CRCR - Certified Revenue Cycle Representative Program Healthcare Compliance and Regulations Questions and Answers

Question 1

An individual arrives at a hospital's Emergency Department with symptoms of a stroke but expresses concern about their ability to pay for treatment.
According to the Emergency Medical Treatment and Active Labor Act (EMTALA), what is the hospital's primary obligation?

Accepted Answer

To provide a medical screening examination to determine if an emergency medical condition exists.

Answer

To obtain a deposit or payment information before any services are rendered.

Answer

To perform a financial screening to determine eligibility for charity care.

Answer

To immediately transfer the patient to a public hospital that accepts uninsured patients.

Question 2

A physician owns a significant financial stake in a local, independent MRI facility. The physician consistently refers their Medicare patients to this specific facility for imaging services. This practice is most likely to be scrutinized under which of the following regulations?

Accepted Answer

The Physician Self-Referral Law (Stark Law)

Answer

The Health Insurance Portability and Accountability Act (HIPAA)

Answer

The False Claims Act (FCA)

Answer

The Emergency Medical Treatment and Active Labor Act (EMTALA)

Question 3

Which of the following billing activities represents a potential violation of the False Claims Act?

Accepted Answer

Knowingly using a billing code for a more complex and expensive service than what was actually performed and documented.

Answer

Submitting a claim with an accidental typographical error in the patient's address.

Answer

Appealing a payer's denial for a service that the provider believes was medically necessary.

Answer

Offering a prompt-pay discount to a patient for paying their balance in full at the time of service.

Question 4

A revenue cycle representative needs to leave a voicemail for a patient regarding an overdue bill. To comply with HIPAA's Minimum Necessary Standard, which of the following messages is most appropriate?

Accepted Answer

"Hello, this is Pat from Central Clinic calling for Jane Doe. We need to discuss an important matter regarding your account. Please call us back at 555-1234."

Answer

"Hello, this is a message for Jane Doe. This is Pat from Central Clinic calling about your overdue balance of $150 for your visit on January 5th. Please call us back at 555-1234."

Answer

"Hello, this is Pat calling from Dr. Smith's office for Jane Doe. Your insurance has denied the claim for your recent lab work, and we need you to call us at 555-1234."

Answer

"Hello, this message is for Jane Doe. This is Pat from the billing office calling about your recent cardiology appointment. Please return our call at 555-1234."

Question 5

A hospital's marketing department launches a new campaign with the slogan, "All patient copays and deductibles waived for the month of June!" This practice of routinely waiving patient cost-sharing amounts to attract patients could be a violation of which federal law?

Accepted Answer

The Anti-Kickback Statute (AKS)

Answer

The Health Information Technology for Economic and Clinical Health (HITECH) Act

Answer

The Affordable Care Act (ACA)

Answer

The Emergency Medical Treatment and Active Labor Act (EMTALA)

Question 6

A Medicare beneficiary is scheduled for a cosmetic procedure that is never covered by Medicare. To ensure the patient understands they will be financially responsible for the entire cost, what is the MOST appropriate action for the provider to take before the service?

Accepted Answer

Issue a voluntary Advance Beneficiary Notice of Noncoverage (ABN) as a courtesy.

Answer

Have the patient review and sign a mandatory Advance Beneficiary Notice of Noncoverage (ABN).

Answer

Inform the patient verbally that the service is not covered and they will be billed.

Answer

Submit the claim to Medicare first and bill the patient only after receiving the denial.