quality standards because - correct answer Inaccurate or incomplete patient data will delay payment or cause denials CRCR Certification exam review 2023 questions and answers A claim for reimbursement submitted to a third-party payer that has all the information and documentation required for the payer to make a decision on it is known as - correct answer A clean claim The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to - correct answer Medicare and Medicaid payments The Correct Coding Initiative Program consists of - correct answer Edits that are implemented within providers' claim processing systems To provide a patient with information that is meaningful to them, all of the following factors must be included EXCEPT - correct answer The actual physician reimbursement Which department supports/collaborates with the revenue cycle? - correct answer Information Technology CRCR Certification exam review 2023 questions and answers Medicare Part B has an annual deductible and the beneficiary is responsible for - correct answer a co-insurance payment for all Part B covered services The two types of claims denial appeals are - correct answer Beneficiary and Provider Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?) - correct answer Registration staff members routinely contact managed care plans for prior authorizations before the patient is seen by the on duty physician Rural Health Clinics (RHC) personnel can provide services in all of the following locations, EXCEPT - correct answer Providing inpatient services in the RHC The patient discharge process begins when - correct answer The physician writes the discharge order CRCR Certification exam review 2023 questions and answers Departments that need to be included in charge master maintenance include all of the following EXCEPT - correct answer Quality Assurance The first thing a health plan does when processing a claim is - correct answer Check if the patient is a health plan beneficiary and what is the coverage Vital to accurate calculations of a patient's self-pay amount is - correct answer The most accurate way to validate patient information is to - correct answer require clinical staff to verify information at each treatment encounter In order for Regulation Z to apply, a hospital must - correct answer CRCR Certification exam review 2023 questions and answers Applying the contracted payment amount to the amount of total charges yields - correct answer A pricing agreement "Hard-coded" is the term used to refer to - correct answer Codes for services, procedures, and drugs automatically assigned by the charge master The advantages to using a third-party collection agency include all of the following EXCEPT - correct answer Providers pay pennies on each dollar collected Which of the following is usually covered on a Conditions of Admission form - correct answer Release of information The 501(r) regulations require not-for-profit providers (501(c)(3) organizations) to do which of the following activities. - correct answer CRCR Certification exam review 2023 questions and answers Complete a community needs assessment and develop a discount program for patient balances after insurance payment To be eligible for Medicaid, an individual must - correct answer meet income and asset requirements Eliminating mail time and reducing data entry time, electronically monitoring the receipt of claims and online claim adjudication, more prompt payment are all benefits achieved by - correct answer The electronic submission of claims using electronic transfers There are unique billing requirements based on - correct answer The provider type The unscheduled "direct" admission represents a patient who: - correct answer Is admitted from a physician's office on an urgent basis CRCR Certification exam review 2023 questions and answers In resolving medical accounts, a law firm may be used as: - correct answer A substitute for a collection agency The legal authority to request and analyze provider claim documentation to ensure that - correct answer The Office of the U.S. Inspector General (OIG) The office of inspector general (OIG) publishes a compliance work plan - correct answer Annually Room and bed charges are typically posted - correct answer From the midnight census All of the following information should be reviewed as part of schedule finalization EXCEPT: - correct answer The results of any and all test CRCR Certification exam review 2023 questions and answers The Electronic Remittance Advice (ERA) data set is : - correct answer A standardized form that provides third party payment details to providers All of the following are conditions that disqualify a procedure or service from being paid for by Medicare EXCEPT - correct answer Services and procedures that are custodial in nature Medicare beneficiaries remain in the same "benefit period" - correct answer Until the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days It is important to calculate reserves to ensure - correct answer Stable financial operations and accurate financial reporting A claim is denied for the following reasons, EXCEPT: - correct answer The submitted claim does not have the physicians signature CRCR Certification exam review 2023 questions and answers HFMA best practices call for patient financial discussions to be reinforced - correct answer By changing policies to programs Patients should be informed that costs presented