CRCR EXAM MULTIPLE CHOICE,
CRCR Exam Prep, Certified Revenue
Cycle Representative – CRCR (2023/2024)
What are collection agency fees based on? – ANSWER
A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule
or what other rule? – ANSWER Birthday
In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers? – ANSWER
Case rates
What customer service improvements might improve the patient accounts
department? – ANSWER Holding staff
accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? –
ANSWER Inform a Medicare beneficiary that
Medicare may not pay for the order or service
What type of account adjustment results from the patient’s unwillingness to pay for
a self-pay balance? – ANSWER Bad debt
adjustment
What is the initial hospice benefit? – ANSWER
Two 90-day periods and an unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? –
ANSWER If the patient requires ambulance
transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account is
billed? – ANSWER Post a late-charge adjustment
to the account
an increase in the dollars aged greater than 90 days from date of service indicate
what about accounts – ANSWER They are not
being processed in a timely manner
What is an advantage of a preregistration program? – ANSWER
It reduces processing times at the time of service
What are the two statutory exclusions from hospice coverage? – ANSWER
Medically unnecessary services and custodial care
What core financial activities are resolved within patient access? – ANSWER
Scheduling, insurance verification, discharge processing, and payment of point-ofservice receipts
What statement applies to the scheduled outpatient? – ANSWER
The services do not involve an overnight stay
How is a mis-posted contractual allowance resolved? – ANSWER
Comparing the contract reimbursement rates with the contract on the admittance
advice to identify the correct amount
What type of patient status is used to evaluate the patient’s need for inpatient care?
- ANSWER Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require
that the beneficiary has received what? – ANSWER
Medically necessary inpatient hospital services for at least 3 consecutive days
before the skilled nursing care admission
When is the word “SAME” entered on the CMS 1500 billing form in Field 0$? –
ANSWER When the patient is the insured
What are non-emergency patients who come for service without prior notification
to the provider called? – ANSWER Unscheduled
patients
If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber’s spouse? – ANSWER
Neither enrolled not entitled to benefits
HFMA CRCR exam 2023/2024 with
100% correct answers
Which of the following statements are true of HFMA’s Patient Financial
Communications Best Practices? – ANSWER
The best practices were developed specifically to help patients understand the cost
of services, their individual insurance benefits, and their responsibility for balances
after insurance, if any.
The patient experience includes all of the following except: – ANSWER
Recognition that revenue cycle processes must be patient-centric and efficient.
This is especially true in the areas of scheduling, registration, admitting, financial
counseling and account resolution conversation with patients.
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: – ANSWER A critical
tool to ensure compliance, essential and integral component, fosters an
environment, (all of the above)
Specific to Medicare free-for-service patients, which of the following payers have
always been liable for payment? – ANSWER
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: – ANSWER
financial misconduct, theft of property, applying policies in inconsistent manner
(all of the above)
What is the intended outcome of collaborations made through an ACO delivery
system for a population of patients? – ANSWER
To eliminate duplicate services, prevent medical errors and ensure appropriateness
of care
What is the new terminology now employed in the calculation of net patient
service revenues? – ANSWER explicit
price concessions and implicit price concessions
What are the two KPIs used to monitor performance related to the production and
submission of claims to third party payers and patients (self-pay)? – ANSWER
Elapsed days from discharge to final bill and elapsed days from final bill to
claim/bill submission
What happens during the post-service stage? – ANSWER
Final coding of all services, preparation and submission of claims, payment
processing and balance billing and resolution.
The following statements describe best practices established by the Medicaid Debt
Task Force. Select true statements. – ANSWER
educate patients, coordinate to avoid duplicate patient contacts, be consistent in
key aspects of account resolution, follow best practices for communication
Which option is NOT a main HFMA Healthcare Dollars & Sense revenue cycle
initiative? – ANSWER Process
Compliance
What is the objective of the HCAHPS initiative? – ANSWER
To provide a standardized method for evaluating patient’s perspective on hospital
care
Which option is NOT a department that supports and collaborates with the revenue
cycle? – ANSWER Assisted Living
Services
CRCR Certification
2023/2024
The disadvantages of outsourcing include all of the following EXCEPT:
a) The impact of customer service or patient relations
b) The impact of loss of direct control of accounts receivable services
c) Increased costs due to vendor ineffectiveness
d) Reduced internal staffing costs and a reliance on outsourced staff –
ANSWER d) Reduced internal
staffing costs and a reliance on outsourced staff
The Medicare fee-for service appeal process for both beneficiaries and
providers
includes all of the following levels EXCEPT:
a) Medical necessity review by an independent physician’s panel
b) Judicial review by a federal district court
c) Redetermination by the company that handles claims for Medicare
d) Review by the Medicare Appeals Council (Appeals Council) – ANSWER
b) Judicial review by a federal district court
Business ethics, or organizational ethics represent:
a) The principles and standards by which organizations operate
b) Regulations that must be followed by law
c) Definitions of appropriate customer service
d) The code of acceptable conduct – ANSWER
a) The principles and standards by which organizations operate
A portion of the accounts receivable inventory which has NOT qualified for
billing
includes:
a) Charitable pledges
b) Accounts created during pre-registration but not activated
c) Accounts coded but held within the suspense period
d) Accounts assigned to a pre-collection agency – ANSWER
a) Charitable pledges
Local Coverage Determinations (LCD) and National Coverage Determinations
(NCD) are
Medicare established guideline(s) used to determine:
a) Medicare and Medicaid provider eligibility
b) Medicare outpatient reimbursement rates
c) Which diagnoses, signs, or symptoms are reimbursable
d) What Medicare reimburses and what should be referred to Medicaid –
ANSWER c) Which diagnoses, signs,
or symptoms are reimbursable
Days in A/R is calculated based on the value of:
a) The total accounts receivable on a specific date
b) Total anticipated revenue minus expenses
c) The time it takes to collect anticipated revenue
d) Total cash received to date – ANSWER
c) The time it takes to collect anticipated revenue
Patients are contacting hospitals to proactively inquire about costs and fees
prior to
agreeing to service. The problem for hospitals in providing such information
is:
a) That hospitals don’t want to establish a price without knowing if
the patient has insurance and how much reimbursement can be
expected
b) The fact that charge master lists the total charge, not net charges
that reflect charges after a payer’s contractual adjustment
c) That hospitals don’t want to be put in the position of
“guaranteeing” price without having room for additional charges
that may arise in the course of treatment
d) Their reluctance to share proprietary information – ANSWER
b) The fact that charge master lists the total charge, not net charges
that reflect charges after a payer’s contractual adjustment
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) Make sure that the attending staff can answer questions and
assist in obtaining required patient financial data
b) Have a patient responsibilities kit ready for the patient,
containing all of the required registration forms and instructions
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 – ANSWER c)
Support that choice, providing that the discussion does not interfere with
patient care or disrupt patient flow
A comprehensive “Compliance Program” is defined as
a) Annual legal audit and review for adherence to regulations
b) Educating staff on regulations
c) Systematic procedures to ensure that the provisions of regulations imposed
by a government
agency are being met
d) The development of operational policies that correspond to regulations –
ANSWER c) Systematic procedures
to ensure that the provisions of regulations imposed by a government
- Case Management requires that a case manager be assigned
a) To patients of any physician requesting case management
b) To a select patient group
c) To every patient
d) To specific cases designated by third party contractual agreement –
ANSWER b) To a select patient
group
Pricing transparency is defined as readily available information on the price of
healthcare
services, that together with other information, help define the value of those
services and