CRCR Technology and Data Analytics 5 — Questions and Answers
Question 1: A provider organization receives a 277CA transaction from a payer. What information does this transaction convey?
- The patient's eligibility and benefit details
- Claim acknowledgment and acceptance or rejection status (Correct answer)
- Remittance advice with payment details
- Prior authorization approval or denial
Correct answer: Claim acknowledgment and acceptance or rejection status
The 277CA (Claim Acknowledgment) transaction is sent by payers to confirm receipt of claims and indicate whether they were accepted or rejected for processing.
Question 2: When configuring a charge capture system, which data governance practice helps ensure that charge descriptions and CDM codes remain accurate and compliant over time?
- Annual CDM review and reconciliation (Correct answer)
- Daily manual charge entry audits
- Quarterly patient satisfaction surveys
- Monthly EHR downtime testing
Correct answer: Annual CDM review and reconciliation
Conducting an annual Charge Description Master (CDM) review ensures codes, descriptions, and prices stay aligned with current coding guidelines and payer requirements.
Question 3: Which cybersecurity framework is most commonly referenced by healthcare organizations to assess and improve their security posture for protecting revenue cycle systems?
- PCI DSS
- NIST Cybersecurity Framework (Correct answer)
- SOC 2 Type II
- ISO 14001
Correct answer: NIST Cybersecurity Framework
The NIST Cybersecurity Framework provides identify, protect, detect, respond, and recover functions widely adopted by healthcare organizations to manage cybersecurity risk.
Question 4: A data analyst builds a report showing the volume of claims by payer, service line, and month over the past year. This is an example of which type of analytics?
- Predictive analytics
- Descriptive analytics (Correct answer)
- Prescriptive analytics
- Cognitive analytics
Correct answer: Descriptive analytics
Descriptive analytics summarizes historical data to show what has happened, such as claim volume trends over time.
Question 5: Under meaningful use / Promoting Interoperability programs, providers are incentivized to use EHR systems that meet which certification requirement?
- Joint Commission accreditation
- ONC Health IT Certification Program standards (Correct answer)
- CMS Star Rating minimum thresholds
- URAC accreditation criteria
Correct answer: ONC Health IT Certification Program standards
The ONC Health IT Certification Program certifies EHR technology to ensure it meets federal standards for interoperability and meaningful use criteria.
Question 6: A revenue cycle team discovers that patient demographic data entered at registration frequently contains errors that lead to claim rejections. Which technology solution directly addresses this problem at the point of entry?
- Retrospective claim scrubber
- Real-time eligibility verification with data validation rules (Correct answer)
- Automated payment posting engine
- AI-powered denial overturn system
Correct answer: Real-time eligibility verification with data validation rules
Real-time eligibility verification with built-in data validation catches demographic mismatches at registration before claims are ever submitted.
Question 7: Which regulatory requirement mandates that covered entities conduct a periodic evaluation of their security policies and procedures to ensure continued effectiveness?
- HIPAA Privacy Rule Notice of Privacy Practices
- HIPAA Security Rule periodic evaluation standard (§164.308(a)(8)) (Correct answer)
- CMS Conditions of Participation financial reporting
- OIG Work Plan annual compliance checklist
Correct answer: HIPAA Security Rule periodic evaluation standard (§164.308(a)(8))
The HIPAA Security Rule at §164.308(a)(8) requires covered entities to perform a periodic evaluation of their security policies in response to operational or environmental changes.
CRCR Technology and Data Analytics 5
A provider organization receives a 277CA transaction from a payer.
What information does this transaction convey?