HFMA CRCR EXAM QUESTIONS WITH VERIFIED ANSWERS
What are collection agency fees based on? - ans-A percentage of dollars collected
zx zx zx zx zx zx zx zx zx zx zx zx
Self-
funded benefit plans may choose to coordinate benefits using the gender rule or what other
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
rule? - ans-Birthday zx zx
In what type of payment methodology is a lump sum or bundled payment negotiated betwe
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
en the payer and some or all providers? - ans-Case rates
zx zx zx zx zx zx zx zx zx zx
What customer service improvements might improve the patient accounts department? -
zx zx zx zx zx zx zx zx zx zx
ans-Holding staff accountable for customer service during performance reviews
zx zx zx zx zx zx zx zx zx
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx
Inform a Medicare beneficiary that Medicare may not pay for the order or service
zx zx zx zx zx zx zx zx zx zx zx zx zx
What type of account adjustment results from the patient's unwillingness to pay for a self-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
pay balance? - ans-Bad debt adjustment
zx zx zx zx zx
What is the initial hospice benefit? - ans-Two 90-
zx zx zx zx zx zx zx zx
day periods and an unlimited number of subsequent periods
zx zx zx zx zx zx zx zx
When does a hospital add ambulance charges to the Medicare inpatient claim? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx
If the patient requires ambulance transportation to a skilled nursing facility
zx zx zx zx zx zx zx zx zx zx
How should a provider resolve a late-charge credit posted after an account is billed? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Post a late-charge adjustment to the account
zx zx zx zx zx zx
an increase in the dollars aged greater than 90 days from date of service indicate what abou
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
t accounts - ans-They are not being processed in a timely manner
zx zx zx zx zx zx zx zx zx zx zx
What is an advantage of a preregistration program? - ans-
zx zx zx zx zx zx zx zx zx
It reduces processing times at the time of service
zx zx zx zx zx zx zx zx
What are the two statutory exclusions from hospice coverage? - ans-
zx zx zx zx zx zx zx zx zx zx
Medically unnecessary services and custodial care zx zx zx zx zx
What core financial activities are resolved within patient access? - ans-
zx zx zx zx zx zx zx zx zx zx
Scheduling, insurance verification, discharge processing, and payment of point-of- zx zx zx zx zx zx zx zx
service receipts zx
,What statement applies to the scheduled outpatient? - ans-
zx zx zx zx zx zx zx zx
The services do not involve an overnight stay
zx zx zx zx zx zx zx
How is a mis-posted contractual allowance resolved? - ans-
zx zx zx zx zx zx zx zx
Comparing the contract reimbursement rates with the contract on the admittance advice to i
zx zx zx zx zx zx zx zx zx zx zx zx zx
dentify the correct amount zx zx zx
What type of patient status is used to evaluate the patient's need for inpatient care? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the be
zx zx zx zx zx zx zx zx zx zx zx zx
neficiary has received what? - ans- zx zx zx zx zx
Medically necessary inpatient hospital services for at least 3 consecutive days before the s
zx zx zx zx zx zx zx zx zx zx zx zx zx
killed nursing care admission zx zx zx
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
When the patient is the insured zx zx zx zx zx
What are non- zx zx
emergency patients who come for service without prior notification to the provider called? -
zx zx zx zx zx zx zx zx zx zx zx zx zx
ans-Unscheduled patients
zx zx
If the insurance verification response reports that a subscriber has a single policy, what is th
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
e status of the subscriber's spouse? - ans-Neither enrolled not entitled to benefits
zx zx zx zx zx zx zx zx zx zx zx zx
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
, establishes what? - ans-Disclosure rules for consumer credit sales and consumer loans
zx zx zx zx zx zx zx zx zx zx zx zx
What is a principal diagnosis? - ans-Primary reason for the patient's admission
zx zx zx zx zx zx zx zx zx zx zx
Collecting patient liability dollars after service leads to what? - ans-zx zx zx zx zx zx zx zx zx zx
Lower accounts receivable levels zx zx zx
What is the daily out-of-pocket amount for each lifetime reserve day used? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx
