CRCR Exam Questions & Answers Latest 2023/24
What is a consumer directed health plan?
Correct Answer:
A high deductible plan that is coupled with a personal health account that they can use to pay expenses not covered by insurance. Funds roll over each year
What is a Medicare advantage plan?
Correct 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?
Correct Answer:
Medicaid managed care plan that focus on preventative healthcare.
What are the managed care plan requirements?
Correct Answer:
Pre-auth, referrals, notification, site-of-service limitations, discharge planning and case management
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What is price?
Correct Answer:
The amount actually paid by the health plan/patient
What are the steps of constructing a price estimate with insurance?
Correct Answer:
- Verify the insurance coverage used for the service. Document the current
- Identify the contract terms between the hospital and the health plans.
- Obtain the total charges for the hospital portion of the case; concurrently
- Apply the benefit information to the charge information. Apply the payment
status of deductible and any co-ins amount
identify any additional providers who may be involved and not their in/out of network status
methodologies to the total charges
What are the steps for constructing a price estimate for uninsured patients?
Correct Answer:
- Verify the patient is not eligible for Medicaid or financial assistance
- Obtain any total charges for the hospital and any other providers. Note their
- Apply your organization's self-pay discount and financial assistance adjs if
- Share the results with the patient and explain the discount applied
in/out of network status
applicable
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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?
Correct 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:
Correct 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
The purpose of discharge planning is:
Correct 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:
Correct Answer:
Omission of charges, obsolete or invalid codes, and the omission of required modifiers
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The primary types of coding systems currently used in healthcare are:
Correct 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:
Correct 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:
Correct 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:
Correct Answer:
A relative weight which is multiplied by the established base payment rate to calculate the reimbursement for a specific DRG. For exceptionally costly cases over a set dollar amount, an outlier payment is added to the calculated payment.
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