HFMA CRCR EXAM PREPARATION
Domain 1: Patient Financial Services (Registration & Scheduling)
1. A patient presents for a scheduled outpatient procedure. During registration, the registrar discovers
that the patient’s insurance was termed 3 days ago due to non-payment of premium. What is the
MOST appropriate action?
A. Proceed with the service as scheduled and bill the patient later.
B. Cancel the procedure immediately.
C. Notify the clinical team and attempt to contact the patient to discuss financial responsibility and
options before service.
D. Change the payer to Self-Pay and proceed.
Answer: C
Rationale: The registrar must ensure financial clearance. Proceeding without verifying coverage (A)
leads to denials. Canceling (B) without notification is poor customer service. Changing to Self-Pay (D)
without patient consent violates patient rights. The correct action is to halt the financial clearance
process, notify clinical staff to avoid resource waste, and counsel the patient regarding their options
(COB, reinstatement, or self-pay estimate).
2. Which of the following is a critical component of the "No Surprises Act" regarding patient
estimates?
A. Providing a Good Faith Estimate (GFE) to uninsured or self-pay patients prior to scheduled services.
B. Waiving all deductibles for emergency services.
C. Requiring patients to sign a blanket assignment of benefits.
D. Eliminating the need for prior authorizations.
Answer: A
Rationale: The No Surprises Act mandates that uninsured and self-pay patients receive a GFE of
expected charges prior to scheduled services. It also protects insured patients from surprise balance
billing for emergency services or ancillary care at in-network facilities, but it does not eliminate prior
authorizations (D) or waive deductibles (B).
,3. What is the primary purpose of the MSP (Medicare Secondary Payer) questionnaire?
A. To determine if the patient has a living will.
B. To identify if there is other insurance that should be primary to Medicare.
C. To calculate the patient’s co-insurance amount.
D. To verify the referring physician’s NPI number.
Answer: B
Rationale: The MSP questionnaire is a regulatory requirement to identify situations where Medicare is
secondary (e.g., employer group health plans for working beneficiaries, auto insurance, or liability).
Accurate determination prevents improper primary payment by Medicare and subsequent recovery
audits.
4. A patient is covered by both Medicare Part A and Tricare. Medicare pays its portion. What is the
typical secondary payment behavior?
A. Tricare will pay the remaining balance up to 100% of the allowable amount if the provider is a Tricare-
authorized provider.
B. Tricare denies all claims if Medicare is primary.
C. The patient is responsible for the entire coinsurance.
D. The provider must write off the balance as a contractual adjustment.
Answer: A
Rationale: Tricare acts as a secondary payer to Medicare. If the provider is a Tricare-authorized
(participating) provider, Tricare typically pays the Medicare coinsurance and deductible amounts
(subject to Tricare’s allowable amount), resulting in minimal to zero patient liability.
5. Which registration data element is MOST critical for ensuring accurate DRG (Diagnosis Related
Group) assignment for an inpatient stay?
A. The patient’s email address
B. The admitting diagnosis and principal procedure codes
C. The guarantor’s social security number
D. The estimated length of stay
Answer: B
Rationale: DRG assignment is based on the principal diagnosis, secondary diagnoses, and principal
procedures coded from the clinical documentation. Accurate registration of these clinical indicators (or
ensuring documentation supports them) is foundational to correct reimbursement under the Inpatient
Prospective Payment System (IPPS).
6. According to CMS guidelines, what is the maximum timeframe for providing the "Notice of Privacy
Practices" (NPP) to a patient?
A. Only upon written request
B. At the time of the first service delivery or admission, and in an emergency, as soon as reasonably
practicable
C. Within 30 days of discharge
, D. Only at the time of billing
Answer: B
Rationale: HIPAA requires that covered entities provide the NPP no later than the date of the first
service delivery. In an emergency treatment situation, the provider must give the notice as soon as
reasonably practicable after the emergency situation ends.
7. What is the role of a "Financial Counselor" in the revenue cycle?
A. To collect payments only after insurance has processed.
B. To assess patient liability upfront, screen for government program eligibility (Medicaid/Charity), and
establish payment plans.
C. To assign ICD-10 codes.
D. To manage the hospital’s accounts payable.
Answer: B
Rationale: Financial counseling occurs early in the revenue cycle (pre-service or point-of-service). The
goal is to estimate patient out-of-pocket costs, identify potential payer sources (including Medicaid or
Charity Care), and secure payment arrangements to reduce bad debt.
Domain 2: Revenue Cycle & Health Information Management (Coding & CDI)
8. What is the primary goal of Clinical Documentation Integrity (CDI) programs?
A. To increase the number of inpatient admissions.
B. To ensure clinical documentation accurately reflects the severity of illness (SOI) and risk of mortality
(ROM) to support accurate coding and reimbursement.
C. To replace the coding department.
D. To only focus on outpatient observation services.
Answer: B
Rationale: CDI programs focus on concurrent review of the medical record to clarify documentation,
ensuring that the coded data accurately represents the patient’s clinical condition. This directly impacts
DRG assignment, quality scores, and severity-adjusted reimbursement.
9. A coder is reviewing a progress note. The physician writes, "Patient likely has CHF exacerbation, but
ruling out pneumonia. Will treat with diuretics." What is the correct coding action?
A. Code both CHF and Pneumonia as definitive.
B. Query the physician for a definitive diagnosis based on the treatment plan.
C. Code CHF exacerbation only.
D. Code Pneumonia only because it was listed second.
Answer: B
Rationale: Coders cannot assign diagnoses based on "likely," "probable," or "ruled out" for inpatient
admissions (per Uniform Hospital Discharge Data Set—UHDDS). The coder must query the physician to
Domain 1: Patient Financial Services (Registration & Scheduling)
1. A patient presents for a scheduled outpatient procedure. During registration, the registrar discovers
that the patient’s insurance was termed 3 days ago due to non-payment of premium. What is the
MOST appropriate action?
