CRCR - Certified Revenue Cycle Representative Program Revenue Cycle Management Fundamentals Questions and Answers Flashcards
7 cards from real CRCR practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 CRCR - Certified Revenue Cycle Representative Program Revenue Cycle Management Fundamentals Questions and Answers flashcards as text
Which federal act established the requirement for hospitals to provide emergency medical treatment regardless of ability to pay?
Answer: EMTALA
EMTALA (Emergency Medical Treatment and Labor Act) requires hospitals with emergency departments to provide stabilizing treatment to any patient regardless of insurance status or ability to pay.
In revenue cycle management, what does 'clean claim' refer to?
Answer: A claim that passes all edits and requires no additional information before processing
A clean claim contains all required data elements, passes all payer edits, and can be processed without requesting additional information, leading to faster reimbursement.
What is the primary purpose of a Remittance Advice (RA) in the revenue cycle?
Answer: To communicate payment decisions and adjustments made to submitted claims
A Remittance Advice details how a payer processed each claim, including payment amounts, denial reasons, and contractual adjustments, and is used to post payments accurately.
Which metric measures the average number of days it takes a provider to collect payment after services are rendered?
Answer: Days in Accounts Receivable (AR)
Days in AR is a key performance indicator calculated by dividing total AR by average daily charges, indicating the efficiency of the billing and collections process.
A patient's insurance requires a $500 deductible and 20% coinsurance after the deductible. The allowed amount for a service is $1,500. If the deductible has not been met, what is the patient's responsibility?
Answer: $700
The patient pays $500 for the deductible plus 20% of the remaining $1,000 ($200), totaling $700 in patient responsibility.
What is the function of the National Correct Coding Initiative (NCCI) edits?
Answer: To prevent improper payment of procedures that should not be reported together
NCCI edits are procedure-to-procedure edits developed by CMS that prevent unbundling—the improper billing of component procedures separately when a comprehensive code exists.
Which organization accredits hospitals and other healthcare organizations and is recognized by CMS for Medicare certification surveys?
Answer: The Joint Commission (TJC)
The Joint Commission is a nonprofit accreditation body that CMS has granted deeming authority, meaning TJC-accredited hospitals are considered to meet Medicare's Conditions of Participation.