CRCR CRCR - Certified Revenue Cycle Representative Program Charge Capture and Coding 5

Question 1

A hospital provides a service on January 15 but does not enter the charge until February 20. What is this scenario commonly called in revenue cycle management?

Accepted Answer

Charge lag

Answer

Charge lag refers to the delay between the date of service and the date a charge is entered into the billing system, which can jeopardize timely filing.

Question 2

Which of the following is an example of a HCPCS Level II 'J' code?

Accepted Answer

Injectable drug administration

Answer

HCPCS Level II J codes are used to report drugs administered by injection or other non-oral methods, including chemotherapy agents.

Question 3

Under the Medicare Outpatient Prospective Payment System (OPPS), how are services grouped for reimbursement?

Accepted Answer

Ambulatory Payment Classifications (APCs)

Answer

Medicare OPPS groups outpatient services into Ambulatory Payment Classifications (APCs), each with a fixed payment rate.

Question 4

A coder assigns a diagnosis code that results in a higher-paying DRG than the documentation supports. This is an example of:

Accepted Answer

Upcoding/DRG creep

Answer

Upcoding (also called DRG creep) is the fraudulent or erroneous practice of assigning codes that yield higher reimbursement than the clinical documentation supports.

Question 5

Which condition is required for a secondary diagnosis to qualify as a Major Complication or Comorbidity (MCC) under MS-DRG grouping?

Accepted Answer

It must increase the expected length of stay significantly

Answer

MCCs are secondary diagnoses that substantially increase the hospital's resources and are recognized by CMS as significantly impacting the DRG assignment and payment.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR CRCR - Certified Revenue Cycle Representative Program Charge Capture and Coding 5