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
