CRCR (Certified Revenue Cycle Representative) Exam Study Guide
It is critical that the Chargemaster is reviewed and updated regularly to ensure?
Correct Answer:
It supports and represents the services provided within the organization.
The standard hospital claim form is:
Correct Answer:
UB-04
Standard professional service claim form is:
Correct Answer:
The CMS 1500
Claim Edits
Correct Answer:
Claim edits are rules developed to verify the accuracy and completeness of claims based on each health plan's policies.
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Current Electronic Transaction Standards:
Correct Answer:
Version 5010
Next Version of Current Electronic Transaction Standards:
Correct Answer:
Version 7030
Council for Affordable Quality Healthcare (CAQH) goal:
Correct Answer:
To ensure that detailed, real-time response becomes the standard for claims- related healthcare transactions.
Swing bed definition:
Correct Answer:
Rural hospitals with fewer than 100 beds (excluding beds for newborns and intensive care-type units) can be reimbursed under Medicare as a SNF.Approval from Department of Health and Human Services (HHS) is required.
SNF 3 day rule:
Correct Answer:
Under Medicare, the patient must have received medically necessary inpatient hospital services with a stay of at least three consecutive calendar days.
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Care in a SNF is covered if all of the following four factors are met:
Correct Answer:
1) The patient requires skilled nursing services or skilled rehabilitation services.2) The patient requires skilled services on a daily basis.3) As a practical matter, the daily skilled services can be provided only on an inpatient basis in a SNF.4) Ancillary services (example, lab, pharmacy, X-ray) are available if needed on an emergency basis.
APP definition
Correct Answer:
Advance Practice Providers -Physician Assistants -Nurse Practitioners
Examples of some Medicare eligible telehealth services include:
Correct Answer:
1) Office or other outpatient visits (CPT codes 99201- 99215) 2) Individual and group kidney disease education services (HCPCS codes G0420 and G00421) 3) Telehealth consultations, emergency department or initial inpatient (HCPCS codes G0425 - G0427)
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Telehealth Originating Site:
Correct Answer:
An originating site is the location of the patient at the time of service is furnished.
Telehealth Distant Site Practitioner:
Correct Answer:
Practitioners at the distant site may furnish and receive payment for the covered telehealth services.
In order to bill a telehealth visit:
Correct Answer:
Two claims are required-one is an originating site claim and the other is the distant site practitioner claim. Billing telehealth services for a Medicare Advantage plan subscriber is subject to the individual plan billing requirements.
Percentage Discount Payment Model:
Correct Answer:
Typically with a traditional indemnity/fee-for-service (FFS) payment model, actuaries determine insurance premiums for auto, home, medical, and life, and all covered claims are paid by the insurance company, less deductibles or other amounts due from the insured, regardless of the premiums paid by the insured.
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