50% of the current deductible amount
zx zx zx zx zx
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
as an RHC services? - ans-Inpatient care
zx zx zx zx zx zx
What code indicates the disposition of the patient at the conclusion of service? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Patient discharge status code zx zx zx
What are hospitals required to do for Medicare credit balance accounts? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx
They result in lost reimbursement and additional cost to collect
zx zx zx zx zx zx zx zx zx
,When an undue delay of payment results from a dispute between the patient and the third p
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
arty payer, who is responsible for payment? - ans-Patient
zx zx zx zx zx zx zx zx
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the inform
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ation provided on the order must include: - ans-A valid CPT or HCPCS code
zx zx zx zx zx zx zx zx zx zx zx zx zx
With advances in internet security and encryption, revenue-
zx zx zx zx zx zx zx
cycle processes are expanding to allow patients to do what? - ans-
zx zx zx zx zx zx zx zx zx zx zx
Access their information and perform functions on-line
zx zx zx zx zx zx
What date is required on all CMS 1500 claim forms? - ans-onset date of current illness
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
What does scheduling allow provider staff to do - ans-
zx zx zx zx zx zx zx zx zx
Review appropriateness of the service request
zx zx zx zx zx
What code is used to report the provider's most common semiprivate room rate? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Condition code zx
Regulations and requirements for coding accountable care organizations, which allows pro
zx zx zx zx zx zx zx zx zx zx
viders to begin creating these organizations, were finalized in: - ans-2012
zx zx zx zx zx zx zx zx zx zx
What is a primary responsibility of the Recover Audit Contractor? - ans-
zx zx zx zx zx zx zx zx zx zx zx
To correctly identify proper payments for Medicare Part A & B claims
zx zx zx zx zx zx zx zx zx zx zx
How must providers handle credit balances? - ans-
zx zx zx zx zx zx zx
Comply with state statutes concerning reporting credit balance
zx zx zx zx zx zx zx
Insurance verification results in what? - ans- zx zx zx zx zx zx
The accurate identification of the patient's eligibility and benefits
zx zx zx zx zx zx zx zx
What form is used to bill Medicare for rural health clinics? - ans-CMS 1500
zx zx zx zx zx zx zx zx zx zx zx zx zx
What activities are completed when a scheduled pre-registered patient arrives for service?
zx zx zx zx zx zx zx zx zx zx zx
- ans-Registering the patient and directing the patient to the service area
zx zx zx zx zx zx zx zx zx zx zx zx
In addition to being supported by information found in the patient's chart, a CMS 1500 claim
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
must be coded using what? - ans-
zx zx zx zx zx zx
HCPCS (Healthcare Common Procedure Coding system)
zx zx zx zx zx
What results from a denied claim? - ans-The provider incurs rework and appeal costs
zx zx zx zx zx zx zx zx zx zx zx zx zx
Why does the financial counselor need pricing for services? - ans-
zx zx zx zx zx zx zx zx zx zx
To calculate the patient's financial responsibility
zx zx zx zx zx
What type of provider bills third-party payers using CMS 1500 form - ans-Hospital-
zx zx zx zx zx zx zx zx zx zx zx zx
based mammography centers zx zx
, How are disputes with nongovernmental payers resolved? - ans-
zx zx zx zx zx zx zx zx
Appeal conditions specified in the individual payer's contract
zx zx zx zx zx zx zx
The important message from Medicare provides beneficiaries with information concerning
zx zx zx zx zx zx zx zx zx zx
what? - ans-Right to appeal a discharge decision if the patient disagrees with the services
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Why do managed care plans have agreements with hospitals, physicians, and other health
zx zx zx zx zx zx zx zx zx zx zx zx
care providers to offer a range of services to plan members? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx
To improve access to quality healthcare
zx zx zx zx zx
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days, wh
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
at is the SNF permitted to do? - ans-Submit interim bills to the Medicare program.
