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CRCR EXAM LATEST 2024-2025 ACTUAL EXAM AND PRACTICE
EXAMS COMPLETE 550 QUESTIONS AND CORRECT DETAILED
ANSWERS ALREADY GRADED A+
CRCR EXAM A
What is a Medicare advantage plan? - ANSWER-The patient pays their part B premium and an additional premium for extra benefits from an insurance provider
What is a Medicaid HMO plan? - ANSWER-Medicaid managed care plan that focus on preventative healthcare.
What are the managed care plan requirements? - ANSWER-Pre-auth, referrals, notification, site-of-service limitations, discharge planning and case management
What is price? - ANSWER-The amount actually paid by the health plan/patient
What are the steps of constructing a price estimate with insurance? - ANSWER-1. Verify the insurance coverage used for the service. Document the current status of deductible and any co- ins amount
- Identify the contract terms between the hospital and the health plans.
- Obtain the total charges for the hospital portion of the case; concurrently identify any
additional providers who may be involved and not their in/out of network status 1 / 4
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- Apply the benefit information to the charge information. Apply the payment methodologies
to the total charges
What are the steps for constructing a price estimate for uninsured patients? - ANSWER-1. Verify the patient is not eligible for Medicaid or financial assistance
- Obtain any total charges for the hospital and any other providers. Note their in/out of
- Apply your organization's self-pay discount and financial assistance adjs if applicable
- Share the results with the patient and explain the discount applied
network status
EMTALA prohibits inquiries about health plan or liability payer information if the inquiry will delay examination or treatment. What other requirements apply to the Emergency Department registration work? - ANSWER-Patients are initially triaged by medical personnel and a quick registration initiated to allow electronic order entry and documentation Identification and verification of insurance eligibility and benefits once the medical screening has been completed No additional registration may occur until the patient is stabilized
Typical activities which must be performed when an unscheduled patient arrives for service include: - ANSWER-Initiation of a new MPI record, insurance verification if time permits, managed care screening, price estimation and financial counseling to achieve the appropriate account resolution 2 / 4
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The purpose of discharge planning is: - ANSWER-To estimate how long the patient will be in the hospital, identify the expected outcome of the hospitalization and initiate any special requirements for services at or after the time of discharge.
Challenges typically associate with the chargemaster include: - ANSWER-Omission of charges, obsolete or invalid codes, and the omission of required modifiers
The primary types of coding systems currently used in healthcare are: - ANSWER-ICD-10- CM/ICD-10-PCS; CPT/HCPC codes
There are four code sets that provide health plans with additional info as they process claims.Those code sets are: - ANSWER-Condition codes, occurrence codes, occurrence span codes and value codes
For the SNF, care is covered if which of the following factors are present: - ANSWER-The patient requires skilled services on a daily basis and those services can only be provided on an inpatient basis in a SNF
DRG's are a system of classifying inpatients on the basis of diagnoses, procedures, and co- morbidities for purposes of payment to hospitals. Each DRG includes: - ANSWER-A relative weight which is multiplied by the established base payment rate to calculate the 3 / 4
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PPO networks represent one form of discounting commonly used by commercial payers. The silent PPO represents: - ANSWER-A discounting scheme whereby health plans apply generic PPO rates to discount a provider's claims, even though there is no contractual arrangement between the silent PPO and the provider
The concept of timely filing of claims is important to providers, payers and patients. Thus, providers are required to comply with timely claim filing rules.Which of the following statements are NOT true about timely filing limitations: - ANSWER- Payers will waive timely filing denials for claims filed over a year from DOS
What is EMTALA? - ANSWER-Hospitals need to provide medical screening exam and any needed stabilizing treatment to every person in an ED and requesting medical eval or treatment.
What are EMTALA concerns in an ED? - ANSWER-A sign must be posted that tells patients of their right to be seen Prior auth is not allowed for ED services before stabilizing treatment Women in active labor must receive service through delivery If an on-call physician refuses to treat a patient or fails to get there in a reasonable time, that must be reflected in the patient record
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