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CRCR Study Questions and Answers 2023
(Verified Answers by Expert)
1.This includes all the major processing steps required to process a pt
account from the request for service through closing the account with a
zero balance and purging it from the system: Patient Centric Revenue
Cycle
2.this is the period in which scheduling and pre-access takes place,
includ- ing different steps that will be completed: pre-service
3.what is it when the requested service is screened for medical
necessity, health plan coverage & benefits are verified, and pre-auth is
obtained: – pre-service
4.what is it when a final account review is completed prior to the patient’s
arrival? (Pre-reg record is activated, consents are signed, and copayments and other amounts are collected): scheduled patient- Time of
Service
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5.pre-processed patient’s can report to this, which is a desk located in
a centralized access, upon their arrival.: express arrival
6.this includes account activities that occur after the patient is d/c until
the account reaches a zero balance: post-service
7.Final coding of all services, perparation and submission of claims, payment processing and balance billing are all included and finalized when?:
- post-service
8.This brings consistency, clarity, and transparency to patient financial
com- munications: Patient Financial Communications Best Practices
9.this outlines steps to help patient’s understand the cost of services they
receive, their insurance coverage, and their individual responsibility
(review Patient Financial Comm. Best Practice document): Patient
Financial Commu- nications Best Practices
10.true or false: Conversations should occur in a location and manner
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that are sensitive to the patient’s needs: true
11.this type of discussion will help ensure that patient’s understand
their financial obligation and that providers are aware of the patient’s
ability to pay: timely discussions
12.the person responsible for payment of the bill: guarantor
13.true or false: A financial counselor or supervisor should be involve
d for complex situations such as uninsured or underinsured patient’s:
true
14.true or false: You MUST obtain basic registration info and insurance
coverage before the patient is cared for in the ED.: false; NO patient
financial discussions should occur before a patient is screened and
stabilized
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CRCR Test Review Questions and Answers 2023
(Verified ANSwers by Expert)
1.Important revenue cycle activities in the pre-service stage include; ANS
Obtain- ing or updating patient and guarantor information
2.In the pre-service stage, the cost of the scheduled service is identified
and the patient’s health plan and benefits are used to calculate; ANS The
amount the patient may be expected to pay after insurance.
3.Demographic and health plan edit failures are identified and resolved
within the Patient Access area. Census activity is processed, Discharges
are completed and correctly coded. These activities are considered ANS
Point-of-ser- vice revenue cycle activities.
4.HFMA best practices call for patient financial discussions to be
rein- forced; ANS With a written statement of the conversation
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5.HFMA’s patient financial communications best practices specify that patients should be told about the types of services provided and; ANS Who
partici- pates in providing the service, e.g. surgeons, radiologists, etc.
6.The process of evaluating compliance with financial assistance policies
involves; ANS The annual observation, monitoring, and tracking of
results for all best practices.
7.The account resolution clock begins when ANS The first statement is
sent to the patient
8.The soft cost of a dissatisfied customer is ANS The customer passing
on informa- tion about their negative experience to potential patients
or through social media channels
9.The hard cost of a dissatisfied customer is ANS loss of future revenue
10.When there is a request for service, scheduling staff must first ANS
Confirm the patients key identification information
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CRCR Exam Questions and Answers 2023
(Verified ANSwers by Expert)
1.Which of the following statements are true of HFMA’s Patient Financial
Communications Best Practices? ANS The best practices were
developed specifi- cally to help patients understand the cost of
services, their individual insurance benefits, and their responsibility
for balances after insurance, if any.
2.The patient experience includes all of the following except ANS
Recognition that revenue cycle processes must be patient-centric and
efficient. This is espe- cially true in the areas of scheduling,
registration, admitting, financial counseling and account resolution
conversation with patients.
3.Corporate compliance programs play an important role in protecting
the integrity of operations and ensuring compliance with federal and state
requirements. The code of conduct is ANS A critical tool to ensure
compliance, essential and integral component, fosters an
environment, (all of the above)
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4.Specific to Medicare free-for-service patients, which of the following payers have always been liable for payment? ANS Black lung service
programs, veteran affairs program, working aged programs, ESRD, and
disability
- Provider policies and procedures should be in place to reduce the risk
of ethics violations. Examples include ANS financial misconduct, theft of
property, applying policies in inconsistent manner (all of the above)
6.What is the intended outcome of collaborations made through an ACO
delivery system for a population of patients? ANS To eliminate duplicate
services, prevent medical errors and ensure appropriateness of care
7.What is the new terminology now employed in the calculation of net
patient service revenues? ANS explicit price concessions and implicit
price concessions
8.What are the two KPIs used to monitor performance related to the
produc- tion and submission of claims to third party payers and patients
(self-pay)? ANS – Elapsed days from discharge to final bill and elapsed
days from final bill to claim/bill submission
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9.What happens during the post-service stage? ANS Final coding of all
services, preparation and submission of claims, payment processing
and balance billing and resolution.
