Crcs-I and Crcs-p Practice Exam

An emancipated minor refers to a person who is under the legal age of adulthood but has been granted legal independence from their parents or guardians. As a result, they are considered to have the same legal rights and responsibilities as an adult. This includes the ability to make decisions about their own healthcare, including giving consent to receive treatment. Therefore, the statement that an emancipated minor is able to give their own consent to receive treatment is true.

When a correction is needed in a medical record, it is important to maintain the integrity of the original information. Drawing a single line through the error and initialing it ensures that the correction is clearly marked and attributed to the authorized person making the correction. By continuing the note after initialing, it is clear that the correction is a part of the original record. This procedure helps to maintain transparency and accuracy in medical documentation. Therefore, the statement "Should a correction be required to a medical record, an authorized person should draw a single line through the error, initial it, and continue the note" is true.

An intentional skip refers to someone who purposely avoids paying bills by taking deliberate actions such as changing residency without leaving a forwarding address, changing their name, or providing false information. This individual is intentionally evading their financial responsibilities and intentionally trying to avoid detection or accountability.

To qualify for SNF (Skilled Nursing Facility) coverage, Medicare requires a person to have been admitted to a hospital and stayed as an inpatient for a minimum of three consecutive days. This means that the person must have been formally admitted to the hospital and not just receiving outpatient treatment. The day of discharge is not counted towards the three-day requirement. Therefore, the statement is true.

The statement is false because if a physician classifies an admission as an emergency, the hospital is legally obligated to accept and provide necessary medical care to the patient. This is because emergency admissions are typically considered urgent and require immediate attention to prevent further harm or complications. Refusing such admissions would go against the principle of providing timely and appropriate healthcare to those in need.

A non-definitive LCD/NCD provides potential coverage circumstances, but does not provide specific diagnoses, signs, symptoms, or ICD-9-CM codes that will be covered or non-covered. This means that while it may give some general guidelines for coverage, it does not provide specific details about what conditions or treatments will be covered or not covered.

Insurance verification is typically done during pre-certification and/or admitting/registration processes. This is because these are the stages where the patient's insurance coverage is confirmed and verified. Pre-certification involves obtaining approval from the insurance company before a medical procedure or hospitalization, while admitting/registration is the process of gathering patient information and initiating their hospital stay. Both of these stages require insurance verification to ensure that the patient's insurance will cover the necessary medical services.

The goal of reengineering Patient Access is to improve efficiency and effectiveness in the registration and scheduling processes. This includes focusing on customer service, decreasing wait times, and making the process positive and painless for patients and their families. However, freeing up staff time for training on new technology and regulations is not a typical goal for reengineering Patient Access. This is because staff training is necessary to ensure that employees are knowledgeable and competent in using new technology and complying with regulations, which ultimately contributes to improving patient access.

The advantages of courtesy discharge include improving patient-hospital relations, improving traffic flow, reducing the need for additional staff at peak discharge times, and allowing for greater accuracy in billing. By implementing courtesy discharge, hospitals can enhance their relationship with patients, ensuring a positive experience. It also helps in streamlining the discharge process, minimizing congestion and delays. Additionally, courtesy discharge reduces the burden on staff during busy periods and enables more accurate billing, avoiding any discrepancies or errors.

The Patient Protection and Affordable Care Act (PPACA) is a healthcare reform law implemented in the United States. Its primary objective is to decrease the number of uninsured Americans by expanding access to affordable health insurance options. The law achieves this through various provisions, such as the establishment of health insurance marketplaces and the expansion of Medicaid eligibility. Additionally, the PPACA aims to reduce the overall costs of healthcare by implementing measures to improve the efficiency and quality of care delivery. Therefore, the statement that PPACA is aimed primarily at decreasing the number of uninsured Americans and reducing healthcare costs is true.

