2024 CRCR Study Guide Review Latest Questions with Complete Answers
- Through what document does a hospital establish compliance standards?-
Answer: Code of Conduct
- What is the purpose of the OIG work plan?
Answer: Communicate Issues that will be reviewed during the year for compliance
with Medicare Regulations
- If a Medicare patient is admitted on Friday, what services fall within the three-
day DRG window rule?
Answer: Diagnostic services and related charges provided on Wednesday, Thursday
and Friday before admission.
- What does a modifier allow a provider to do?
Answer: Report a specific circumstance that affected a procedure or service without changing the code or its definition
- If outpatient diagnostic services are provided within three days of the ad- mission
of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these charges?
Answer: They must be combined with the inpatient bill and paid under the MS-DRG
(diagnosis related group) system.
- If outpatient diagnostic services are provided within three days of the ad- mission
of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these charges?
Answer: It reviews Medicare payments for beneficiaries who have other insurance
and assesses the effective- ness of procedures in preventing inappropriate Medicare payments for beneficiaries with other insurance coverage.
- What is a recurring or series registration?
Answer: One registration record is created for multiple days of service.
- What are nonemergency patients who come for service without prior notification
to the provider called?
Answer: Unscheduled Patients
- Which of the following statements apply to the observation patient type?
Answer: It is used to evaluate the need for an inpatient admission. 1 / 3
- Which services are hospice programs required to provide on an around-the-
clock basis?
Answer: Physician, nursing and pharmacy
- What is the purpose of the initial step in the outpatient testing scheduling
process?Answer: Identify the correct patient on the providers database or add the patient to the database
- Scheduler instructions are used to prompt the scheduler to do what?
Answer: - Complete the scheduling process correctly based on service requested.
- The time needed to prepare the patient before service is the difference between
the patient's arrival time and which of the following?
Answer: Procedure time
- Medicare guidelines require that when a test is ordered for which as
LCD (local coverage determination) or NCD (national coverage determination) exist, the information provided on the order must include which of the following?
Answer: Documentation of the medical necessity of the test.
- What is an advantage of a preregistration program?
Answer: It reduces processing times at the time of service
- What data are required to establish a new MPI (master patient index) entry?
Answer: The patients full legal name, date of birth and sex
- Which HIPAA transition set provides electronic processing of insurance
verification requests and responses?
Answer: The 270-271 Set
- A mother and father both cover their 16-year-old child as a dependent on their
health insurance plans, which both follow the birthday rule. The mothers date of birth is January 19, 1968; the father's date of birth is July 19, 1967. Whose plan is the primary payer?
Answer: The Mothers Plan
- What is a co-payment?
Answer: The fixed amount that is due for a specific service
- A patient's annual out-of-pocket limitation is $3000, excluding the de- ductible.
To date this calendar year, the patient has satisfied the $500 de- ductible and has 2 / 3
paid $2300 in coinsurance to various providers. For the balance of the calendar year, what is the maximum amount of coinsurance the patient will owe?
Answer: $3000 - $2300 = $700
- What type of plan allows the subscriber to pay lower premium costs in return
for a higher deductible?
Answer: Consumer Directed Health Plan
- What is a characteristic of a managed care contracting methodology?
Answer: - Prospectively set rates for inpatient and outpatient services.
- Which provision protects the patient from Medical expenses that exceed a preset
level?
Answer: Stop Loss
- What document must a primary care physician send to an HMO (health
maintenance organization) patient to authorize a visit to a specialist for additional testing or care?
Answer: Referral
- What activities are completed when a scheduled, pre-registered patient arrives
for service?Answer: Activating the record, obtaining signatures, and finalizing financial issues.
- Under EMTALA (Emergency Medical Treatment and Labor Act) regulations, the
provider may not ask about a patient's insurance information if it would delay what
Answer: Medical Screening and Stabilizing Treatment
- Collecting patient liability dollars after service leads to what?
Answer: Increased efforts by patient accounting staff to resolve these balances.
- The important Message from Medicare (IM) provides beneficiaries with
information concerning what?Answer: Right to appeal discharge decision if the patient disagrees with the plan.
- What circumstances would result in an incorrect nightly room charge?
Answer: If the patient's transfer from the ICU (intensive care unit) to the
medical/surgical floor is not reflected in the registration system
- Which of the following is a step in the discharge process?
Answer: Have case management services complete the discharge plan
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