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CRCR study

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
ERA   show
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Level 1 of ERA   show
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show Electronic remittance is received, entered into computer, and viewed at terminal  
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Level 3 of ERA   show
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show Total automation receipt, data entry, payment posting, adjustment processing  
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EFT   show
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SNF Services Covered (6)   show
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show Electronic Data interchange  
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EDI used for?   show
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835   show
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Violation of the DRG Window (3 day) causes   show
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UBO4 is used for institutional providers(List 4)   show
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show must be IP atleast 3 days before discharging to SNF, must be admitted with in30 days of IP stay.  
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show Inpatient billing  
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show outpatient billing  
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Benefit SNF Period?   show
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show Program consists of Edits implemented w/claim processing to catch errors before sending out  
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Package Pricing is?   show
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Site of service limitation?   show
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Title 804   show
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Title 805   show
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Title 806   show
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show deceptive or false representations  
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Title 604 (FCRA)   show
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show 2 90 day periods and unlimited subsequent periods-60 days each  
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show physicians, allied health professions, CRNA, home health agency's and Medical Equipment suppliers  
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What is EFT balancing and Control   show
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Common Provision found in manage care contracts for protection for medical expense that exceed certain levels.   show
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Per Diem payment   show
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Percentage Discount is   show
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show Percentage discount, DRG, APC, Case Rate, Per Diem, Package Pricing, Capitation  
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show Capitation  
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show Contractual allowance  
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The first critical step for all patients arriving for service scheduled or unscheduled is verifying patients identity with 2 forms...list   show
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show new technology used without determining coverage(3D), charges bundled/unbundled incorrectly, accuity level changes but pt type does not change, admission notification not done, Pt IP but should be OBs, test performed not ordered, invalid HPCPS coding  
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Post Service Denials include   show
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show No Pre Auth, clinicals not called for certification, INS not verified, Inaccurate Data entry, Copying registration without verifying  
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CLIA   show
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APC only covered under medicare part   show
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show Productivity(staff reworks files), patient loss of confidence, employee frustration increased(morals affected)  
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show Cash, Credit, check or debit cards  
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show Auto, Work Comp, Premises for medical coverage under property cases  
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show SUBORGATION  
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show 120 days.  
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show Lien  
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CWF   show
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show Beneficiary appeal and Provdier appeal  
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Second Placement accounts are   show
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show Fair Credit Reporting Act  
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show Title I- established rules for consumers credit and sales and loans  
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show 120 days then goes to collections agency  
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For an acount to be considered bad debt collection must have been attempted and documented T/F   show
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show 13 days electronic/26 for paper claims  
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show Medical Record  
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MPI   show
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CPI   show
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show Legal name, DOB, sex, SSN  
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show Wheelchairs, hospital beds, oxygen tanks  
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show Home Health Care  
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Patients with incurable disease and have a life expectency of six months or less   show
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Orthopedic surgical patient that require intense PT/stroke PT who require comprehensive Rehab   show
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Can you use a ABN for a IP stay   show
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When is a ABN required   show
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Credit balances are created by   show
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Chargemaster issues can result in   show
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Claim rejection is a claim rejected for a # of reasons (list some)   show
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Medicare Claims must be filed within what qualifying time limit?   show
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show Emergency, urgent inpatients, routine walkins outpatients, ED outpatients, obs patients, Newborn  
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3 types of schedule patients   show
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Enrollment and disenrollment of a healthplan transanction set   show
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What must appear on the ABN? (5 items)   show
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show provider received a flat fee every month for taking care of individual  
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show specific condition forms the basis for establishing a single payment for all services(colonscopy)  
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show Full payment proir to service, short term payment plan, bank loan  
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show payer does not pay the agreed contract(Aetna) amount to provider(LUH)  
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show Demographic error, imcomplete insurance 411, no precert or auth, no contunied stay auth, exceeds frequency limit(pt visits)  
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show not medically necessary, diagnosis and cpt do not match, carve out days, inappropriate level of care, HCPCS incorrect for procedure  
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show Straight- involuntary or voluntary  
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Chapter 11   show
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show Rehabilitation- does not liquidate-looks for future earnings  
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show In network  
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show 100 (often use of swing beds)  
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show 03  
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837 transaction set   show
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show claim payment/remittance advice  
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277/278 transaction set   show
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820 transaction set   show
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Created by: Copa
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