CRCR exam-Ensemble Questions and Correct Answers & Latest Updated
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Course
CRCR
Institution
CRCR
Through what document does a hospital establish compliance standards,
o :## Code of Conduct
What is the purpose OIG work plan?
o :## Identify Acceptable compliance programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG
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CRCR exam-Ensemble Questions and Correct
Answers & Latest Updated
Through what document does a hospital establish compliance standards,
o :## Code of Conduct
What is the purpose OIG work plan?
o :## Identify Acceptable compliance programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG
window rule?
o :## Non-diagnostic services provided on Tuesday through Friday
What does a modifier allow a provider to do?
o :## 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 day of the admission of a
Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what
must happen to
o :## They must be billed separately to the Part B carrier
What is a recurring or series registration?
o :## One registration record is created for multiple days of service
Master01: DO NOT COPY AND PASTE!! August 25, 2024 Latest Update
,2|Page: 2024/2025 Grade A+
What are nonemergency patients who come for service without prior notification to the
provider called?
o :## Unscheduled patients
Which of the following statements apply to the observation patient type?
o :## It is used to evaluate the need for an inpatient admission
Which services are hospice programs required to provide on a around-the-clock patient
o :## Physician, nursing, and pharmacy
Scheduler instructions are used to prompt the scheduler to do what?
o :## 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?
o :## Procedure time
Medicare guidelines require that when a test is ordered for which an LCD (Local coverage
determination) or NCD (National coverage determination) exists, the information provided
on the order must include which of the following?
o :## Documentation of the medical necessity for the test.
What is an advantage of a preregistration program?
Master01: DO NOT COPY AND PASTE!! August 25, 2024 Latest Update
,3|Page: 2024/2025 Grade A+
o :## It reduces processing times at the time of service
What date are required to establish a new MPI (Master Patient Index) entry
o :## The responsible party's full legal name, date of birth, and Social Security number
Which of the following statements is true about third-party payments?
o :## The payments are received by the provider from the payer responsible for reimbursing
the provider for the patient's covered services
Which provision protects the patient from medical expenses that exceed pre-set level?
o :## Stop loss
What documentation 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?
o :## Referral
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?
o :## Medical screening and stabilizing treatment
Which of the following is a step in the discharge process?
o :## Have case management services complete the discharge plan
Master01: DO NOT COPY AND PASTE!! August 25, 2024 Latest Update
, 4|Page: 2024/2025 Grade A+
The hospital has a APC (ambulatory payment classification)-based contract for the payment
of outpatient services. Total anticipated charges for the visit are $2,380. The approved APC
payment rate is $780. Where will the patients' benefit package be applied?
o :## To the approved APC payment rate
A patient has met the $200 individual deductible and $900 of the $1000 co-insurance
responsibility. The co-insurance rate is 20%. The estimated insurance plan responsibility is
$1975.00. What amount of coinsurance is due from the patient?
o :## $100
When is a patient considered to be medically indigent?
o :## The patient's outstanding medical bills exceed a defined dollar amount or percentage of
assets.
What patient assets are considered in the financial assistance applications?
o :## Sources of readily available funds, such as vehicles, campers, boats and savings accounts
If the patient cannot agree to payment arrangements, what is the next option?
o :## Warn the patient that unpaid accounts are placed with collection agencies for further
processing
What core financial activities are resolved within patient access?
o :## Scheduling, pre-registration, insurance verification, and managed care processing
What is an unscheduled direct admission?
Master01: DO NOT COPY AND PASTE!! August 25, 2024 Latest Update
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