Crcs-I And Crcs-p Practice Exam

To stress the importance of the relationship between patients and providers

To ensure patients do not experience discrimination in billing and collections

To help patients feel more confident in the U.S. healthcare system

To stress the role that patients have to take to get and stay healthy

The Health Care and Education Reconciliation Act

The Patient Protection and Affordable Care Act

The Health Insurance Portability and Accountability Act

The Hill-Burton Act

Financial assistance

Filing deadlines

Charging limitations

Collections actions

Agents or brokers

Certified application counselors

Navigators

Non-Navigators

CLIA

ACL

QIO

TJC

It is a U.S. federal law passed in 1946.

It offered loans for hospital construction in exchange for future charity care.

The Act stopped providing funds in 1997, so hospitals are no longer obligated to offer charity care because of participation in the program.

It is also known as Title I.

Mandatory and retroactive

Restrictive and permissive

Mandatory and permissive

Restrictive and retroactive

Health Care Extension Action Team

Health Care Executive Assistance Team

Health Care Fraud Elimination Team

Health Care Fraud Prevention and Enforcement Action Team

Accreditation by TJC is a requirement of participation in the Medicare program.

TJC will conduct an audit of the hospital every five years.

TJC can audit without advance notice.

TJC requires hospitals to have facility-wide disaster plans.

Place the focus on customer service so that the initial impression is a positive one.

Identify mechanisms to decrease wait times.

Free up staff time for training on new technology and regulations.

Make the process a positive and painless experience for the patient, guarantor, and/or family.

40% - 50%

50% - 70%

60% - 80%

70% - 90%

History of chief complaint

Patient demographics

Financial information

Socioeconomic information

Therapeutic medical screening

Pre-admission testing (PAT)

Pre-admission screening (PAS)

Diagnostic medical screening (DMS)

Marketing for staff physicians

Telephone triage available to the community

Referral for physicians and/or services

Registration for in-house or hospital-sponsored medical education programs

During pre-certification only

During admitting/registration only

During pre-certification and/or admitting/registration

After admitting/registration

The ABN must contain a complete description of the test(s) in question and the reason(s) that denial is likely.

Patients sign and date the ABN to indicate they understand and agree to pay for the tests if they are deemed noncovered.

The ABN must be signed and faxed to Medicare no later than 24 hours after the test is performed.

A beneficiary should not be given an ABN unless there is genuine doubt of Medicare payment.

Entities that issue ABNs are known by CMS as "notifiers."

Initiation

Reduction

Cessation

Termination

Definitive LCD/NCD

Non-definitive LCD/NCD

Until 2010, Medicare was the primary payer for nearly all Medicare-covered services.

Medicare considers it a fraudulent or abusive practice to regularly submit claims that are the responsibility of another insurer under the MSP provision.

Before becoming entitled to Medicare, beneficiaries receive an IEQ that asks about any other healthcare coverage.

The CWF is a CMS file that contains Medicare patient eligibility and utilization data from the IEQ and ongoing MSPs.

It must be established as safe and effective.

It must be consistent with the symptoms or diagnosis of the illness or injury.

It must be considered cost effective.

It must not be furnished primarily for convenience.

It is also called "accepting assignment."

It is imperative that assignment be obtained prior to discharge, when applicable.

It enables providers to ask the beneficiary to pay the entire charge at the time of service.

It offers higher fee schedule payments and fewer collection efforts.

Services covered by workers' compensation, including the Black Lung Benefits Act

Care related to an accident for which liability or no-fault coverage exists.

Patients 65 or older with group coverage from their own or their spouses' employment with an employer who has 20 or more employees.

Patients with ESRD who have completed their 30-month COB period.

An invoice to document the services ordered or rendered during a patient visit.

Often referred to as an invoice of services.

A tool to eliminate the need for transcribing medical record notes from a patient chart.

All of the above.

The equivalent electronic transaction is the 5010A1, formerly the 837P.

Paper forms are printed in red ink for scanning.

No photocopies are allowed.

One claim can report up to 8 lines of service.

Top left margin of the form.

Top right margin of the form.

Bottom left margin of the form.

Bottom right margin of the form.

Item 9

Item 11

Item 19

Item 22

Code 7, item 22

Code 8, item 22

Code 2, item 23

Code 8, item 24

It releases the guarantor/patient from financial responsibility of any and all account balances listed on the bankruptcy petition.

The account balance is to be written off to the appropriate transaction code.

It covers any patient accounts that occur within six months following the notification.

It is usually entered within six months when a Chapter 7 bankruptcy is deemed to have no assets.

It is a court ruling whereby the bankruptcy is rejected.

The most common reason for dismissal is the debtor agreeing to pay each creditor a portion of the debt owed.

It means a creditor can bill the debtor directly, refer the account to a collection agency, or pursue litigation.

Check if a legitimate estate exists and file an appropriate caveat to the estate.

Check the register of wills for an estate.

Change the mailing address to "The Family of [Patient Name]."

If there is no estate and no one assumes financial responsibility, write off any remaining self-pay balance.

Improves patient-hospital relations

Improves traffic flow

Reduces need for additional staff at peak discharge times

Allows for greater accuracy in billing

All of the above

Bill never received by payer

COB or MSP problems

Medical record/chart needed for review

Excessive number of staff working claims

Intentional skip

Unintentional skip

False skip