HFMA CRCR 2026 PRACTICE EXAM QUESTIONS AND ANSWERS
GRADE A+.
What are collection agency fees based on? - ANSWER: A percentage of dollars
collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule
or what other rule? - ANSWER: Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - ANSWER: Case rates
What customer service improvements might improve the patient accounts
department? - ANSWER: Holding staff accountable for customer service during
performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
ANSWER: Inform a Medicare beneficiary that Medicare may not pay for the order
or service
What type of account adjustment results from the patient's unwillingness to pay for
a self-pay balance? - ANSWER: Bad debt adjustment
What is the initial hospice benefit? - ANSWER: Two 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -
ANSWER: If the patient requires ambulance transportation to a skilled nursing
facility
How should a provider resolve a late-charge credit posted after an account is
billed? - ANSWER: Post a late-charge adjustment to the account
an increase in the dollars aged greater than 90 days from date of service indicate
what about accounts - ANSWER: They are not being processed in a timely manner
What is an advantage of a preregistration program? - ANSWER: It reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? - ANSWER:
Medically unnecessary services and custodial care
,What core financial activities are resolved within patient access? - ANSWER:
Scheduling, insurance verification, discharge processing, and payment of point-of-
service receipts
What statement applies to the scheduled outpatient? - ANSWER: The services do
not involve an overnight stay
How is a mis-posted contractual allowance resolved? - ANSWER: Comparing the
contract reimbursement rates with the contract on the admittance advice to identify
the correct amount
What type of patient status is used to evaluate the patient's need for inpatient care?
- ANSWER: Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require
that the beneficiary has received what? - ANSWER: Medically necessary inpatient
hospital services for at least 3 consecutive days before the skilled nursing care
admission
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? -
ANSWER: When the patient is the insured
What are non-emergency patients who come for service without prior notification
to the provider called? - ANSWER: Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse? - ANSWER: Neither enrolled not
entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
Lending Act, establishes what? - ANSWER: Disclosure rules for consumer credit
sales and consumer loans
What is a principal diagnosis? - ANSWER: Primary reason for the patient's
admission
Collecting patient liability dollars after service leads to what? - ANSWER: Lower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? -
ANSWER: 50% of the current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not
billable as an RHC services? - ANSWER: Inpatient care
,What code indicates the disposition of the patient at the conclusion of service? -
ANSWER: Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? -
ANSWER: They result in lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient and
the third party payer, who is responsible for payment? - ANSWER: Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists,
the information provided on the order must include: - ANSWER: A valid CPT or
HCPCS code
With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - ANSWER: Access their information and
perform functions on-line
What date is required on all CMS 1500 claim forms? - ANSWER: onset date of
current illness
What does scheduling allow provider staff to do - ANSWER: Review
appropriateness of the service request
What code is used to report the provider's most common semiprivate room rate? -
ANSWER: Condition code
Regulations and requirements for coding accountable care organizations, which
allows providers to begin creating these organizations, were finalized in: -
ANSWER: 2012
What is a primary responsibility of the Recover Audit Contractor? - ANSWER: To
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - ANSWER: Comply with state
statutes concerning reporting credit balance
Insurance verification results in what? - ANSWER: The accurate identification of
the patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - ANSWER: CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for
service? - ANSWER: Registering the patient and directing the patient to the
service area
, In addition to being supported by information found in the patient's chart, a CMS
1500 claim must be coded using what? - ANSWER: HCPCS (Healthcare Common
Procedure Coding system)
What results from a denied claim? - ANSWER: The provider incurs rework and
appeal costs
Why does the financial counselor need pricing for services? - ANSWER: To
calculate the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - ANSWER:
Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? - ANSWER: Appeal
conditions specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - ANSWER: Right to appeal a discharge decision if the patient
disagrees with the services
Why do managed care plans have agreements with hospitals, physicians, and other
healthcare providers to offer a range of services to plan members? - ANSWER: To
improve access to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30
days, what is the SNF permitted to do? - ANSWER: Submit interim bills to the
Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for
liability claims after what happens? - ANSWER: 120 days passes, but the claim
then be withdrawn from the liability carrier
What data are required to establish a new MPI entry? - ANSWER: The patient's full
legal name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as primary?
- ANSWER: Determine the correct payer and notify the incorrect payer of the
processing error
What do EMTALA regulations require on-call physicians to do? - ANSWER:
Personally appear in the emergency department and attend to the patient within a
reasonable time
At the end of each shift, what must happen to cash, checks, and credit card
transaction documents? - ANSWER: They must be balanced
GRADE A+.
