HFMA CRCR EXAM QUESTIONS AND
ANSWERS
1. Through what document does a hospital establish compliance
standards?: -
code of conduct
2. What is the purpose OIG work plant?: Identify Acceptable compliance
programs in various provider setting
3. If a Medicare patient is admitted on Friday, what services fall
within the three-day DRG window rule?: Non-diagnostic service provided on
Tuesday through Friday
4. What does a modifier allow a provider to do?: Report a specific circumstance that
affected a procedure or service without changing the code or its definition
5. IF outpatient diagnostic services are provided within three days of
the ad- mission of a Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to these charges:
They must be billed separately to the part B Carrier
6. what is a recurring or series registration?: One registration record is created for
,multiple days of service
7. What are nonemergency patients who come for service without
prior notifi- cation to the provider called?: Unscheduled patients
8. Which of the following statement apply to the observation patient
type?: It is used to evaluate the need for an inpatient admission
9. which services are hospice programs required to provide around
the clock patient: Physician, Nursing, Pharmacy
10. Scheduler instructions are used to prompt the scheduler to do
what?: Complete the scheduling process correctly based on service requeste
11. The Time needed to prepare the patient before service is
the difference between the patients arrival time and which of the
following?: Procedure time
12. Medicare guidelines require that when a test is ordered for a
LCD or NCD exists, the information provided on the order must
include:: Documentation of the medical necessity for the test
13. What is the advantage of a pre-registration program: It reduces
processing times at the time of service
, 14. What date are required to establish a new MPI(Master patient
Index) entry-
: The responsible party's full legal name, date of birth, and social security number
15. Which of the following statements is true about third-party
payments?: The payments are received by the provider from the payer responsible for
reimbursing the provider for the patient's covered services.
16. Which provision protects the patient from medical expenses
that exceed the pre-set level: stop loss
17. what documentation must a primary care physician send to
HMO patient to authorize a visit to a specialist for additional testing
or care?: Referral
18. 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?: Medical screening and stabilizing treatment
19. Which of the following is a step in the discharge process?: Have a
case management service complete the discharge plan
20. The hospital has a APC based contract for the payment of
outpatient ser- vices. Total anticipated charges for the visit are
$2,380. The approved APC payment rate is $780. Where will the
ANSWERS
1. Through what document does a hospital establish compliance
standards?: -
code of conduct
2. What is the purpose OIG work plant?: Identify Acceptable compliance
programs in various provider setting
3. If a Medicare patient is admitted on Friday, what services fall
within the three-day DRG window rule?: Non-diagnostic service provided on
Tuesday through Friday
4. What does a modifier allow a provider to do?: Report a specific circumstance that
affected a procedure or service without changing the code or its definition
5. IF outpatient diagnostic services are provided within three days of
the ad- mission of a Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to these charges:
They must be billed separately to the part B Carrier
6. what is a recurring or series registration?: One registration record is created for
,multiple days of service
7. What are nonemergency patients who come for service without
prior notifi- cation to the provider called?: Unscheduled patients
8. Which of the following statement apply to the observation patient
type?: It is used to evaluate the need for an inpatient admission
9. which services are hospice programs required to provide around
the clock patient: Physician, Nursing, Pharmacy
10. Scheduler instructions are used to prompt the scheduler to do
what?: Complete the scheduling process correctly based on service requeste
11. The Time needed to prepare the patient before service is
the difference between the patients arrival time and which of the
following?: Procedure time
12. Medicare guidelines require that when a test is ordered for a
LCD or NCD exists, the information provided on the order must
include:: Documentation of the medical necessity for the test
13. What is the advantage of a pre-registration program: It reduces
processing times at the time of service
, 14. What date are required to establish a new MPI(Master patient
Index) entry-
: The responsible party's full legal name, date of birth, and social security number
15. Which of the following statements is true about third-party
payments?: The payments are received by the provider from the payer responsible for
reimbursing the provider for the patient's covered services.
16. Which provision protects the patient from medical expenses
that exceed the pre-set level: stop loss
17. what documentation must a primary care physician send to
HMO patient to authorize a visit to a specialist for additional testing
or care?: Referral
18. 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?: Medical screening and stabilizing treatment
19. Which of the following is a step in the discharge process?: Have a
case management service complete the discharge plan
20. The hospital has a APC based contract for the payment of
outpatient ser- vices. Total anticipated charges for the visit are
$2,380. The approved APC payment rate is $780. Where will the
