CRCR Regulatory and Compliance Knowledge 5

Question 1

Which federal program requires hospitals to report quality measures and, if they fail to do so, reduces their Medicare inpatient prospective payment system update by 2%?

Accepted Answer

Inpatient Quality Reporting Program

Answer

The Inpatient Quality Reporting (IQR) Program requires hospitals to report specified quality measures or face a 2% reduction to their IPPS annual payment update.

Question 2

Under the No Surprises Act effective January 2022, what must out-of-network providers give to patients receiving non-emergency services at in-network facilities?

Accepted Answer

Written notice and consent to charge out-of-network rates at least 72 hours in advance

Answer

The No Surprises Act requires out-of-network providers to give written notice and obtain patient consent to charge out-of-network rates at least 72 hours before the scheduled service.

Question 3

Which entity administers the Medicare Integrity Program, which includes Recovery Audit Contractors (RACs) tasked with identifying improper payments?

Accepted Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

CMS administers the Medicare Integrity Program, which authorizes RACs to audit Medicare claims and identify overpayments and underpayments.

Question 4

A provider submits a claim for a surgical procedure and separately bills for a service that is considered an integral component of that procedure. This billing error is known as:

Accepted Answer

Unbundling

Answer

Unbundling is billing separately for services that should be reported together under a single comprehensive code, violating correct coding principles.

Question 5

Under Medicaid's Federal Financial Participation (FFP) rules, what must states ensure to receive matching federal funds for Medicaid expenditures?

Accepted Answer

Expenditures must be for services that are medically necessary and covered under the approved state plan

Answer

To receive FFP, Medicaid expenditures must be for services that are medically necessary, properly documented, and covered under the CMS-approved state Medicaid plan.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR Regulatory and Compliance Knowledge 5