FREE STANDARDIZED TESTS AND STUDY GAMES ABOUT

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FREE STANDARDIZED TESTS AND STUDY GAMES ABOUT

CRCR Actual Qs and Ans Expert-Verified Explanation

This Exam contains:

-Guarantee passing score -87 Questions and Answers -format set of multiple-choice -Expert-Verified Explanation

Question 1: Site of service limitation?

Answer:

health plans developed care plans for common disease and procedures and must happen in approved setting Question 2: The first critical step for all patients arriving for service scheduled or unscheduled is verifying patients identity with 2 forms...list

Answer:

ID, name, DOB, SSN

Question 3: UBO4 is used for institutional providers(List 4)

Answer:

hospitals, hospice, rural health clinic, snf

Question 4: 277/278 transaction set

Answer:

referral certification and authorization

Question 5: Medicare allows providers to submit liability claims after this waiting period

Answer:

120 days.Question 6: Onsite self pay is enhanced by the ability to accept these forms of payment

Answer:

Cash, Credit, check or debit cards

Question 7: Liability payers include

Answer:

Auto, Work Comp, Premises for medical coverage under property cases Question 8: Method of payment to healthcare providers whereby a FIXED amount is paid per ENROLLEE to cover defined set of services over a specifica period of time

Answer:

Capitation

Question 9: Technical Denial

Answer:

Demographic error, imcomplete insurance 411, no precert or auth, no contunied stay auth, exceeds frequency limit(pt visits)

Question 10: Medicare has 2 types of appeals to charges

Answer:

Beneficiary appeal and Provdier appeal

Question 11: Patient discharged status code

Answer:

03 Question 12: By siging a contractual agreement(aetna, cigna etc) the facility becomes

Answer:

In network

Question 13: Can you use a ABN for a IP stay

Answer:

NO

Question 14: Per Diem payment

Answer:

fixed daily payments that do not vary based on level of services/IP

Question 15: Level 1 of ERA

Answer:

Receipt of Data/the information is printed

Question 16: MR

Answer:

Medical Record

Question 17: Second Placement accounts are

Answer:

an agency accepting assignment of returned or cancelled debts from initial collection agency.

Question 18: CCI Edits are?

Answer:

Program consists of Edits implemented w/claim processing to catch errors before sending out

Question 19: Title 804

Answer:

governs actions of skip tracing

Question 20: ERA

Answer:

Electronic Remittance Advice

Question 21: Clinical Denial

Answer:

not medically necessary, diagnosis and cpt do not match, carve out days, inappropriate level of care, HCPCS incorrect for procedure

Question 22: EFT

Answer:

is the electronic transfer of funds from payer to payee thru the banking system (fasted way to move money) Question 23: Healthplan process claim from reimbursement and subsequently pursues payment from liability payer is...

Answer:

SUBORGATION

Question 24: Claim rejection is a claim rejected for a # of reasons (list some)

Answer:

inability to identify patient, ineligibility of pt, noncompliance of the provider with billing requirements.

Question 25: Types of unscheduled patients (6)

Answer:

Emergency, urgent inpatients, routine walkins outpatients, ED outpatients, obs patients, Newborn

Question 26: Bankruptcy Chapter 7

Answer:

Straight- involuntary or voluntary

Question 27: Title 806

Answer:

proibits harassment abuse from the collector

Question 28: Credit balances are created by

Answer:

posting errors, billing errors, payment errors, hospital and payer system limitations