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability clai
zx zx zx zx zx zx zx zx zx zx zx zx zx
ms after what happens? - ans-
zx zx zx zx zx
120 days passes, but the claim then be withdrawn from the liability carrier
zx zx zx zx zx zx zx zx zx zx zx zx
What data are required to establish a new MPI entry? - ans-
zx zx zx zx zx zx zx zx zx zx zx
The patient's full legal name, date of birth, and sex
zx zx zx zx zx zx zx zx zx
What should the provider do if both of the patient's insurance plans pay as primary? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Determine the correct payer and notify the incorrect payer of the processing error
zx zx zx zx zx zx zx zx zx zx zx zx
What do EMTALA regulations require on-call physicians to do? - ans-
zx zx zx zx zx zx zx zx zx zx
Personally appear in the emergency department and attend to the patient within a reasona
zx zx zx zx zx zx zx zx zx zx zx zx zx
ble time zx
At the end of each shift, what must happen to cash, checks, and credit card transaction doc
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
uments? - ans-They must be balanced zx zx zx zx zx
What will cause a CMS 1500 claim to be rejected? - ans-
zx zx zx zx zx zx zx zx zx zx zx
The provider is billing with a future date of service
zx zx zx zx zx zx zx zx zx
Under Medicare regulations, which of the following is not included on a valid physician's ord
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
er for services? - ans-The cost of the test
zx zx zx zx zx zx zx zx
how are HCPCS codes and the appropriate modifiers used? - ans-
zx zx zx zx zx zx zx zx zx zx
To report the level 1, 2, or 3 code that correctly describes the service provided
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
If a Medicare patient is admitted on Friday, what services fall within the three-
zx zx zx zx zx zx zx zx zx zx zx zx zx
day DRG window rule? - ans-Diagnostic and clinically-related non-
zx zx zx zx zx zx zx zx
diagnostic charges provided on the Tuesday, Wednesday, Thursday, and Friday before ad
zx zx zx zx zx zx zx zx zx zx zx
mission
What are collection agency fees based on? - ans-A percentage of dollars collected
zx zx zx zx zx zx zx zx zx zx zx zx
Self-
funded benefit plans may choose to coordinate benefits using the gender rule or what other
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
rule? - ans-Birthday zx zx
In what type of payment methodology is a lump sum or bundled payment negotiated betwe
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
en the payer and some or all providers? - ans-Case rates
zx zx zx zx zx zx zx zx zx zx
What customer service improvements might improve the patient accounts department? -
zx zx zx zx zx zx zx zx zx zx
ans-Holding staff accountable for customer service during performance reviews
zx zx zx zx zx zx zx zx zx
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx
Inform a Medicare beneficiary that Medicare may not pay for the order or service
zx zx zx zx zx zx zx zx zx zx zx zx zx
What type of account adjustment results from the patient's unwillingness to pay for a self-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
pay balance? - ans-Bad debt adjustment
zx zx zx zx zx
What is the initial hospice benefit? - ans-Two 90-
zx zx zx zx zx zx zx zx
day periods and an unlimited number of subsequent periods
zx zx zx zx zx zx zx zx
When does a hospital add ambulance charges to the Medicare inpatient claim? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx
If the patient requires ambulance transportation to a skilled nursing facility
zx zx zx zx zx zx zx zx zx zx
How should a provider resolve a late-charge credit posted after an account is billed? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Post a late-charge adjustment to the account
zx zx zx zx zx zx
an increase in the dollars aged greater than 90 days from date of service indicate what abou
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
t accounts - ans-They are not being processed in a timely manner
zx zx zx zx zx zx zx zx zx zx zx
What is an advantage of a preregistration program? - ans-
zx zx zx zx zx zx zx zx zx
It reduces processing times at the time of service
zx zx zx zx zx zx zx zx
What are the two statutory exclusions from hospice coverage? - ans-
zx zx zx zx zx zx zx zx zx zx
Medically unnecessary services and custodial care zx zx zx zx zx
What core financial activities are resolved within patient access? - ans-
zx zx zx zx zx zx zx zx zx zx
Scheduling, insurance verification, discharge processing, and payment of point-of- zx zx zx zx zx zx zx zx
service receipts zx