in a price estimate may - correct answer Vary from estimates, depending on the actual services performed The nuanced data resulting from detailed ICD-10 coding allows senior leadership to work with physicians to do all of the following EXCEPT: - correct answer Obtain higher compensation for physicians Charges as the most appropriate measurement of utilization enables - correct answer Accuracy of expense and cost capture Once the EMTALA requirements are satisfied - correct answer The remaining registration processing is initiated at the bedside or in a registration area CRCR Certification exam review 2023 questions and answers Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite discharge, the HFMA best practice is to: - correct answer Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow In Chapter 7 straight bankruptcy filling - correct answer The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt Chapter 13 Bankruptcy, debtor rehabilitation is a court proceeding - correct answer That reorganizes a debtor's holdings and instructs creditors to look to the debtors' future earnings for payment This concept encompasses all activities required to send a request for payment to a third-party health plan for payment of benefits - correct answer Claims processing CRCR Certification exam review 2023 questions and answers An originating site is - correct answer The location of the patient at the time the service is provided Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare established guideline(s) used to determine: - correct answer Which diagnoses, signs, or symptoms are reimbursable If further treatment can only be provided in a hospital setting, the patient's condition cannot be evaluated and/or treated within 24 hours, or if there is not an anticipation of improvement in the patient's condition with 24 hours, the patient - correct answer Will be admitted as an inpatient The benefit of Medicare Advantage Plan is - correct answer Patients generally have their Medicare-coverage healthcare through the plan and do not need to worry about "part a" or "part b" benefits CRCR Certification exam review 2023 questions and answers The process of creating the pre-registration record ensures - correct answer Accurate billing Claims with dates of service received later than one calendar year beyond the date of service, will be - correct answer Denied by Medicare A portion of the accounts receivable inventory which has NOT qualified for billing includes - correct answer Charitable pledges The standard claim form used for billing by hospitals, nursing facilities, and other in-patient - correct answer UB-04 Once the price is estimated in the pre-service stage, a provider's financial best practice is to - correct answer Explain to the patient their financial responsibility and to determine the plan for payment CRCR Certification exam review 2023 questions and answers Internal controls addressing coding and reimbursement changes are put in place to guard against - correct answer Compliance fraud by upcoding Health Plan Contracting Departments do all of the following EXCEPT - correct answer Establish a global reimbursement rate to use with all third-party payer For routine scenarios, such as patients with insurance coverage or a known ability to pay, financial discussions: - correct answer Should take place between the patient or guarantor and properly trained provider representatives What type of account adjustment results from the patient's unwillingness to pay a self-pay balance? - correct answer Bad debt adjustment Most major health plans including Medicare and Medicaid, offer - correct answer Electronic and/or web portal verification CRCR Certification exam review 2023 questions and answers The first and most critical step in registering a patient, whether scheduled or unscheduled, is - correct answer Verifying the patient's identification When Recovery Audit Contractors (RAC) identify improper payments as over payments, the - correct answer Send a demand letter to the provider to recover the over payment amount Across all care settings, if a patient consents to a financial discussion during a medical encounter - correct answer Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by: - correct answer Each state's Medicaid plan CRCR Certification exam review 2023 questions and answers Medicare patients are NOT required to produce a physician order to receive which of these services - correct answer Screening Mammography, flu vaccine or pneumonia vaccine EFT (electronic funds transfer) is - correct answer An electronic transfer of funds from payer to payee The importance of medical records being maintained by HIM is that the patient records - correct answer Are the primary source for clinical data required for reimbursement by health plans and liability payers Days in A/R is calculated based on the value of: - correct answer The time it takes to collect anticipated revenue To maximize the value derived from customer complaints, all consumer complaints should be - correct answer Responded to within two business days CRCR Certification exam review 2023 questions and answers A scheduled inpatient represents an opportunity for the provider to do which of the following? - correct answer Complete registration and insurance approval before service In the pre-service stage, the requested service is screened for medical necessity, health - correct answer Pre-authorization