10.The following statements describe best practices established by the
Med- icaid Debt Task Force. Select true statements. ANS educate patients,
coordinate to avoid duplicate patient contacts, be consistent in key
aspects of account resolution, follow best practices for communication
11.Which option is NOT a main HFMA Healthcare Dollars & Sense
revenue cycle initiative? ANS Process Compliance
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CRCR PracticeQuestions and Answers 2023
(Verified Answers by Expert)
- The 501(r) regulations require not-for-profit providers 501(c) (3) to
do which of the following activities?
A. Complete a community needs assessment and develop a discount
pro- gram for patient balances after insurance payment.
B. Pursue extraordinary collection activities with all patients eligible
for financial assistance.
C. Implement a financial assistance program for uninsured and
underinsured patients.
D. Discount all charges to self-pay patients to an amount generally billed
to all other patients.: A. Complete a community needs assessment and
develop a discount program for patient balances after insurance
payment - The accurate capture of charges remains critically important because:
A. Of the potential of fraud and abuse charges from erroneous billing.
B. Charges remain one of the few consistent indicators available to
monitor resource use.
C. Charges are means of measuring physician productivity.
D.Charges provide the data used in activity based costing.: B. Charges
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remain one of the few consistent indicators available to monitor
resource use
- The ACO investment model will test the use of pre-paid shared savings
to:
A. Invest in treatment protocols that reduce costs to Medicare
B. Attract physicians to participate in the ACO payment system.
C. Raise quality ratings in designated hospitals.
D. Encourage new ACOs to form in rural and underserved areas.: D.
Encour- age new ACOs to form in rural and underserved areas - 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:
A. Have a patient financial responsibilities kit ready for the patient,
contain- ing all of the required registration forms and instructions.
B. Make sure that the attending staff can answer questions and assist
in obtaining required patient financial data.
C. Support that choice, providing that the discussion does not interfere
with patient care or disrupt patient flow.
D. Decline such request as finance discussions can disrupt patient care
and patient flow.: C. Support that choice, providing that the discussion
does not interfere with patient care or disrupt patient flow - Activities completed when the scheduled, pre-registered patient
arrives for service includes:
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A.Verifying insurance, activating the record and directing the patient to
the service area.
B. Scanning the driver’s license or other phot identification and directing
the patient to the financial counselor.
C. Activating the record, obtaining signatures and finalizing financial
issues.
D. Registering the patient and directing the patient to the service area.:
C. Activating the record, obtaining signatures and
- 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:
A. Utilization review
B. Case Management
C. Census Management
D. Patient through-put: A. Utilization
review or
B. Case Management - An advantage of a pre-registration program is:
A.The markets value of such a program
B.The ability to eliminate no-show appointments.
C.The opportunity to reduce processing times at the time of service.
D.The opportunity to reduce corporate compliance failures within the registration process.: C. The opportunity to reduce processing times at
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the time of service.
- The Affordable Care Act legislated the development of Health
Insurance Exchanges, where individuals and small businesses can:
A. Obtain price estimates for medical services
B. Negotiate the price of medical services with providers
C. Purchase qualified health benefit plans regardless of insured’s
health status
D. Meet federal mandates for insurance coverage and obtain the corresponding tax deduction: C. Purchase qualified health benefit plans
regardless of insured’s health status. - All of the following are conditions that disqualify a procedure or
service from being paid for by Medicare EXCEPT:
