FREE AND STUDY GAMES ABOUT SECTION 3 CRCR EXAM

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FREE AND STUDY GAMES ABOUT SECTION 3 CRCR EXAM

QUESTIONS

Actual Qs and Ans Expert-Verified Explanation

This Exam contains:

-Guarantee passing score -125 Questions and Answers -format set of multiple-choice -Expert-Verified Explanation

Question 1: Consulting Physician

Answer:

used by attending physician for advice on care

Question 2: Ambulance Billing

Answer:

Goes directly to the health plan except if there is a diagnostic service that the hospital cannot provide, Divides services into 600 procedural groups.

Question 3: Modifiers

Answer:

• digit alphanumeric characters that can be appended to the CPT or HCPCS that provides additional

information

Question 4: Electronic Claim Submission

Answer:

• Submit receipt and processing is all electronic
• providers can electronically monitor receipt of claims
• online claim adjudication is performed and providers recieve result so providers collect patient

liability with payment turnaround minimized

Question 5: Hospital Based Physicians

Answer:

HBP

Question 6: Importance of HIM

Answer:

helps with health insurance claims. Effects reimbursement of providers because medical records serve as the basis for reimbursement of payment from 3rd party payers. Used to substantiate health insurance claims filed by physician, provider, and patient.

Question 7: Patient Dumping

Answer:

Sending a patient to another facility for care that should be completed in the ED and if the patient is referred for follow up care and a physician accepts the referral the physician must provide the care regardless of the patient ability to pay

Question 8: Outpatient Series

Answer:

one single claim but must submit interim bill used for extending out patient status if over 30 days an interim bill is sent every 30 days

Question 9: What is the charge Master

Answer:

List of services procedures room accommodations supplies and drug s or radiopharmaceuticals billed to the hospital inpatient or outpatient

Question 10: Capitation

Answer:

provider receives a flat fee every month per individual for enrolled in a managed care health plan. Per member per monthon

Question 11: Types of Registration Forms

Answer:

Consent to treat, privacy notice, and condition of admission, important message from Medicare, Power of Attorney/Advanced directive, Medicare Outpatient Observation Notice, Patients Bill of Rights

Question 12: Charge Captuer

Answer:

how a provider charges patients and the health plan. Revenue associated with service. The process of recording a change for service or item on a patient's record

Question 13: EHR and Claim generation

Answer:

connected to coding an charge software . The connection between clinical documentation process to the coding and charge process that supports claims

Question 14: EHR System

Answer:

medical and treatment histories . Diagnosis, meds, treatment plans, immunization dates , allergies and radiology

Question 15: Ambulatory Payment Classification

Answer:

divides all included outpatient services into 600 procedure groups

Question 16: Clinic Billing

Answer:

CMS regulations for facility and professional billing are 2 claims 2 copays and 2 coinsurance

Question 17: What is MPI

Answer:

Full name, soc, DOB, Photo ID

Question 18: Denials and appeals

Answer:

Managed by case managers

Question 19: BPCI

Answer:

Medicare Bundled Care Initiative

Question 20: What are level 2 HCPCS Codes

Answer:

CMS developed codes to classify supplies and non physician services such as DME, ambulance, medical and surgical supplies and drugs. This begins with a single letter A-V

Question 21: HCPCS Codes

Answer:

Indicate that a procedure was altered by circumstances but not changed in the definition or code. Used to indicate that a procedure was altered by a circumstance but not charged in its definition or code There are 3 levels of modifiers

Question 22: Types of Case Management Review

Answer:

Perspective view (pre cert) Concurrent review, discharge, retrospective review after service

Question 23: EMTALA Requirements

Answer:

hospitals provide MSE medical screening examination to determine EMC Emergency Medical Condition. Must stabilizing health treatment to everyone that request it . Do not ask about insurance or payment if it delays treatment

Question 24: UB-04 Source of Data Summary

Answer:

Patient access staff has a significant role in ensuring that the UB-04 form is completed accurately

Question 25: Revenue Capture and Recognition

Answer:

grouped by revenue codes for billing.

Question 26: Per Diem Payment

Answer:

per day a fixed amount per patient per day inpatient stay FFS used by PPO HMO MCO