,What statement applies to the scheduled outpatient? - ans-
zx zx zx zx zx zx zx zx
The services do not involve an overnight stay
zx zx zx zx zx zx zx
How is a mis-posted contractual allowance resolved? - ans-
zx zx zx zx zx zx zx zx
Comparing the contract reimbursement rates with the contract on the admittance advice to i
zx zx zx zx zx zx zx zx zx zx zx zx zx
dentify the correct amount zx zx zx
What type of patient status is used to evaluate the patient's need for inpatient care? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the be
zx zx zx zx zx zx zx zx zx zx zx zx
neficiary has received what? - ans- zx zx zx zx zx
Medically necessary inpatient hospital services for at least 3 consecutive days before the s
zx zx zx zx zx zx zx zx zx zx zx zx zx
killed nursing care admission zx zx zx
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
When the patient is the insured zx zx zx zx zx
What are non- zx zx
emergency patients who come for service without prior notification to the provider called? -
zx zx zx zx zx zx zx zx zx zx zx zx zx
ans-Unscheduled patients
zx zx
If the insurance verification response reports that a subscriber has a single policy, what is th
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
e status of the subscriber's spouse? - ans-Neither enrolled not entitled to benefits
zx zx zx zx zx zx zx zx zx zx zx zx
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
, establishes what? - ans-Disclosure rules for consumer credit sales and consumer loans
zx zx zx zx zx zx zx zx zx zx zx zx
What is a principal diagnosis? - ans-Primary reason for the patient's admission
zx zx zx zx zx zx zx zx zx zx zx
Collecting patient liability dollars after service leads to what? - ans-zx zx zx zx zx zx zx zx zx zx
Lower accounts receivable levels zx zx zx
What is the daily out-of-pocket amount for each lifetime reserve day used? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx
50% of the current deductible amount
zx zx zx zx zx
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
as an RHC services? - ans-Inpatient care
zx zx zx zx zx zx
What code indicates the disposition of the patient at the conclusion of service? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Patient discharge status code zx zx zx
What are hospitals required to do for Medicare credit balance accounts? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx
They result in lost reimbursement and additional cost to collect
zx zx zx zx zx zx zx zx zx
,When an undue delay of payment results from a dispute between the patient and the third p
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
arty payer, who is responsible for payment? - ans-Patient
zx zx zx zx zx zx zx zx
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the inform
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ation provided on the order must include: - ans-A valid CPT or HCPCS code
zx zx zx zx zx zx zx zx zx zx zx zx zx
With advances in internet security and encryption, revenue-
zx zx zx zx zx zx zx
cycle processes are expanding to allow patients to do what? - ans-
zx zx zx zx zx zx zx zx zx zx zx
Access their information and perform functions on-line
zx zx zx zx zx zx
What date is required on all CMS 1500 claim forms? - ans-onset date of current illness
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
What does scheduling allow provider staff to do - ans-
zx zx zx zx zx zx zx zx zx
Review appropriateness of the service request
zx zx zx zx zx
What code is used to report the provider's most common semiprivate room rate? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Condition code zx
Regulations and requirements for coding accountable care organizations, which allows pro
zx zx zx zx zx zx zx zx zx zx
viders to begin creating these organizations, were finalized in: - ans-2012
zx zx zx zx zx zx zx zx zx zx
What is a primary responsibility of the Recover Audit Contractor? - ans-
zx zx zx zx zx zx zx zx zx zx zx
To correctly identify proper payments for Medicare Part A & B claims
zx zx zx zx zx zx zx zx zx zx zx
How must providers handle credit balances? - ans-
zx zx zx zx zx zx zx
Comply with state statutes concerning reporting credit balance
zx zx zx zx zx zx zx
Insurance verification results in what? - ans- zx zx zx zx zx zx
The accurate identification of the patient's eligibility and benefits
zx zx zx zx zx zx zx zx
What form is used to bill Medicare for rural health clinics? - ans-CMS 1500
zx zx zx zx zx zx zx zx zx zx zx zx zx
What activities are completed when a scheduled pre-registered patient arrives for service?
