Download CRCR Exam Questions and Answers (Graded A+) and more Exams Nursing in PDF only on Docsity!
ANSWERS (GRADED A+) 2024
code of conduct - SOLUTION hospital establish compliance standards
Purpose of OIG work plan? - SOLUTION communicate issues that will be reviewed during the year for
compliance with Medicare regulations
Medicare pt. admitted on Friday, what services fall within the three day window rule? - SOLUTION Dx
services and related charges provided on the W,R, and F before adm.
What does modifier allow a provider to do? - SOLUTION Report a specific circumstance that affected a
procedure or service without changing the code or its definition Out pt. dx services provided within 3 days of adm. of a medicare benef. to an IPPS hospt, what must
happen to these charges - SOLUTION combined with the in pt. bill and paid under the MS-DRG system
Why is OIG pursuing the medicare Secondary Payer - SOLUTION reviews medicare payments for
beneficiaries who have other insurance and assesses the effect. of procedures in preventing inappro. medcare payments for benef. with other ins. coverage
Recurring or series registration? - SOLUTION one reg. record is created for multi days of service
Nonemergency pt. who comes for service w/out prior notif. to the provider called? - SOLUTION
unscheduled pt.
stmnts apply to observ. pt. type - SOLUTION used to evaluate the need for an in pt. adm.
which services are hospice programs required to provide on an around the clock basis - SOLUTION
physician, nursing, pharmacy
ANSWERS (GRADED A+) 2024
purpose of initial step in put pt. testing scheduling process - SOLUTION identifying the correct pt. in
the providers database or add the pt. to the database
scheduler instructions are used to prompt the scheduler to do what? - SOLUTION complete the
scheduling process correctly based on service requested medicare guidelines require that when a test is ordered for which an LCD or NCD exists, the info
provided on the order must include which of the following? - SOLUTION documentation of the
medical necessity for the test
advantage of pre reg. program? - SOLUTION reduces processing times at the time of serivce
what data are required to est. a new MPI entry? - SOLUTION pts. name, DOB, sex
Which HIPAA trans. set provides electronic processing of ins, verif requests and responses? -
SOLUTION the 270-271 set
a mother and father both cover their 16 yo child as a dep. on their health ins, plans, which both follow
the bday rule. mothers dob is 1-19-68 and fathers dob is 7-19-67; whose plan is primary - SOLUTION
mothers
true about third party payers? - SOLUTION payments received by the provider from the payer respon.
for reimbursing the provider for the pts. covered services
co-payment? - SOLUTION fixed amt. that is due for a specific service
pts annual out of pocket limitation is 3000, excluding deduct. to date this cal. year the pt has satisfied the 500 deduct. and has paid 2300 in co insurance to various providers. max amount of coinsurance the
pt will owe - SOLUTION 700
ANSWERS (GRADED A+) 2024
what curcumstances would result in an incorrect nightly room charge? - SOLUTION if pt. transfer from
the ICU to medical/surgical floor is not reflected in the reg system
which stmnt describes the goal of fin counseling services - SOLUTION help the pt. understand
insurance coverage, including what the pt will owe for the current services hospital has an APC based contract for the payment of out pt. services. total anticipated charges for the visit are 2,380. the approved apc payment rate is 780. Where will the patient benefit package be
applied? - SOLUTION to the approved APC payment rate
pt. has met the 200 ind. deductible and 900 of the 1000 co-ins. resp. the co-ins. rate is 20%. the est. ins.
