Certified Revenue Cycle Representative - CRCR (2022/23) Exam Guide Pack.
What are collection agency fees based on? A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? Birthday
In what type of payment me...
Certified Revenue Cycle Representative - CRCR (2022/23) Exam Guide Pack. What are collection agency fees based on? ✔✔ A percentage of dollars collected Self-funded benefit plans may choose to coordinate bene fits using the gender rule or what other rule? ✔✔ Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? ✔✔ Case rates What customer service improvements might improve the patient accounts department? ✔✔ Holding staff accountable for customer service during performance reviews What is an ABN (Advance Beneficiary Notice of Non -coverage) required to do? ✔✔ Inform a Medica re 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? ✔✔ Bad debt adjustment What is the initial hospice benefit? ✔✔ Two 90 -day periods and an unlimited number of subsequent periods When does a hospital add ambulance charges to the Medicare inpatient claim? ✔✔ If the patient requires ambulance transportation to a skilled nursing facility How should a provider resolve a late -charge credi t posted after an account is billed? ✔✔ Post 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 ✔✔ They are not being processed in a timely manner What is an ad vantage of a preregistration program? ✔✔ It reduces processing times at the time of service What are the two statutory exclusions from hospice coverage? ✔✔ Medically unnecessary services and custodial care What core financial activities are resolved wi thin patient access? ✔✔ Scheduling, insurance verification, discharge processing, and payment of point -of-service receipts What statement applies to the scheduled outpatient? ✔✔ The services do not involve an overnight stay How is a mis -posted contract ual allowance resolved? ✔✔ Comparing 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? ✔✔ Observation Covera ge rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has received what? ✔✔ Medically 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$? ✔✔ When the patient is the insured What are non -emergency patients who come for service without prior notification to the provider called? ✔✔ Unscheduled patients If the insuranc e verification response reports that a subscriber has a single policy, what is the status of the subscriber's spouse? ✔✔ Neither enrolled not entitled to benefits Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act, establishes what? ✔✔ Disclosure rules for consumer credit sales and consumer loans What is a principal diagnosis? ✔✔ Primary reason for the patient's admission Collecting patient liability dollars after service leads to what? ✔✔ Lower accounts receiv able levels What is the daily out -of-pocket amount for each lifetime reserve day used? ✔✔ 50% 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? ✔✔ Inpatie nt care What code indicates the disposition of the patient at the conclusion of service? ✔✔ Patient discharge status code What are hospitals required to do for Medicare credit balance accounts? ✔✔ They result in lost reimbursement and additional cost t o collect When an undue delay of payment results from a dispute between the patient and the third party payer, who is responsible for payment? ✔✔ Patient Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information pr ovided on the order must include: ✔✔ A valid CPT or HCPCS code With advances in internet security and encryption, revenue -cycle processes are expanding to allow patients to do what? ✔✔ Access their information and perform functions on -line What date is required on all CMS 1500 claim forms? ✔✔ onset date of current illness What does scheduling allow provider staff to do ✔✔ Review appropriateness of the service request What code is used to report the provider's most common semiprivate room rate? ✔✔ Condition code Regulations and requirements for coding accountable care organizations, which allows providers to begin creating these organizations, were finalized in: ✔✔ 2012 What is a primary responsibility of the Recover Audit Contractor? ✔✔ To correctly identify proper payments for Medicare Part A & B claims How must providers handle credit balances? ✔✔ Comply with state statutes concerning reporting credit balance Insurance verification results in what? ✔✔ The accurate identification of the patient's eligibility and benefits What form is used to bill Medicare for rural health clinics? ✔✔ CMS 1500 What activities are completed when a scheduled pre -registered patient arrives for service? ✔✔ Registering the patient and directing the patient to the service area In addition to being supported by information found in the patient's chart, a CMS 1500 claim must be coded using what? ✔✔ HCPCS (Healthcare Common Procedure Coding system) What results from a denied claim? ✔✔ The provider incurs rew ork and appeal costs Why does the financial counselor need pricing for services? ✔✔ To calculate the patient's financial responsibility What type of provider bills third -party payers using CMS 1500 form ✔✔ Hospital -based mammography centers How are di sputes with nongovernmental payers resolved? ✔✔ Appeal conditions specified in the individual payer's contract The important message from Medicare provides beneficiaries with information concerning what? ✔✔ Right to appeal a discharge decision if the pa tient disagrees with the services Why do managed care plans have agreements with hospitals, physicians, and other healthcare providers to offer a range of services to plan members? ✔✔ To improve access to quality healthcare If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days, what is the SNF permitted to do? ✔✔ Submit interim bills to the Medicare program. 90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for l iability claims after what happens? ✔✔ 120 days passes, but the claim then be withdrawn from the liability carrier What data are required to establish a new MPI entry? ✔✔ The patient's full legal name, date of birth, and sex What should the provider do if both of the patient's insurance plans pay as primary? ✔✔ Determine the correct payer and notify the incorrect payer of the processing error What do EMTALA regulations require on -call physicians to do? ✔✔ Personally appear in the emergency department and attend to the patient within a reasonable time At the end of each shift, what must happen to cash, checks, and credit card transaction documents? ✔✔ They must be balanced What will cause a CMS 1500 claim to be rejected? ✔✔ The provider is billing with a future date of service Under Medicare regulations, which of the following is not included on a valid physician's order for services? ✔✔ The cost of the test how are HCPCS codes and the appropriate modifiers used? ✔✔ To report the level 1, 2, or 3 code that correctly describes the service provided If a Medicare patient is admitted on Friday, what services fall within the three -day DRG window rule? ✔✔ Diagnostic and clinically -related non -diagnostic charges provided on the Tuesday, Wednesday, Thu rsday, and Friday before admission
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