The recommendation for the percentage of scheduled admissions to be pre-registered within 24 hours of the service date is 70% - 90%. This means that it is recommended for 70% to 90% of the scheduled admissions to be pre-registered within 24 hours of the service date. Pre-registering admissions helps in streamlining the process and ensures that necessary information is collected beforehand, saving time and improving efficiency.

The Quality Improvement Organization (QIO) is the organization responsible for ensuring the quality, effectiveness, and efficiency of healthcare provided to Medicare beneficiaries. They also review all written quality-of-service complaints submitted by Medicare beneficiaries. The QIO plays a crucial role in monitoring and improving the quality of healthcare services provided to Medicare beneficiaries.

The correct answer is Health Care Fraud Prevention and Enforcement Action Team. This team is responsible for preventing and enforcing actions against health care fraud. They work towards eliminating fraudulent activities in the health care industry and ensuring that proper measures are taken to prevent such frauds in the future.

The correct answer is "Excessive number of staff working claims". This option is the exception because it does not contribute to stalls and delays with third party payers. The other options, such as bills not being received by the payer, COB or MSP problems, and the need for medical records/charts for review, are all potential causes of stalls and delays in the payment process. However, having an excessive number of staff working claims would typically help expedite the process rather than cause delays.

The statement "Change the mailing address to 'The Family of [Patient Name].'" is not a true statement about the steps to be taken when notice is received that a patient is deceased. The correct steps include checking if a legitimate estate exists and filing an appropriate caveat to the estate, checking the register of wills for an estate, and if there is no estate and no one assumes financial responsibility, writing off any remaining self-pay balance. Changing the mailing address to "The Family of [Patient Name]" is not a necessary step in this process.

An unintentional skip refers to someone who moves or changes residence without notifying their creditors, but they have a forwarding address available. This suggests that the person did not intentionally try to avoid their creditors, but rather failed to inform them about their new address. They may have simply overlooked this step or been unaware of the importance of notifying creditors.

When there is a discontinuation in the services being provided, it is referred to as "termination." This term signifies the end or conclusion of the services, indicating that they have been stopped or discontinued. It is different from initiation, which implies the beginning or start of something, reduction, which suggests a decrease in the services, and cessation, which means the act of ceasing or stopping something. Therefore, "termination" is the most appropriate term to describe the scenario described in the question.

A superbill is a document that serves as an invoice to record the services that were either ordered or provided during a patient's visit. It is often referred to as an invoice of services because it lists the specific procedures, tests, or treatments that were performed. Additionally, a superbill can be considered a tool to eliminate the need for transcribing medical record notes from a patient chart, as it provides a concise summary of the services rendered. Therefore, the correct answer is "All of the above" as all the statements mentioned accurately describe a superbill.

During pre-registration or pre-admission, the history of the chief complaint is not gathered. This information is typically collected during the initial assessment or examination of the patient, after they have been admitted or registered. Pre-registration or pre-admission mainly focuses on gathering patient demographics, such as name, address, contact information, and insurance details, as well as financial and socioeconomic information to determine eligibility for financial assistance or support.

Until 2010, Medicare was not the primary payer for nearly all Medicare-covered services. This statement is false because Medicare has always been the primary payer for Medicare-covered services.

The explanation for the given correct answer is that the date of birth must always be entered as 8 digits in the format MM | DD | CCYY. However, other dates on the claim form can be entered in either 6-digit format (MM | DD | YY) or 8-digit format (MM | DD | CCYY). It is important to note that you cannot mix the formats on the same claim form.

The treating and/or attending physician, a physician extender (physician assistant, nurse practitioner, etc.), a licensed, registered nurse, and a student from an accredited health profession program (under the supervision of his or her clinical instructor) are authorized to make entries in the patient's medical record. These individuals have the necessary qualifications and expertise to document and update the patient's medical information accurately and responsibly.