zx zx zx zx zx zx zx zx zx zx zx
- ans-Registering the patient and directing the patient to the service area
zx zx zx zx zx zx zx zx zx zx zx zx
In addition to being supported by information found in the patient's chart, a CMS 1500 claim
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
must be coded using what? - ans-
zx zx zx zx zx zx
HCPCS (Healthcare Common Procedure Coding system)
zx zx zx zx zx
What results from a denied claim? - ans-The provider incurs rework and appeal costs
zx zx zx zx zx zx zx zx zx zx zx zx zx
Why does the financial counselor need pricing for services? - ans-
zx zx zx zx zx zx zx zx zx zx
To calculate the patient's financial responsibility
zx zx zx zx zx
What type of provider bills third-party payers using CMS 1500 form - ans-Hospital-
zx zx zx zx zx zx zx zx zx zx zx zx
based mammography centers zx zx
, How are disputes with nongovernmental payers resolved? - ans-
zx zx zx zx zx zx zx zx
Appeal conditions specified in the individual payer's contract
zx zx zx zx zx zx zx
The important message from Medicare provides beneficiaries with information concerning
zx zx zx zx zx zx zx zx zx zx
what? - ans-Right to appeal a discharge decision if the patient disagrees with the services
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Why do managed care plans have agreements with hospitals, physicians, and other health
zx zx zx zx zx zx zx zx zx zx zx zx
care providers to offer a range of services to plan members? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx
To improve access to quality healthcare
zx zx zx zx zx
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days, wh
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
at is the SNF permitted to do? - ans-Submit interim bills to the Medicare program.
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability clai
zx zx zx zx zx zx zx zx zx zx zx zx zx
ms after what happens? - ans-
zx zx zx zx zx
120 days passes, but the claim then be withdrawn from the liability carrier
zx zx zx zx zx zx zx zx zx zx zx zx
What data are required to establish a new MPI entry? - ans-
zx zx zx zx zx zx zx zx zx zx zx
The patient's full legal name, date of birth, and sex
zx zx zx zx zx zx zx zx zx
What should the provider do if both of the patient's insurance plans pay as primary? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Determine the correct payer and notify the incorrect payer of the processing error
zx zx zx zx zx zx zx zx zx zx zx zx
What do EMTALA regulations require on-call physicians to do? - ans-
zx zx zx zx zx zx zx zx zx zx
Personally appear in the emergency department and attend to the patient within a reasona
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ble time zx
At the end of each shift, what must happen to cash, checks, and credit card transaction doc
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uments? - ans-They must be balanced zx zx zx zx zx
What will cause a CMS 1500 claim to be rejected? - ans-
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The provider is billing with a future date of service
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Under Medicare regulations, which of the following is not included on a valid physician's ord
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er for services? - ans-The cost of the test
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how are HCPCS codes and the appropriate modifiers used? - ans-
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To report the level 1, 2, or 3 code that correctly describes the service provided
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If a Medicare patient is admitted on Friday, what services fall within the three-
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day DRG window rule? - ans-Diagnostic and clinically-related non-
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diagnostic charges provided on the Tuesday, Wednesday, Thursday, and Friday before ad
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mission