A. Proceed with the service as scheduled and bill the patient later.
B. Cancel the procedure immediately.
C. Notify the clinical team and attempt to contact the patient to discuss financial responsibility and
options before service.
D. Change the payer to Self-Pay and proceed.
Answer: C
Rationale: The registrar must ensure financial clearance. Proceeding without verifying coverage (A)
leads to denials. Canceling (B) without notification is poor customer service. Changing to Self-Pay (D)
without patient consent violates patient rights. The correct action is to halt the financial clearance
process, notify clinical staff to avoid resource waste, and counsel the patient regarding their options
(COB, reinstatement, or self-pay estimate).
2. Which of the following is a critical component of the "No Surprises Act" regarding patient
estimates?
A. Providing a Good Faith Estimate (GFE) to uninsured or self-pay patients prior to scheduled services.
B. Waiving all deductibles for emergency services.
C. Requiring patients to sign a blanket assignment of benefits.
D. Eliminating the need for prior authorizations.
Answer: A
Rationale: The No Surprises Act mandates that uninsured and self-pay patients receive a GFE of
expected charges prior to scheduled services. It also protects insured patients from surprise balance
billing for emergency services or ancillary care at in-network facilities, but it does not eliminate prior
authorizations (D) or waive deductibles (B).
,3. What is the primary purpose of the MSP (Medicare Secondary Payer) questionnaire?
A. To determine if the patient has a living will.
B. To identify if there is other insurance that should be primary to Medicare.
C. To calculate the patient’s co-insurance amount.
D. To verify the referring physician’s NPI number.
Answer: B
Rationale: The MSP questionnaire is a regulatory requirement to identify situations where Medicare is
secondary (e.g., employer group health plans for working beneficiaries, auto insurance, or liability).
Accurate determination prevents improper primary payment by Medicare and subsequent recovery
audits.
4. A patient is covered by both Medicare Part A and Tricare. Medicare pays its portion. What is the
typical secondary payment behavior?
A. Tricare will pay the remaining balance up to 100% of the allowable amount if the provider is a Tricare-
authorized provider.
B. Tricare denies all claims if Medicare is primary.
C. The patient is responsible for the entire coinsurance.
D. The provider must write off the balance as a contractual adjustment.
Answer: A
Rationale: Tricare acts as a secondary payer to Medicare. If the provider is a Tricare-authorized
(participating) provider, Tricare typically pays the Medicare coinsurance and deductible amounts
(subject to Tricare’s allowable amount), resulting in minimal to zero patient liability.
5. Which registration data element is MOST critical for ensuring accurate DRG (Diagnosis Related
Group) assignment for an inpatient stay?
A. The patient’s email address
B. The admitting diagnosis and principal procedure codes
C. The guarantor’s social security number
D. The estimated length of stay
Answer: B
Rationale: DRG assignment is based on the principal diagnosis, secondary diagnoses, and principal
procedures coded from the clinical documentation. Accurate registration of these clinical indicators (or
ensuring documentation supports them) is foundational to correct reimbursement under the Inpatient
Prospective Payment System (IPPS).
6. According to CMS guidelines, what is the maximum timeframe for providing the "Notice of Privacy
Practices" (NPP) to a patient?
A. Only upon written request
B. At the time of the first service delivery or admission, and in an emergency, as soon as reasonably
practicable
C. Within 30 days of discharge
, D. Only at the time of billing
Answer: B
Rationale: HIPAA requires that covered entities provide the NPP no later than the date of the first
service delivery. In an emergency treatment situation, the provider must give the notice as soon as
reasonably practicable after the emergency situation ends.
7. What is the role of a "Financial Counselor" in the revenue cycle?
A. To collect payments only after insurance has processed.
B. To assess patient liability upfront, screen for government program eligibility (Medicaid/Charity), and
establish payment plans.
C. To assign ICD-10 codes.
D. To manage the hospital’s accounts payable.
Answer: B
Rationale: Financial counseling occurs early in the revenue cycle (pre-service or point-of-service). The
goal is to estimate patient out-of-pocket costs, identify potential payer sources (including Medicaid or
Charity Care), and secure payment arrangements to reduce bad debt.
Domain 2: Revenue Cycle & Health Information Management (Coding & CDI)
8. What is the primary goal of Clinical Documentation Integrity (CDI) programs?
A. To increase the number of inpatient admissions.
B. To ensure clinical documentation accurately reflects the severity of illness (SOI) and risk of mortality
(ROM) to support accurate coding and reimbursement.
C. To replace the coding department.
D. To only focus on outpatient observation services.
Answer: B
Rationale: CDI programs focus on concurrent review of the medical record to clarify documentation,
ensuring that the coded data accurately represents the patient’s clinical condition. This directly impacts
DRG assignment, quality scores, and severity-adjusted reimbursement.
9. A coder is reviewing a progress note. The physician writes, "Patient likely has CHF exacerbation, but
ruling out pneumonia. Will treat with diuretics." What is the correct coding action?
A. Code both CHF and Pneumonia as definitive.
B. Query the physician for a definitive diagnosis based on the treatment plan.
C. Code CHF exacerbation only.
D. Code Pneumonia only because it was listed second.
Answer: B
Rationale: Coders cannot assign diagnoses based on "likely," "probable," or "ruled out" for inpatient
admissions (per Uniform Hospital Discharge Data Set—UHDDS). The coder must query the physician to