The correct answer is "The ABN must be signed and faxed to Medicare no later than 24 hours after the test is performed." This statement is not true because the ABN does not need to be faxed to Medicare within 24 hours after the test is performed. The ABN must be given to the patient before the test is performed, and the patient must sign and date it to indicate their understanding and agreement to pay if the test is deemed noncovered. The ABN does not need to be sent to Medicare unless requested.

A false skip refers to a skip in the records that is not intentional or unintentional but rather a result of a clerical error during the registration process. This means that the skip was not deliberately or accidentally made, but rather a mistake occurred during the registration, causing the false skip to happen.

The correct answer is The Patient Protection and Affordable Care Act. This act, commonly referred to as "Obamacare," was signed into law in 2010. It aimed to provide affordable health insurance coverage for all Americans and protect them from insurance company abuses. The act introduced various reforms to the healthcare system, including the expansion of Medicaid and the creation of health insurance exchanges. It also implemented regulations such as the individual mandate, requiring most individuals to have health insurance or face a penalty. Overall, the act aimed to improve access to healthcare and make it more affordable for individuals and families.

The correct answer is "Endorse checks immediately with 'Payable to [Name of Office] Only.'" This is not a GAAP (Generally Accepted Accounting Principle) that applies to the cashier role because it is not a standard practice for cashiers to endorse checks in this manner. GAAP principles focus on ensuring accurate and transparent financial reporting, and endorsing checks in this way does not directly contribute to those goals.

The statement is false because it is not common practice to have a single general consent document that covers all procedures and services performed in any 24-hour period. In reality, separate consent forms are typically required for each specific procedure or service to ensure that patients fully understand and agree to the risks, benefits, and alternatives of each individual treatment. Having separate consent forms also helps to ensure that patients are giving informed consent for each specific procedure or service.

The given statement states that TJC will conduct an audit of the hospital every five years. However, this is not true of TJC as they can conduct audits without advance notice. Therefore, the statement that TJC will conduct an audit of the hospital every five years is not true.

Marketing for staff physicians is not an example of affiliated health services because it pertains to promoting and advertising the services of specific physicians, rather than providing direct healthcare services or support. Affiliated health services typically involve activities such as telephone triage, referrals for physicians or services, and registration for medical education programs.

Pre-admission testing (PAT) refers to the process of screening patients before surgical or invasive procedures to assess their suitability for hospitalization and surgery. This testing helps healthcare providers evaluate the patient's overall health condition, identify any potential risks or complications, and determine the appropriate course of action. PAT involves various diagnostic tests, such as blood tests, imaging scans, and electrocardiograms, to ensure that the patient is physically fit for the procedure. By conducting PAT, healthcare professionals can minimize the chances of adverse events during surgery and optimize patient outcomes.

Telephone orders from a referring physician cannot be edited for clarity by an individual authorized to receive verbal orders. This means that any orders given over the phone must be accurately recorded without any changes or edits to ensure that the original intent of the physician is preserved.

When completing the CMS 1500 form, there are special restrictions regarding the top right margin of the form. This means that there are limitations on what can be done in that specific area of the form. The restrictions may include not using adhesive-backed labels, printing, or correction fluid in the top right margin. It is important to adhere to these restrictions to ensure that the form is filled out correctly and accurately.

The applicant may be asked to disclose this information to assist federal agencies to enforce anti-discrimination laws. However, creditors may not use the information when deciding whether to give a person credit or when setting the terms of the credit.

The appropriate bill frequency code for replacement of a prior claim when resubmitting a claim is Code 7, item 22. This code indicates that the claim being resubmitted is a replacement for a previously submitted claim.

Patients with ESRD who have completed their 30-month COB period are not an exception to Medicare being secondary. In this situation, Medicare would still be considered secondary to any other insurance coverage the patient may have. This means that Medicare would only cover costs that are not already covered by the primary insurance.

