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CRCR STUDY QUESTIONS AND ANSWERS (RATED A) 2023, Exams of Nursing

CRCR STUDY QUESTIONS AND ANSWERS (RATED A) 2023

Typology: Exams

2022/2023

Available from 08/27/2023

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CRCR STUDY QUESTIONS AND
ANSWERS (RATED A) 2023
code of conduct - correct answer hospital establish compliance standards
Purpose of OIG work plan? - correct answer 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? - correct
answer Dx services and related charges provided on the W,R, and F before adm.
What does modifier allow a provider to do? - correct answer 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 - correct answer combined with the in pt. bill and paid under the MS-DRG
system
Why is OIG pursuing the medicare Secondary Payer - correct answer 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? - correct answer one reg. record is created for multi days of service
Nonemergency pt. who comes for service w/out prior notif. to the provider called? - correct answer
unscheduled pt.
stmnts apply to observ. pt. type - correct answer used to evaluate the need for an in pt. adm.
which services are hospice programs required to provide on an around the clock basis - correct
answer physician, nursing, pharmacy
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Download CRCR STUDY QUESTIONS AND ANSWERS (RATED A) 2023 and more Exams Nursing in PDF only on Docsity!

ANSWERS (RATED A) 2023

code of conduct - correct answer hospital establish compliance standards

Purpose of OIG work plan? - correct answer 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? - correct

answer Dx services and related charges provided on the W,R, and F before adm.

What does modifier allow a provider to do? - correct answer 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 - correct answer combined with the in pt. bill and paid under the MS-DRG

system

Why is OIG pursuing the medicare Secondary Payer - correct answer 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? - correct answer one reg. record is created for multi days of service

Nonemergency pt. who comes for service w/out prior notif. to the provider called? - correct answer

unscheduled pt.

stmnts apply to observ. pt. type - correct answer used to evaluate the need for an in pt. adm.

which services are hospice programs required to provide on an around the clock basis - correct

answer physician, nursing, pharmacy

ANSWERS (RATED A) 2023

purpose of initial step in put pt. testing scheduling process - correct answer 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? - correct answer 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? - correct answer documentation of the

medical necessity for the test

advantage of pre reg. program? - correct answer reduces processing times at the time of serivce

what data are required to est. a new MPI entry? - correct answer pts. name, DOB, sex

Which HIPAA trans. set provides electronic processing of ins, verif requests and responses? - correct

answer 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 - correct

answer mothers

true about third party payers? - correct answer payments received by the provider from the payer

respon. for reimbursing the provider for the pts. covered services

co-payment? - correct answer fixed amt. that is due for a specific service

ANSWERS (RATED A) 2023

which of the following is a step in the discharge process? - correct answer have case management

services complete the discharge plan

what curcumstances would result in an incorrect nightly room charge? - correct answer 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 - correct answer 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? - correct answer 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. - correct answer 100

which of the following items are considered valid proof of income documents. - correct answer

copies of paycheck stubs from the recent three months

When is a pt. considered to be medically indigent? - correct answer pt. outstanding med bills exceed

a defined dollar amt or percent of asset

what pt assets are considered in the fin assist app - correct answer primary residence

if the pt cannot agree to payment arrangments, what is the next best option - correct answer warn

pt that unpaid accts are placed w collection agencies for further processing

what are numbered receipts for - correct answer ensure all payments are properly acted for and

deposited

ANSWERS (RATED A) 2023

what is an effective tool to help staff collect payments at time of service - correct answer develop

scripts for the process of requesting payment

what must happen to cash, checks, and credit card transactions at the end of each shift - correct

answer balance

why is it important to have a high quality standards for reg. - correct answer bc quality failures affect

the providers Joint Commish results on review day

how does utilization review staff use correct ins info - correct answer obtain approval for in pt. days

and coordinate services

what core fin activities are resolved within pt. access - correct answer scheduling, pre-reg, ins verif,

mng care process

what is an unscheduled direct admission - correct answer pt. who is admitted from the physicians

office on an urgent basis

when is not appro to use an observ status - correct answer as a sub for in pt admission

pt who require periodic skilled nursing or therapeutic care receive services from what type of program -

correct answer home health agency

type of info that is typically collected during the scheduling contact - correct answer 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 - correct answer printed copy f

providers privacy notice

ANSWERS (RATED A) 2023

NOT true of medicare adv plans - correct answer pts who join medicare adv plan will not receive a

health ins card from the plan they selected

an acceptable way to complete MSP screening for a liability situation - correct answer 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 - correct answer failure to

complete auth requirements

NOT a possible consequence of selecting the wrong pt in the MPI - correct answer claim is paid in

full

comprehensive [re-reg data includes which of the following - correct answer complete insurance

and emergency contact info

which is true of medicare adv plan - correct answer a managed care plan for medicare beneficiaries

which is not a characteristics of a Medicaid HMO - correct answer Medicaid-eligible pts are never

required to join a Medicaid HMO plan

which stmnt describes APC (ambulatory payment classification) system - correct answer 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 -

correct answer auth services beofer they are provided and strictly limit days of in pt. care approved

w/out additional clinical info from the provider

ANSWERS (RATED A) 2023

a violation of EMTALA - correct answer 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 - correct answer

notification can be issued no earlier than 7 days before admission and no more than 2 days before discharge

true stmnt of internal in pt tansfers - correct answer 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 - correct answer portion of the adjudicated claim that is

fure from the patient

which of the following is an alternative to valid lonf-term payment plans - correct answer 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 - correct answer 6000

type of plan restricts benefits for nonemergency care to approced providers only - correct answer A

PPO plan

what does scheduling allow a provider staff to do - correct answer 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 -

correct answer pt ins is the primary ins.

ANSWERS (RATED A) 2023

example of a technical denial - correct answer exceeding frequency limitations

how does financial counseling process begin - correct answer explain the hospitals credit and

collection policies and what they mean to the patients

hoe does a health pln recover dollars paid for a liability claim from the liability carrier - correct

answer subrogation

type of acct adjustment results from the pt inability to pay a self balance - correct answer charity

adjustment according to the department of health and human services guidelines, which of the following is not

considered income - correct answer sale of property , house, or car

what must a provider do to qualify an acct as a medicare bad debt - correct answer 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 - correct answer archiving

of the fully resolved acct

how does increasing the provision for bad debts affect the financial statements - correct answer

reduces gross receivables and increase operating expense for the period

a successful medicare pay for performance initiative will likely result iin what - correct answer higher

payments while covering sicker beneficiaries

what are some component of the charge master - correct answer room charges and detailed

ancillary charges

ANSWERS (RATED A) 2023

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 - correct answer 400

how are charges recorded as charity care treated - correct answer 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 - correct answer prospective review, concurrent review, and

retrospective review

the situation where neither the pt nor spouse is employed is described to the payer using: - correct

answer a condition code

regulations and requirements for creating accountable care organizations which allowed providers to

beign creating these organization were finalized - correct answer 2012

what is correct discharge status code for a pt who is discharged to a swing bed unit in the same hospital -

correct answer 61

what is the primary responsibility of the recovery audit contractor - correct answer to correct

identity proper payments for medicare part a and b claims