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CRCR Exam PrepWhat are collection agency fees based on? - ANSA percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other
rule? - ANSBirthday
In what type of payment methodology is a lump sum or bundled payment negotiated between
the payer and some or all providers? - ANSCase rates
What customer service improvements might improve the patient accounts department? -
ANSHolding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - ANSInform 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? - ANSBad debt adjustment
What is the initial hospice benefit? - ANSTwo 90-day periods and an unlimited number of
subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - ANSIf 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? - ANSPost
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 - ANSThey are not being processed in a timely manner
What is an advantage of a preregistration program? - ANSIt reduces processing times at the
time of service
What are the two statutory exclusions from hospice coverage? - ANSMedically unnecessary
services and custodial care
What core financial activities are resolved within patient access? - ANSScheduling, insurance
verification, discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - ANSThe services do not involve an
overnight stay
, How is a mis-posted contractual allowance resolved? - ANSComparing 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? -
ANSObservation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - ANSMedically 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$? - ANSWhen the
patient is the insured
What are non-emergency patients who come for service without prior notification to the provider
called? - ANSUnscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what is the
status of the subscriber's spouse? - ANSNeither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act,
establishes what? - ANSDisclosure rules for consumer credit sales and consumer loans
What is a principal diagnosis? - ANSPrimary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - ANSLower accounts receivable
levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - ANS50% of the
current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as
an RHC services? - ANSInpatient care
What code indicates the disposition of the patient at the conclusion of service? - ANSPatient
discharge status code
What are hospitals required to do for Medicare credit balance accounts? - ANSThey result in
lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient and the third party
payer, who is responsible for payment? - ANSPatient
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