The Medicare Participating Physician Program, also known as "accepting assignment," does not enable providers to ask the beneficiary to pay the entire charge at the time of service. This program actually offers higher fee schedule payments and fewer collection efforts, and it is imperative to obtain assignment prior to discharge, when applicable.

A discharged bankruptcy does not cover any patient accounts that occur within six months following the notification. This means that the guarantor/patient is still responsible for any new account balances that arise within this period.

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An ABN must be retained for five years from the date of service, not three years from discharge or completion of care. This is important because it ensures that healthcare providers have the necessary documentation in case of any audits or disputes.

The Hill-Burton Act, also known as Title I, is a U.S. federal law passed in 1946. It offered loans for hospital construction in exchange for future charity care. However, the statement that the Act stopped providing funds in 1997, so hospitals are no longer obligated to offer charity care because of participation in the program is not true. The Act still remains in effect, and hospitals that received funds under the program are still required to provide a certain amount of free or reduced-cost care to those who cannot afford it.

The correct answer is Mandatory and permissive. Mandatory exclusions are required by law and must be imposed on healthcare providers and suppliers who have been convicted of certain crimes, such as Medicare or Medicaid fraud. Permissive exclusions, on the other hand, are discretionary and may be imposed by the OIG based on factors such as the seriousness of the offense or the risk posed to federal healthcare programs. This means that while mandatory exclusions are mandatory and must be imposed, permissive exclusions are optional and may or may not be imposed depending on the circumstances.

The statement suggests that it is rare for a patient to remain in observation for more than 24 hours according to CMS. The correct answer is False, indicating that the statement is not true. This means that CMS has not indicated that instances of patients staying in observation for more than 24 hours are rare.

Medicare provides coverage for a wide range of medical services for qualified beneficiaries. However, there are certain services that are not covered. Cosmetic surgery is not covered by Medicare as it is considered elective and not medically necessary. Routine eye care and most eyeglasses are also not covered, although Medicare does cover certain eye-related conditions such as cataract surgery. Similarly, hearing aids are not covered by Medicare, although there may be some exceptions for certain Medicare Advantage plans. Kidney dialysis and kidney transplants are covered by Medicare for qualified beneficiaries.

Non-Navigators refers to individuals who assist consumers in filling out applications for health coverage in state-based or state partnership Marketplaces but are not qualified as Navigators. Navigators are individuals who are trained and certified to provide unbiased assistance to consumers in understanding their health coverage options. Agents or brokers are licensed professionals who help individuals and businesses purchase insurance plans. Certified application counselors are trained individuals who provide assistance to consumers in completing applications for health coverage. Therefore, the correct title for individuals who help consumers fill out applications for health coverage in a state-based or state partnership Marketplace but are not Navigators is Non-Navigators.

A dismissed bankruptcy refers to a court ruling where the bankruptcy is rejected, meaning it is not accepted or approved. This ruling implies that the debtor is not granted the benefits of bankruptcy protection. The statement that "the most common reason for dismissal is the debtor agreeing to pay each creditor a portion of the debt owed" is incorrect. In fact, this statement contradicts the concept of a dismissed bankruptcy, as it suggests that the debtor is willing to make partial payments to creditors, which would typically be associated with a different outcome such as a debt repayment plan or a settlement agreement.

Tax-exempt hospitals are affected by the PPACA in various areas, such as financial assistance, charging limitations, and collections actions. However, filing deadlines are not an area where tax-exempt hospitals are affected by the PPACA. The PPACA primarily focuses on regulating and reforming healthcare coverage and delivery, rather than imposing specific requirements or regulations regarding filing deadlines for tax-exempt hospitals.

The given answer states that the requirement for an item or service to be considered medically necessary is that it must be considered cost effective. However, this statement is incorrect. The other options provided in the question are all valid requirements for Medicare to consider an item or service medically necessary. The fact that an item or service is cost-effective is not a requirement for Medicare, as the focus is primarily on the safety, effectiveness, and relevance to the illness or injury being treated.