are obtained Hospitals need which of the following information sets to assess a patient's financial status: - correct answer Patient and guarantor's income, expenses and assets Patients are contacting hospitals to proactively inquire about costs and fees prior to - correct answer The fact that charge master lists the total charge, not net charges that reflect charges after a payer's contractual adjustment HIPAA had adopted Employer Identification Numbers (EIN) to be used in standard transactions to identify the employer of an individual CRCR Certification exam review 2023 questions and answers HFMA best practices stipulate that a reasonable attempt should be made to have the financial - correct answer As early as possible, before a financial obligation is incurred Recognizing that health coverage is complicated and not all pts are able to navigate this terrain, HFMA best practices specify that - correct answer Patients should be given the opportunity to request a patient advocate, family member or other designee to help them In these discussions For scheduled patients, important revenue cycle activities In the Time of Service stage DO NOT INCLUDE: - correct answer Final bill is presented for payment HFMA's patient financial communication best practices specify that patients should be told about the types of services provided and - correct answer The service providers that typically participate in the service, e.g., radiologists, pathologists, etc. CRCR Certification exam review 2023 questions and answers Successful account resolution begins with - correct answer Collecting all deductibles and copayments during the pre-service stage Recognizing that health coverage is complicated and not all patients are able to navigate this terrain, HFMA best practices specify that - correct answer Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions In the balance resolution process, providers should: - correct answer Ask the patient if he or she would like to receive information about payment options and supportive financial assistance programs Business ethics, or organizational ethics represent: - correct answer The principles and standards by which organizations operate Which option is a government-sponsored health care program that is financed through taxes and general revenue funds - correct answer Medicare CRCR Certification exam review 2023 questions and answers Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on; a monthly fee is known as a - correct answer HMO In a Chapter 7 Straight Bankruptcy filing - correct answer The court liquidates the debtor's nonexempt property, pays creditors, and discharges the debtor from the debt When there is a request for service the scheduling staff member must confirm the patient's - correct answer Ensure that she/he accesses the correct information in the historical database A four digit number code established by the National Uniform Billing Committee (NUBC)that categorizes/classifies a line item in the charge master is known as - correct answer Revenue codes CRCR Certification exam review 2023 questions and answers What is Continuum of Care? - correct answer The coordination and linkage of resources needed to avoid the duplication of services and the facilitation of a seamless movement among care settings HIPAA privacy rules require covered entities to take all of the following actions EXCEPT - correct answer Use only designated software platforms to secure patient data The Two Midnight Rule allows hospitals to account for total hospital time when determining if an inpatient admission order should be written based on - correct answer A beneficiary needing a minimum of 48 hours of care Since passage of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to - correct answer Assist patients in understanding their insurance coverage and their financial obligation CRCR Certification exam review 2023 questions and answers HFMA patient financial communications best practices call for annual training for all staff EXCEPT - correct answer Nursing The process of verifying health insurance coverage, identifying contract terms, and obtaining total charges is known as - correct answer Insurance verification of reimbursable charges Net Accounts Receivable is - correct answer The amount an entity is reasonably confident of collecting from overall accounts receivable. ED patients should be informed that their ability to pay - correct answer Will not interfere with treatment of any emergency medical conditions Providers are advised that it is best to establish patient financial responsibility and assistance policies and make sure they are followed internally and by - correct answer Business affiliates CRCR Certification exam review 2023 questions and answers Incorrect data gathering can cause all of the following EXCEPT - correct answer The inability to discuss quality with physicians All Hospitals are required to establish a written financial assistance policy that applies to - correct answer All emergency and medically necessary care All of the following are reference resources used to help guide in the application of business ethics EXCEPT - correct answer Consumer satisfaction reports Each patient is assigned a unique number, commonly called the - correct answer Master Patient Index (MPI) number HIPAA contains all of the following goals EXCEPT - correct answer To ensure proper coding across the continuum of care