HFMA CRCR TEST EXAM 2026 COMPLETE
QUESTIONS WITH CORRECT ANSWERS
GUARANTEED PASS
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - 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? - Bad debt adjustment
What is the initial hospice benefit? - Two 90-day periods and an unlimited number of
subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - 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? -
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 - They are not being processed in a timely manner
What is an advantage of a preregistration program? - It reduces processing times at the
time of service
What are the two statutory exclusions from hospice coverage? - Medically unnecessary
services and custodial care
What are collection agency fees based on? - A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? - Birthday
,In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - Case rates
What customer service improvements might improve the patient accounts department?
- Holding staff accountable for customer service during performance reviews
What core financial activities are resolved within patient access? - Scheduling,
insurance verification, discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - The services do not involve an
overnight stay
How is a mis-posted contractual allowance resolved? - 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? -
Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - 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$? - When
the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what
is the status of the subscriber's spouse? - Neither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - Disclosure rules for consumer credit sales and consumer loans
What is a principal diagnosis? - Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - Lower accounts
receivable levels
,What is the daily out-of-pocket amount for each lifetime reserve day used? - 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? - Inpatient care
What code indicates the disposition of the patient at the conclusion of service? - Patient
discharge status code
What are hospitals required to do for Medicare credit balance accounts? - 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? - Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - A valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - Access their information and perform
functions on-line
What date is required on all CMS 1500 claim forms? - onset date of current illness
What does scheduling allow provider staff to do - Review appropriateness of the service
request
What code is used to report the provider's most common semiprivate room rate? -
Condition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: - 2012
What is a primary responsibility of the Recover Audit Contractor? - To correctly identify
proper payments for Medicare Part A & B claims
How must providers handle credit balances? - Comply with state statutes concerning
reporting credit balance
Insurance verification results in what? - The accurate identification of the patient's
eligibility and benefits
What form is used to bill Medicare for rural health clinics? - CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for
service? - 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? - HCPCS (Healthcare Common Procedure Coding
system)
What results from a denied claim? - The provider incurs rework and appeal costs
Why does the financial counselor need pricing for services? - To calculate the patient's
financial responsibility
What type of provider bills third-party payers using CMS 1500 form - Hospital-based
mammography centers
How are disputes with nongovernmental payers resolved? - Appeal conditions specified
in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - 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? - 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? - Submit interim bills to the Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - 120 days passes, but the claim then be withdrawn from
the liability carrier
What data are required to establish a new MPI entry? - 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? -
Determine the correct payer and notify the incorrect payer of the processing error
What do EMTALA regulations require on-call physicians to do? - 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? - They must be balanced
What will cause a CMS 1500 claim to be rejected? - The provider is billing with a future
date of service
QUESTIONS WITH CORRECT ANSWERS
GUARANTEED PASS
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - 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? - Bad debt adjustment
What is the initial hospice benefit? - Two 90-day periods and an unlimited number of
subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - 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? -
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 - They are not being processed in a timely manner
What is an advantage of a preregistration program? - It reduces processing times at the
time of service
What are the two statutory exclusions from hospice coverage? - Medically unnecessary
services and custodial care
What are collection agency fees based on? - A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? - Birthday
,In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - Case rates
What customer service improvements might improve the patient accounts department?
- Holding staff accountable for customer service during performance reviews
What core financial activities are resolved within patient access? - Scheduling,
insurance verification, discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - The services do not involve an
overnight stay
How is a mis-posted contractual allowance resolved? - 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? -
Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - 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$? - When
the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what
is the status of the subscriber's spouse? - Neither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - Disclosure rules for consumer credit sales and consumer loans
What is a principal diagnosis? - Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - Lower accounts
receivable levels
,What is the daily out-of-pocket amount for each lifetime reserve day used? - 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? - Inpatient care
What code indicates the disposition of the patient at the conclusion of service? - Patient
discharge status code
What are hospitals required to do for Medicare credit balance accounts? - 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? - Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - A valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - Access their information and perform
functions on-line
What date is required on all CMS 1500 claim forms? - onset date of current illness
What does scheduling allow provider staff to do - Review appropriateness of the service
request
What code is used to report the provider's most common semiprivate room rate? -
Condition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: - 2012
What is a primary responsibility of the Recover Audit Contractor? - To correctly identify
proper payments for Medicare Part A & B claims
How must providers handle credit balances? - Comply with state statutes concerning
reporting credit balance
Insurance verification results in what? - The accurate identification of the patient's
eligibility and benefits
What form is used to bill Medicare for rural health clinics? - CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for
service? - 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? - HCPCS (Healthcare Common Procedure Coding
system)
What results from a denied claim? - The provider incurs rework and appeal costs
Why does the financial counselor need pricing for services? - To calculate the patient's
financial responsibility
What type of provider bills third-party payers using CMS 1500 form - Hospital-based
mammography centers
How are disputes with nongovernmental payers resolved? - Appeal conditions specified
in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - 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? - 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? - Submit interim bills to the Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - 120 days passes, but the claim then be withdrawn from
the liability carrier
What data are required to establish a new MPI entry? - 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? -
Determine the correct payer and notify the incorrect payer of the processing error
What do EMTALA regulations require on-call physicians to do? - 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? - They must be balanced
What will cause a CMS 1500 claim to be rejected? - The provider is billing with a future
date of service
