CRCR Cohort 6| 72 Questions with Answers 2023,100% CORRECT
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Course
CRCR Cohort 6
Institution
CRCR Cohort 6
CRCR Cohort 6| 72 Questions with Answers 2023
EMTALA - CORRECT ANSWERS- Emergency Medical Treatment and Labor Act
- requires hospitals to provide a medical screening examination and any needed stabilizing treatment to every person presenting at an ED and requesting medical evaluation or tre...
EMTALA - CORRECT ANSWERS- Emergency Medical Treatment and Labor Act
- requires hospitals to provide a medical screening examination and any needed
stabilizing treatment to every person presenting at an ED and requesting medical
evaluation or treatment
- EMTALA prohibits inquiries about insurance or payment if the inquiry will delay
examination or treatment
MRN - CORRECT ANSWERSMedical Record Number. Will have 1 MRN wherever
they go in the facility (Cerner)
EDI - CORRECT ANSWERSElectronic Data Interchange is the technology used for
translating, standardizing, and sending transactions electronically
The outbound inquiry from the provider to the payer
Transaction includes the identification number and the date of birth of the
insured party
UB-04 - CORRECT ANSWERSHospital claims submitted via UB-04
Electronic version is the 837i
CMS 1500 - CORRECT ANSWERSStandard professional services claim form.
Electronic version is the 837p
Clean Claim - CORRECT ANSWERSa clean claim is defined as a claim that is sent to
a payer either electronically or on paper that has no defect, impropriety, or
particular circumstance requiring special treatment that prevents prompt
payment
, HCPCS (hic pics) - CORRECT ANSWERSHealthcare Common Procedure Coding
System
Created to provide standardized coding system for describing specific items and
services provided in the delivery of healthcare
Procedure used to fix diagnoses. Outpatient procedures
Created to make up for what was lacking in the CPT codes
- drugs, supplies, etc.
Claim Edits - CORRECT ANSWERSClaim Edits are rules developed to verify the
accuracy and completeness of claims based on each payer's policies
Claim editing lets providers identify and resolve claim issues to ensure clean claim
submission to the payer
Result is prompt payment, reduced AR outstanding, and increased cash flow
Managed Care Plans - CORRECT ANSWERSComprehensive healthcare plans that
attempt to reduce costs through contractural agreements with providers and
through care management initiatives
Common billing rules for managed care plans include coordination of all care by
the primary care physician and obtaining the appropriate authorization and
referrals
Authorization and referral numbers must be included when submitting claims.
Ex - PPO, HMO, EPO, POS
Medicare Part A - CORRECT ANSWERSbenefits provide coverage for inpatient
hospital services, skilled nursing care and home healthcare. Hospital Care
Medicare Part B - CORRECT ANSWERSBenefits are available for outpatient and
professional service coverage, but the beneficiary must pay a monthly premium
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