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HFMA CRCR Questions and Answers with 100%
Correct Solutions UPDATED!!!
Through what document does a hospital establish compliance
standards? - ANSWER code of conduct
What is the purpose OIG work plant? - ANSWER Identify
Acceptable compliance programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall
within the three-day DRG window rule? - ANSWER Non-
diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do? - ANSWER Report
a specific circumstance that affected a procedure or service
without changing the code or its definition
IF outpatient diagnostic services are provided within three days
of the admission of a Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to
these charges - ANSWER They must be billed separately to the
part B Carrier
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what is a recurring or series registration? - ANSWER One
registration record is created for multiple days of service
What are nonemergency patients who come for service without
prior notification to the provider called? - ANSWER
Unscheduled patients
Which of the following statement apply to the observation
patient type? - ANSWER It is used to evaluate the need for an
inpatient admission
which services are hospice programs required to provide
around the clock patient - ANSWER Physician, Nursing,
Pharmacy
Scheduler instructions are used to prompt the scheduler to do
what? - ANSWER Complete the scheduling process correctly
based on service requeste
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The Time needed to prepare the patient before service is the
difference between the patients arrival time and which of the
following? - ANSWER Procedure time
Medicare guidelines require that when a test is ordered for a
LCD or NCD exists, the information provided on the order must
include: - ANSWER Documentation of the medical necessity for
the test
What is the advantage of a pre-registration program - ANSWER
It reduces processing times at the time of service
What date are required to establish a new MPI(Master patient
Index) entry - ANSWER The responsible party's full legal name,
date of birth, and social security number
Which of the following statements is true about third-party
payments? - ANSWER The payments are received by the
provider from the payer responsible for reimbursing the
provider for the patient's covered services.
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Which provision protects the patient from medical expenses
that exceed the pre-set level - ANSWER stop loss
what documentation must a primary care physician send to
HMO patient to authorize a visit to a specialist for additional
testing or care? - ANSWER Referral
Under EMTALA (Emergency Medical Treatment and Labor Act)
regulations, the provider may not ask about a patient's
insurance information if it would delay what? - ANSWER
Medical screening and stabilizing treatment
Which of the following is a step in the discharge process? -
ANSWER Have a case management service complete the
discharge plan
The hospital has a APC based contract for the payment of
outpatient services. Total anticipated charges for the visit are
$2,380. The approved APC payment rate is $780. Where will the
patients benefit package be applied? - ANSWER To the
approved APC payment rate
HFMA CRCR Questions and Answers with 100%
Correct Solutions UPDATED!!!
Through what document does a hospital establish compliance
standards? - ANSWER code of conduct
What is the purpose OIG work plant? - ANSWER Identify
Acceptable compliance programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall
within the three-day DRG window rule? - ANSWER Non-
diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do? - ANSWER Report
a specific circumstance that affected a procedure or service
without changing the code or its definition
IF outpatient diagnostic services are provided within three days
of the admission of a Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to
these charges - ANSWER They must be billed separately to the
part B Carrier
,2|Page
what is a recurring or series registration? - ANSWER One
registration record is created for multiple days of service
What are nonemergency patients who come for service without
prior notification to the provider called? - ANSWER
Unscheduled patients
Which of the following statement apply to the observation
patient type? - ANSWER It is used to evaluate the need for an
inpatient admission
which services are hospice programs required to provide
around the clock patient - ANSWER Physician, Nursing,
Pharmacy
Scheduler instructions are used to prompt the scheduler to do
what? - ANSWER Complete the scheduling process correctly
based on service requeste
,3|Page
The Time needed to prepare the patient before service is the
difference between the patients arrival time and which of the
following? - ANSWER Procedure time
Medicare guidelines require that when a test is ordered for a
LCD or NCD exists, the information provided on the order must
include: - ANSWER Documentation of the medical necessity for
the test
What is the advantage of a pre-registration program - ANSWER
It reduces processing times at the time of service
What date are required to establish a new MPI(Master patient
Index) entry - ANSWER The responsible party's full legal name,
date of birth, and social security number
Which of the following statements is true about third-party
payments? - ANSWER The payments are received by the
provider from the payer responsible for reimbursing the
provider for the patient's covered services.
, 4|Page
Which provision protects the patient from medical expenses
that exceed the pre-set level - ANSWER stop loss
what documentation must a primary care physician send to
HMO patient to authorize a visit to a specialist for additional
testing or care? - ANSWER Referral
Under EMTALA (Emergency Medical Treatment and Labor Act)
regulations, the provider may not ask about a patient's
insurance information if it would delay what? - ANSWER
Medical screening and stabilizing treatment
Which of the following is a step in the discharge process? -
ANSWER Have a case management service complete the
discharge plan
The hospital has a APC based contract for the payment of
outpatient services. Total anticipated charges for the visit are
$2,380. The approved APC payment rate is $780. Where will the
patients benefit package be applied? - ANSWER To the
approved APC payment rate
