CRCR (Certified Revenue Cycle Representative) Exam All Correct & Verified
What % of pts should be pre-registered of all scheduled pts?
Correct Answer:
98%
What is the code for HIPAA transaction set for HC eligibility and benefit responses
Correct Answer:
270 outgoing 271 response
What are some payer data elements needed to process payment?
Correct Answer:
policy type, covered persons, mail address, cvr type (HMO), deductible
What is an PPO
Correct Answer:
closest to indemnity plan, only preferred doctors in network get contracted prices
- / 4
What is an EPO
Correct Answer:
exclusive provider - limits services to only EP
What is POS
Correct Answer:
point of service - if doc makes referral out, plan will pay, if pt requests out of service, pt pays
What is CDHP
Correct Answer:
consumer directed healthplan, often with a HSA
What is the % discount model in MCO
Correct Answer:
a % is discounted
What is the DRG model in MCO
Correct Answer:
pymt based on predetermined fixed amount
- / 4
What is the APG model in MCO
Correct Answer:
divides outpt services into 600 procedural groups, each APG assigned a relative payment weight
What is a case rate
Correct Answer:
pt's condition forms basis for payment for all services
What is stop loss
Correct Answer:
plan covers 80% of charges to 100%, stop loss is plan covers 50% of charges >$120k
What are some managed care requirments?
Correct Answer:
pre-certification/pre-authorization, referral (PCP->specialist), notification - providers notify payer pt is requesting service, days approval, continued stay review, site of service limitations (eg only colonosco as outpt)
What are some concerns with EMTALA
Correct Answer:
sign posted on walls, no prior authorization, women in active labor must be assisted thru delivery, on-call MD must respond, no dumping, no transfer (unless cannot provide service), must do mental health screening, must keep pt log 3 / 4
What is the referring MD
Correct Answer:
the one to referred to another MD
What is the attending MD
Correct Answer:
One who wrote order for service
What is the consulting MD
Correct Answer:
who consults with another MD
How long does Medicare Part A cover inpat services?
Correct Answer:
60 days, then 30 co-insurance, then pt can use 60 days of lifetime reserve
HICN
Correct Answer:
healthcare insurance claim # issued by SSN to those elgible for SSN
How often does Medicare update co-insurance amounts for Part B?
Correct Answer:
yearly done by OPPS, outpt prospective pymnt system
- / 4