Certified Revenue Cycle Representative (CRCR) Practice Exam

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Study for the Certified Revenue Cycle Representative Exam. Prepare with flashcards and multiple choice questions. Each question offers hints and explanations. Get ready for your exam!

Each practice test/flash card set has 50 randomly selected questions from a bank of over 500. You'll get a new set of questions each time!

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In which program might another payer take full payment responsibility based on enrollment?

A) Medicaid
B) Medicare Advantage
C) TRICARE
D) CHIP

The correct answer is: B) Medicare Advantage

Medicare Advantage programs, also known as Medicare Part C, is an alternative to traditional Medicare that allows private insurance companies to provide Medicare benefits. When an individual enrolls in a Medicare Advantage plan, the private insurer takes on full responsibility for payment of healthcare services provided to the enrollees, rather than the federal government. This means that for the services covered under the plan, the Medicare Advantage organization handles the billing and payment processes. Individuals who enroll in a Medicare Advantage plan typically receive additional benefits beyond what traditional Medicare offers, including coverage for services such as vision, dental, and wellness programs. The plan determines payment rates and claims based on its established agreements with healthcare providers, which may differ from Medicare's payment systems. This makes Medicare Advantage unique among the options listed, as it explicitly transfers full payment responsibility to a private payer upon enrollment. Medicaid, TRICARE, and CHIP also involve payment responsibilities, but their structures differ significantly, focusing more on state or military responsibilities rather than the transfer of all payment responsibilities to a private insurer upon enrollment.