A. Offered in an outpatient setting
B. Medically unnecessary
C. Not delivered in a Medicare licensed care setting.
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CRCR Certification Exam Questions and Answers 2023
(Verified Answers by Expert)
1.Overall aggregate payments made to a hospice are subject to a
computed “cap amount” calculated by>>> The Medicare Administrative
Contractor (MAC) at the end of the hospice cap period
2.Which of the following is required for participation in Medicaid>>>
Meet In- come and Assets Requirements
3.In choosing a setting for patient financial discussions,
organizations should first and foremost>>> Respect the patients
privacy
4.A nightly room charge will be incorrect if the patient’s>>> Transfer
from ICU (intensive care unit) to the Medical/Surgical
floor is not reflected in the registration system
5.The Affordable Care Act legislated the development of Health Insurance
Exchanges, where individuals and small businesses can>>> Purchase
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qualified health benefit plans regardless of insured’s
health status
6.A portion of the accounts receivable inventory which has NOT qualified
for billing includes>>>>>> Charitable pledges
7.What is required for the UB-04/837-I, used by Rural Health Clinics
to generate payment from Medicare?>>> Revenue codes
8.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>>> Patient bill of rights
9.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>>> Case management
10.Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation?>>> Registration staff may routinely contact
managed are plans for prior authorizations before the patient is seen
by the on-duty physician
- HIPAA had adopted Employer Identification Numbers (EIN) to be used
in standard transactions to identify the employer of an individual described
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in a transaction EIN’s are
assigned by>>> The Internal Revenue Service
12.Checks received through mail, cash received through mail, and lock
box are all examples of>>> Control points for cash posting
13.What are some core elements if a board-approved financial
assistance policy?>>> Eligibility, application process, and nonpayment
collection activities
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14.A recurring/series registration is characterized by>>> The creation
of one registration record for multiple days of service
15.With the advent 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>>> Assist patients in understanding
their insurance coverage and their financial obligation
16.The purpose of a financial report is to>>>>>> Present financial
information to decision makers
17.Patient financial communications best practices produce
communica- tions that are>>> Consistent, clear and transparent
18.Medicare has established guidelines called the Local Coverage
Determi- nations (LCD) and National Coverage Determinations (NCD) that
establish>>> – What services or healthcare items are covered under
Medicare
19.Any provider that has filed a timely cost report may appeal an adverse
final decision received from the Medicare Administrative Contractor
(MAC). This appeal may be filed with>>> The Provider Reimbursement
Review Board
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CRCR Exam Prep Questions and Answers 2023
1.What are collection agency fees based on ANS A percentage of dollars
collected
2.Self-funded benefit plans may choose to coordinate benefits using
the gender rule or what other rule ANS Birthday
3.In what type of payment methodology is a lump sum or bundled
payment negotiated between the payer and some or all providers ANS
Case rates
4.What customer service improvements might improve the patient
accounts department ANS Holding staff accountable for customer
service during performance reviews
5.What is an ABN (Advance Beneficiary Notice of Non-coverage) required
to do ANS Inform a Medicare beneficiary that Medicare may not pay for
the order or service
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6.What type of account adjustment results from the patient’s
unwillingness to pay for a self-pay balance ANS Bad debt adjustment
7.What is the initial hospice benefit ANS Two 90-day periods and an
unlimited number of subsequent periods
8.When does a hospital add ambulance charges to the Medicare inpatient
claim ANS If the patient requires ambulance transportation to a skilled
nursing facility
9.How should a provider resolve a late-charge credit posted after an
account is billed ANS Post a late-charge adjustment to the account
10.an increase in the dollars aged greater than 90 days from date of
service indicate what about accounts ANS They are not being processed
in a timely manner
11.What is an advantage of a preregistration program ANS It reduces
processing times at the time of service
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12.What are the two statutory exclusions from hospice coverage ANS
Medically unnecessary services and custodial care
13.What core financial activities are resolved within patient access ANS
Sched- uling, insurance verification, discharge processing, and
payment of point-of-ser- vice receipts
14.What statement applies to the scheduled outpatient ANS The services
do not involve an overnight stay
15.How is a mis-posted contractual allowance resolved ANS Comparing
the contract reimbursement rates with the contract on the admittance
advice to identify the correct amount
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CRCR Study Questions and Answers 2023
(Verified Answers by Expert)
1.code of conduct ANS hospital establish compliance standards
2.Purpose of OIG work plan ANS communicate issues that will be
reviewed during the year for compliance with Medicare regulations
3.Medicare pt. admitted on Friday, what services fall within the three day
window rule ANS Dx services and related charges provided on the W,R,
and F before adm.
4.What does modifier allow a provider to do ANS Report a specific
circumstance that affected a procedure or service without changing
the code or its definition
5.Out pt. dx services provided within 3 days of adm. of a medicare benef.
to an IPPS hospt, what must happen to these charges ANS combined
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with the in pt. bill and paid under the MS-DRG system
6.Why is OIG pursuing the medicare Secondary Payer ANS 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
7.Recurring or series registration ANS one reg. record is created for
multi days of service
8.Nonemergency pt. who comes for service w/out prior notif. to the
provider called ANS unscheduled pt.
9.stmnts apply to observ. pt. type ANS used to evaluate the need for an
in pt. adm.
10.which services are hospice programs required to provide on an
around the clock basis ANS physician, nursing, pharmacy
11.purpose of initial step in put pt. testing scheduling process ANS
identifying the correct pt. in the providers database or add the pt. to
the database
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- scheduler instructions are used to prompt the scheduler to do what
ANS –
complete the scheduling process correctly based on service requested
13.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 ANS documentation of the medical necessity for the test
14.advantage of pre reg. program ANS reduces processing times at
the time of service
15.what data are required to est. a new MPI entry ANS pts. name, DOB,
sex
16.Which HIPAA tr ANS. set provides electronic processing of ins, verif
re- quests and responses ANS the 270-271 set