HFMA CRCR and Practice Exam Test
Bank – 2026/2027 Edition – Verified
Questions and Answers 100% Correct
What core financial activities are resolved within patient access? - ANSWER -
scheduling , pre-registration, insurance verification and managed care processing
What is an unscheduled direct admission? - ANSWER -A patient who arrives at
the hospital via ambulance for treatment in the emergency department
When is it not appropriate to use observation status? - ANSWER -As a substitute
for an inpatient admission
Patients who require periodic skilled nursing or therapeutic care receive services
from what type of program? - ANSWER -Home health agency
Every patient who is new to the healthcare provider must be offered what? -
ANSWER -A printed copy of the provider privacy notice
Which of the following statements apples to self insured insurance plans? -
ANSWER -The employer provides a traditional HMO health plan
In addition to the member's identification number, what information is recorded in
a 270 transaction - ANSWER -Name
What process does a patient's health plan use to retroactively collect payments
from liability automobile or worker's compensation plan? - ANSWER -
Subrogation
In what type of payment methodology is a lump sum of bundled payment
negotiated between the payer and some or all providers? - ANSWER -DRG/Case
rate
, What Restriction does a managed care plan place on locations that must be used if
the plan is to pay for the service provided? - ANSWER -Site of service limitation
Which of the following statements applies to private rooms? - ANSWER -If the
medical necessity for a private room is documented in the chart. The patients
insurance will be billed for the differential
Which of the following is true about screening a beneficiary of possible
MSP(Medicare secondary payer) situations? - ANSWER -It is necessary to ask the
patient each of the MSP questions
Which of the following is not true of Medicare Advantage Plans? - ANSWER -A
patient must have both Medicare Part A and B benefits to be eligible for a
Medicare Advantage plan
Which of the following is a valid reason for a payer to deny a claim? - ANSWER
-Failure to complete authorization
Which of the following statements is NOT a possible consequence of selecting the
wrong patient in the MPI(master patient index) - ANSWER -Claim is paid in full
Which of the following statements is true of a Medicare Advantage Plan? -
ANSWER -This plan supplements Part A and Part B benefits
Which is the following is not a characteristic of Medicaid HMO plan? -
ANSWER -Medicaid-eligible patients are never required to join a Medicaid HMO
plan
Which of the following is violation of the EMTALA ? - ANSWER -Registration
staff members routinely contact managed care plans for prior authorizations before
the patients is seen by the on duty physician
Which of the following statements is true of the important message from Medicare
notification requirements? - ANSWER -Notification can be issued no earlier than
7 days before admission and no more than 2 days before discharge.
, What is the self pay balance after insurance - ANSWER -The portion of the
adjudicated claim that is due from the patient
Which of the following options is an alternative to valid long term payment plans -
ANSWER -Bank loans
The patient has the following benefit plan $400 per family member deductible, to
a maximum of $1200 per year and $2000 per family member co insurance, to a
family maximum of $6000 per year excluding the deductible . Five family
members are enrolled in this benefit plan. What is the maximum out of pocket
expense that that family could incur during the calendar year? - ANSWER -$6000
What type of plan restricts benefits for non-emergency care to approve providers
only? - ANSWER -A POS (point of service )plan
What does scheduling allow provider staff to do? - ANSWER -Review the
appropriateness of the service requested
When an adult patient is covered by both his own and his spouse health insurance
plan, which of the statements is true? - ANSWER -The patients insurance plan is
primary
Mrs. Jones , a Medicare beneficiary was admitted to the hospital on June 20,2010.