plan respon is 1975. what amt. of co-ins. is due from pt. - SOLUTION 100
which of the following items are considered valid proof of income documents. - SOLUTION copies of
paycheck stubs from the recent three months
When is a pt. considered to be medically indigent? - SOLUTION pt. outstanding med bills exceed a
defined dollar amt or percent of asset
what pt assets are considered in the fin assist app - SOLUTION primary residence
if the pt cannot agree to payment arrangments, what is the next best option - SOLUTION warn pt that
unpaid accts are placed w collection agencies for further processing
what are numbered receipts for - SOLUTION ensure all payments are properly acted for and
deposited
what is an effective tool to help staff collect payments at time of service - SOLUTION develop scripts
for the process of requesting payment
ANSWERS (GRADED A+) 2024
what must happen to cash, checks, and credit card transactions at the end of each shift - SOLUTION
balance
why is it important to have a high quality standards for reg. - SOLUTION bc quality failures affect the
providers Joint Commish results on review day
how does utilization review staff use correct ins info - SOLUTION obtain approval for in pt. days and
coordinate services
what core fin activities are resolved within pt. access - SOLUTION scheduling, pre-reg, ins verif, mng
care process
what is an unscheduled direct admission - SOLUTION pt. who is admitted from the physicians office
on an urgent basis
when is not appro to use an observ status - SOLUTION as a sub for in pt admission
pt who require periodic skilled nursing or therapeutic care receive services from what type of program -
SOLUTION home health agency
type of info that is typically collected during the scheduling contact - SOLUTION pt name, dob, sex, dx,
req test/proced, prefer dos, ordering phys, pt tele #
every pt who is new to health care provider must be offered what - SOLUTION printed copy f
providers privacy notice
which stmnt applies to self insured plans - SOLUTION employer assumes direct respon and risk for
employee healthcare claims
ANSWERS (GRADED A+) 2024
an acceptable way to complete MSP screening for a liability situation - SOLUTION ask if the current
service is related to an accident
which of the following is a valid reason for a payer to deny a claim - SOLUTION failure to complete
auth requirements
NOT a possible consequence of selecting the wrong pt in the MPI - SOLUTION claim is paid in full
comprehensive [re-reg data includes which of the following - SOLUTION complete insurance and
emergency contact info
which is true of medicare adv plan - SOLUTION a managed care plan for medicare beneficiaries
which is not a characteristics of a Medicaid HMO - SOLUTION Medicaid-eligible pts are never required
to join a Medicaid HMO plan
which stmnt describes APC (ambulatory payment classification) system - SOLUTION APC rates are
calculated on national basis and are wage adjusted by geographic region process does a managed care plan use to determing if health care servces are approp for a pt. condition -
SOLUTION auth services beofer they are provided and strictly limit days of in pt. care approved w/out
additional clinical info from the provider
a violation of EMTALA - SOLUTION registration staff members routinely contact mnged care plans for
prior auth before pt is seen by the on duty physician
stmnt is trueof important message from medicare notification requirements - SOLUTION notification
can be issued no earlier than 7 days before admission and no more than 2 days before discharge
ANSWERS (GRADED A+) 2024
true stmnt of internal in pt tansfers - SOLUTION transfers are coordinated by the bed-placement
coordinator and are not recorded in the system until the pt is moved to the receiving unit and bed
what is the self pay balance after insurance - SOLUTION portion of the adjudicated claim that is fure
from the patient
which of the following is an alternative to valid lonf-term payment plans - SOLUTION bank loans
pt has the following benefit plan: 400 per family member deductible, to max of 1200 per year and 2000 per family member co-ins, toa family max of 6000 per year, excluding the deductible. 5 family memebers are enrolled in this benefit plan. what is the max out of pocket exp that the family can occur during the
calender year - SOLUTION 6000
type of plan restricts benefits for nonemergency care to approced providers only - SOLUTION A PPO
plan
what does scheduling allow a provider staff to do - SOLUTION review the approp of the service
requested when an adult pt is covered by both his own and his spouses health ins plan, which of the stmnt is true -
SOLUTION pt ins is the primary ins.
claim is related to an accident, what must the hospital report - SOLUTION county in which the
accident occured mrs jones, a med beneficiary, was admitted to the hospital on june 20, 2010. as of the admission date, she had only used 8 in pt. days in the current benefit period. if not discharged, on what date will mrs.
jones exhaust her full coverage days - SOLUTION August 9, 2010
ANSWERS (GRADED A+) 2024
hoe does a health pln recover dollars paid for a liability claim from the liability carrier - SOLUTION
subrogation
type of acct adjustment results from the pt inability to pay a self balance - SOLUTION charity
adjustment according to the department of health and human services guidelines, which of the following is not
considered income - SOLUTION sale of property , house, or car
what must a provider do to qualify an acct as a medicare bad debt - SOLUTION pursue the acct for
120 days and then refer it to an outside collection agency
revenue cycle begins with scheduling a pt. for service and ends with what - SOLUTION archiving of the
fully resolved acct
how does increasing the provision for bad debts affect the financial statements - SOLUTION reduces
gross receivables and increase operating expense for the period
a successful medicare pay for performance initiative will likely result iin what - SOLUTION higher
payments while covering sicker beneficiaries
what are some component of the charge master - SOLUTION room charges and detailed ancillary
charges using pt specific info, calculate the pt liability for MRI of the right knww. the charge master price based on CPT code for MRI is 2500; the payers contract discount wtht the provider is 20% of the charges; the pt
benefit plan deductible of 80/20 with no limit on pt portion was met - SOLUTION 400
ANSWERS (GRADED A+) 2024
how are charges recorded as charity care treated - SOLUTION as a deduction from the revenue that is
reported as a footnote to the financial statments what type of utilization review are used to ensure that resources and services are provided in the most
efficient and effective ways - SOLUTION prospective review, concurrent review, and retrospective
review the situation where neither the pt nor spouse is employed is described to the payer using: -
SOLUTION a condition code
regulations and requirements for creating accountable care organizations which allowed providers to
beign creating these organization were finalized - SOLUTION 2012
what is correct discharge status code for a pt who is discharged to a swing bed unit in the same hospital -
SOLUTION 61
what is the primary responsibility of the recovery audit contractor - SOLUTION to correct identity
proper payments for medicare part a and b claims
