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CRCR Study Guide Review questions and answers graded A+ 2024/2025
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CRCR Study Guide Review questions and answers graded A+ 2024/2025
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CRCRStudy
Guide
Review
Through
what
document
does
a
hospital
establish
compliance
standards?
-
ANSCode
of
Conduct
What
is
the
purpose
of
the
OIG
work
plan?
-
ANSCommunicate
Issues
that
will
be
reviewed
during
the
year
for
compliance
with
Medicare
Regulations
If
a
Medicare
patient
is
admitted
on
Friday,
what
services
fall
within
the
three-day
DRG
window
rule?
-
ANSDiagnostic
services
and
related
charges
provided
on
Wednesday,
Thursday
and
Friday
before
admission.
What
does
a
modifier
allow
a
provider
to
do?
-
ANSReport
a
specific
circumstance
that
affected
a
procedure
or
service
without
changing
the
code
or
its
definition
If
outpatient
diagnostic
services
are
provided
within
three
days
of
the
admission
of
a
Medicare
beneficiary
to
an
IPPS
(Inpatient
Prospective
Payment
System)
hospital,
what
must
happen
to
these
charges?
-
ANSThey
must
be
combined
with
the
inpatient
bill
and
paid
under
the
MS-DRG
(diagnosis
related
group)
system.
If
outpatient
diagnostic
services
are
provided
within
three
days
of
the
admission
of
a
Medicare
beneficiary
to
an
IPPS
(Inpatient
Prospective
Payment
System)
hospital,
what
must
happen
to
these
charges?
-
ANSIt
reviews
Medicare
payments
for
beneficiaries
who
have
other
insurance
and
assesses
the
effectiveness
of
procedures
in
preventing
inappropriate
Medicare
payments
for
beneficiaries
with
other
insurance
coverage.
What
is
a
recurring
or
series
registration?
-
ANSOne
registration
record
is
created
for
multiple
days
of
service.
What
are
nonemergency
patients
who
come
for
service
without
prior
notification
to
the
provider
called?
-
ANSUnscheduled
Patients
Which
of
the
following
statements
apply
to
the
observation
patient
type?
-
ANSIt
is
used
to
evaluate
the
need
for
an
inpatient
admission.
Which
services
are
hospice
programs
required
to
provide
on
an
around-the-clock
basis?
-
ANSPhysician,
nursing
and
pharmacy
What
is
the
purpose
of
the
initial
step
in
the
outpatient
testing
scheduling
process?
-
ANSIdentify
the
correct
patient
on
the
providers
database
or
add
the
patient
to
the
database Scheduler
instructions
are
used
to
prompt
the
scheduler
to
do
what?
-
ANSComplete
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?
-
ANSProcedure
time
Medicare
guidelines
require
that
when
a
test
is
ordered
for
which
as
LCD
(local
coverage
determination)
or
NCD
(national
coverage
determination)
exist,
the
information
provided
on
the
order
must
include
which
of
the
following?
-
ANSDocumentation
of
the
medical
necessity
of
the
test.
What
is
an
advantage
of
a
preregistration
program?
-
ANSIt
reduces
processing
times
at
the
time
of
service
What
data
are
required
to
establish
a
new
MPI
(master
patient
index)
entry?
-
ANSThe
patients
full
legal
name,
date
of
birth
and
sex
Which
HIPAA
transition
set
provides
electronic
processing
of
insurance
verification
requests
and
responses?
-
ANSThe
270-271
Set
A
mother
and
father
both
cover
their
16-year-old
child
as
a
dependent
on
their
health
insurance
plans,
which
both
follow
the
birthday
rule.
The
mothers
date
of
birth
is
January
19,
1968;
the
father's
date
of
birth
is
July
19,
1967.
Whose
plan
is
the
primary
payer?
-
ANSThe
Mothers
Plan
What
is
a
co-payment?
-
ANSThe
fixed
amount
that
is
due
for
a
specific
service
A
patient's
annual
out-of-pocket
limitation
is
$3000,
excluding
the
deductible.
To
date
this
calendar
year,
the
patient
has
satisfied
the
$500
deductible
and
has
paid
$2300
in
coinsurance
to
various
providers.
For
the
balance
of
the
calendar
year,
what
is
the
maximum
amount
of
coinsurance
the
patient
will
owe?
-
ANS$3000
-
$2300
=
$700
What
type
of
plan
allows
the
subscriber
to
pay
lower
premium
costs
in
return
for
a
higher
deductible?
-
ANSConsumer
Directed
Health
Plan
What
is
a
characteristic
of
a
managed
care
contracting
methodology?
-
ANSProspectively
set
rates
for
inpatient
and
outpatient
services.
Which
provision
protects
the
patient
from
Medical
expenses
that
exceed
a
preset
level?
-
ANSStop
Loss
What
document
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?
-
ANSReferral
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