Certified Revenue Cycle Representative - Crcr (2021) Study Guide Rated A+

Which option is a federally-aided, state-operated program to provide health and long-term care coverage? {Ans: A. Medicare **B. Medicaid C. Self-Insured Plans D. Liability Coverage}Which concept is NOT a contracted payment model? {Ans: **A. Stop-Loss Provision B. Percentage Discount C. Per Diem Payment D. Capitation}What do business/organizational ethics represent? {Ans: **A. Principles and standards by which organizations operate B. A healthcare provider's practices and principles C. An employee's actions influenced by experiences and value system D. The patient privacy standard within healthcare}What is the sequential order for a Silent PPO scheme? {Ans: The patient's claims is sent to the listed primary insurance carrier The patient's insurance company (a silent PPO) runs the healthcare provider's tax ID number through a PPO discount database or provides a repricing company a copy of the claim After a successful "hit", the claim is "re-priced" based on the PPO discounts that were accessed. After applying the discount, the silent PPO states on the EOB that the healthcare provider agreed to reduce your bill based on your contract with the PPO The medical provider accepts the health plan's statement on the EOB and writes the discount off-never knowing that the discount was