What are collection agency fees based on? - ANSWER: A percentage of dollars
collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule
or what other rule? - ANSWER: Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - ANSWER: Case rates
What customer service improvements might improve the patient accounts
department? - ANSWER: Holding staff accountable for customer service during
performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
ANSWER: Inform a Medicare beneficiary that Medicare may not pay for the order
or service
What type of account adjustment results from the patient's unwillingness to pay for
a self-pay balance? - ANSWER: Bad debt adjustment
What is the initial hospice benefit? - ANSWER: Two 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -
ANSWER: If the patient requires ambulance transportation to a skilled nursing
facility
How should a provider resolve a late-charge credit posted after an account is
billed? - ANSWER: Post a late-charge adjustment to the account
an increase in the dollars aged greater than 90 days from date of service indicate
what about accounts - ANSWER: They are not being processed in a timely manner
What is an advantage of a preregistration program? - ANSWER: It reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? - ANSWER:
Medically unnecessary services and custodial care
,What core financial activities are resolved within patient access? - ANSWER:
Scheduling, insurance verification, discharge processing, and payment of point-of-
service receipts
What statement applies to the scheduled outpatient? - ANSWER: The services do
not involve an overnight stay
How is a mis-posted contractual allowance resolved? - ANSWER: Comparing the
contract reimbursement rates with the contract on the admittance advice to identify
the correct amount
What type of patient status is used to evaluate the patient's need for inpatient care?
- ANSWER: Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require
that the beneficiary has received what? - ANSWER: Medically necessary inpatient
hospital services for at least 3 consecutive days before the skilled nursing care
admission
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? -
ANSWER: When the patient is the insured
What are non-emergency patients who come for service without prior notification
to the provider called? - ANSWER: Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse? - ANSWER: Neither enrolled not
entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
Lending Act, establishes what? - ANSWER: Disclosure rules for consumer credit
sales and consumer loans
What is a principal diagnosis? - ANSWER: Primary reason for the patient's
admission
Collecting patient liability dollars after service leads to what? - ANSWER: Lower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? -
ANSWER: 50% of the current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not
billable as an RHC services? - ANSWER: Inpatient care
,What code indicates the disposition of the patient at the conclusion of service? -
ANSWER: Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? -
ANSWER: They result in lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient and
the third party payer, who is responsible for payment? - ANSWER: Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists,
the information provided on the order must include: - ANSWER: A valid CPT or
HCPCS code
With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - ANSWER: Access their information and
perform functions on-line
What date is required on all CMS 1500 claim forms? - ANSWER: onset date of
current illness
What does scheduling allow provider staff to do - ANSWER: Review
appropriateness of the service request
What code is used to report the provider's most common semiprivate room rate? -
ANSWER: Condition code
Regulations and requirements for coding accountable care organizations, which
allows providers to begin creating these organizations, were finalized in: -
ANSWER: 2012
What is a primary responsibility of the Recover Audit Contractor? - ANSWER: To
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - ANSWER: Comply with state
statutes concerning reporting credit balance
Insurance verification results in what? - ANSWER: The accurate identification of
the patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - ANSWER: CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for
service? - ANSWER: Registering the patient and directing the patient to the
service area
, In addition to being supported by information found in the patient's chart, a CMS
1500 claim must be coded using what? - ANSWER: HCPCS (Healthcare Common
Procedure Coding system)
What results from a denied claim? - ANSWER: The provider incurs rework and
appeal costs
Why does the financial counselor need pricing for services? - ANSWER: To
calculate the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - ANSWER:
Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? - ANSWER: Appeal
conditions specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - ANSWER: Right to appeal a discharge decision if the patient
disagrees with the services
Why do managed care plans have agreements with hospitals, physicians, and other
healthcare providers to offer a range of services to plan members? - ANSWER: To
improve access to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30
days, what is the SNF permitted to do? - ANSWER: Submit interim bills to the
Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for
liability claims after what happens? - ANSWER: 120 days passes, but the claim
then be withdrawn from the liability carrier
What data are required to establish a new MPI entry? - ANSWER: The patient's full
legal name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as primary?
- ANSWER: Determine the correct payer and notify the incorrect payer of the
processing error
What do EMTALA regulations require on-call physicians to do? - ANSWER:
Personally appear in the emergency department and attend to the patient within a
reasonable time
At the end of each shift, what must happen to cash, checks, and credit card
transaction documents? - ANSWER: They must be balanced
