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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| ERA | show 🗑
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| Level 1 of ERA | show 🗑
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| Level 2 of ERA | show 🗑
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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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| show | is the electronic transfer of funds from payer to payee thru the banking system (fasted way to move money)
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| SNF Services Covered (6) | show 🗑
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| EDI | show 🗑
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| show | translating, standardizing and sending transactions electronically (claims) 837. 270/271, etc...
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| show | Remittance
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| show | delay in billing, rejection of claim, additionaly sanctions, fines, revocation of medicare status
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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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| DRG used for | show 🗑
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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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| show | proibits harassment abuse from the collector
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| Title 807 | show 🗑
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| show | gives permision to see credit reports by court, by consumer, and a reporting agency who has legitimate business to view
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| Hospice Benefits with Medicare include | show 🗑
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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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| Method of payment to healthcare providers whereby a FIXED amount is paid per ENROLLEE to cover defined set of services over a specifica period of time | show 🗑
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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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| Time of Service Denials include | show 🗑
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| show | late charges, 2 claims with DOS that overlap, untimely filing
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| Pre Service Denials include | show 🗑
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| CLIA | show 🗑
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| show | B
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| show | Productivity(staff reworks files), patient loss of confidence, employee frustration increased(morals affected)
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| Onsite self pay is enhanced by the ability to accept these forms of payment | show 🗑
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| Liability payers include | show 🗑
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| Healthplan process claim from reimbursement and subsequently pursues payment from liability payer is... | show 🗑
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| Medicare allows providers to submit liability claims after this waiting period | show 🗑
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| show | Lien
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| show | Common Working File
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| show | Beneficiary appeal and Provdier appeal
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| show | an agency accepting assignment of returned or cancelled debts from initial collection agency.
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| show | Fair Credit Reporting Act
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| The truth and lending act is | show 🗑
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| Medicare will try to collect self pay portions for how many days? | show 🗑
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| show | True
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| show | 13 days electronic/26 for paper claims
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| MR | show 🗑
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| MPI | show 🗑
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| CPI | show 🗑
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| Critical patient information collected when scheduling are used as identifiers(list 4) | show 🗑
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| DME examples | show 🗑
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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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| show | when a test or service does not meet medical necessity according to LCD/NCD
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| Credit balances are created by | show 🗑
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| Chargemaster issues can result in | show 🗑
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| show | inability to identify patient, ineligibility of pt, noncompliance of the provider with billing requirements.
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| show | 1 year
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| Types of unscheduled patients (6) | show 🗑
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| show | Scheduled IP, Scheduled OP, reaccuring/series
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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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| Capitation Contract Payment Method is | show 🗑
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| Case Rate Contract Patyment Method is | show 🗑
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| show | Full payment proir to service, short term payment plan, bank loan
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| Underpayment denial | show 🗑
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| Technical Denial | show 🗑
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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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| show | debtor reogranization (court supervised plan) within 120 days
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| Chapter 13 | show 🗑
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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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| 835 transaction set | show 🗑
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| 277/278 transaction set | show 🗑
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| 820 transaction set | show 🗑
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Copa
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