As of the admission date, she had only used 8 inpatient days in the current benefit
period. If she is not discharge on what date will Mr jones exhaust her full coverage
days. - ANSWER -August 9, 2010
In order to meet eligibility guidelines for healthcare benefits, Medicaid
beneficiaries must fall into a specified need category and meet what other types of
requirements - ANSWER -Income and assets
Fee for service plans pay claims based on a percentage of charges. How are
patients out of pocket cost calculated? - ANSWER -They are calculated quarterly
Bank – 2026/2027 Edition – Verified
Questions and Answers 100% Correct
What core financial activities are resolved within patient access? - ANSWER -
scheduling , pre-registration, insurance verification and managed care processing
What is an unscheduled direct admission? - ANSWER -A patient who arrives at
the hospital via ambulance for treatment in the emergency department
When is it not appropriate to use observation status? - ANSWER -As a substitute
for an inpatient admission
Patients who require periodic skilled nursing or therapeutic care receive services
from what type of program? - ANSWER -Home health agency
Every patient who is new to the healthcare provider must be offered what? -
ANSWER -A printed copy of the provider privacy notice
Which of the following statements apples to self insured insurance plans? -
ANSWER -The employer provides a traditional HMO health plan
In addition to the member's identification number, what information is recorded in
a 270 transaction - ANSWER -Name
What process does a patient's health plan use to retroactively collect payments
from liability automobile or worker's compensation plan? - ANSWER -
Subrogation
In what type of payment methodology is a lump sum of bundled payment
negotiated between the payer and some or all providers? - ANSWER -DRG/Case
rate
, What Restriction does a managed care plan place on locations that must be used if
the plan is to pay for the service provided? - ANSWER -Site of service limitation
Which of the following statements applies to private rooms? - ANSWER -If the
medical necessity for a private room is documented in the chart. The patients
insurance will be billed for the differential
Which of the following is true about screening a beneficiary of possible
MSP(Medicare secondary payer) situations? - ANSWER -It is necessary to ask the
patient each of the MSP questions
Which of the following is not true of Medicare Advantage Plans? - ANSWER -A
patient must have both Medicare Part A and B benefits to be eligible for a
Medicare Advantage plan
Which of the following is a valid reason for a payer to deny a claim? - ANSWER
-Failure to complete authorization
Which of the following statements is NOT a possible consequence of selecting the
wrong patient in the MPI(master patient index) - ANSWER -Claim is paid in full
Which of the following statements is true of a Medicare Advantage Plan? -
ANSWER -This plan supplements Part A and Part B benefits
Which is the following is not a characteristic of Medicaid HMO plan? -
ANSWER -Medicaid-eligible patients are never required to join a Medicaid HMO
plan
Which of the following is violation of the EMTALA ? - ANSWER -Registration
staff members routinely contact managed care plans for prior authorizations before
the patients is seen by the on duty physician
Which of the following statements is true of the important message from Medicare
notification requirements? - ANSWER -Notification can be issued no earlier than
7 days before admission and no more than 2 days before discharge.
, What is the self pay balance after insurance - ANSWER -The portion of the
adjudicated claim that is due from the patient
Which of the following options is an alternative to valid long term payment plans -
ANSWER -Bank loans
The patient has the following benefit plan $400 per family member deductible, to
a maximum of $1200 per year and $2000 per family member co insurance, to a
family maximum of $6000 per year excluding the deductible . Five family
members are enrolled in this benefit plan. What is the maximum out of pocket
expense that that family could incur during the calendar year? - ANSWER -$6000
What type of plan restricts benefits for non-emergency care to approve providers
only? - ANSWER -A POS (point of service )plan
What does scheduling allow provider staff to do? - ANSWER -Review the
appropriateness of the service requested
When an adult patient is covered by both his own and his spouse health insurance
plan, which of the statements is true? - ANSWER -The patients insurance plan is
primary
Mrs. Jones , a Medicare beneficiary was admitted to the hospital on June 20,2010.
As of the admission date, she had only used 8 inpatient days in the current benefit
period. If she is not discharge on what date will Mr jones exhaust her full coverage
days. - ANSWER -August 9, 2010
In order to meet eligibility guidelines for healthcare benefits, Medicaid
beneficiaries must fall into a specified need category and meet what other types of
requirements - ANSWER -Income and assets
Fee for service plans pay claims based on a percentage of charges. How are
patients out of pocket cost calculated? - ANSWER -They are calculated quarterly
