CRCR Certification Exam
1.The disadvantages of outsourcing include all of the following EXCEPT
a)The impact of customer service or patient relations
b)The impact of loss of direct control of accounts receivable services
c)Increased costs due to vendor ineffectiveness
d)Reduced internal staffing costs and a reliance on outsourced staff
ANS d) Reduced internal staffing costs and a reliance on outsourced staff
2.The Medicare fee-for service appeal process for both beneficiaries and providers
includes all of the following levels EXCEPT
a)Medical necessity review by an independent physician's panel
b)Judicial review by a federal district court
c)Redetermination by the company that handles claims for Medicare
d)Review by the Medicare Appeals Council (Appeals Council)
ANS b) Judicial review by a federal district court .Business ethics, or organizational ethics represent
a)The principles and standards by which organizations operate
b)Regulations that must be followed by law
c)Definitions of appropriate customer service
d)The code of acceptable conduct
ANS a) The principles and standards by which organizations operate
4.A portion of the accounts receivable inventory which has NOT qualified for billing
includes
a)Charitable pledges
b)Accounts created during pre-registration but not activated
c)Accounts coded but held within the suspense period
d)Accounts assigned to a pre-collection agency
ANS a) Charitable pledges
5.Local Coverage Determinations (LCD) and National Coverage Determina- tions (NCD) are
Medicare established guideline(s) used to determine a)Medicare and Medicaid provider eligibility
b)Medicare outpatient reimbursement rates
c)Which diagnoses, signs, or symptoms are reimbursable
d)What Medicare reimburses and what should be referred to Medicaid
ANS c) Which diagnoses, signs, or symptoms are reimbursable
6.Days in A/R is calculated based on the value of
a)The total accounts receivable on a specific date
b)Total anticipated revenue minus expenses c)The time it takes to collect anticipated revenue
d)Total cash received to date
ANS c) The time it takes to collect anticipated revenue
7.Patients are contacting hospitals to proactively inquire about costs and fees prior to
agreeing to service. The problem for hospitals in providing such information is
a)That hospitals don't want to establish a price without knowing if the patient has insurance and how much reimbursement can be expected
b)The fact that charge master lists the total charge, not net charges that reflect charges after a payer's contractual adjustment
c)That hospitals don't want to be put in the position of "guaranteeing" price without having room for additional charges that may arise in the course of treatment
d)Their reluctance to share proprietary information
ANS b) The fact that charge master lists the total charge, not net
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