1|Page
HFMA CRCR (Certified Revenue Cycle Representative) Exam
||Just Out!!!
The important Message from Medicare provides beneficiaries
information concerning
their
a) Understanding of billing issues and the deductibles and/or
co-insurance
due for the current visit
b) Right to refuse to use lifetime reserve days for the current
stay
c) Right to appeal a discharge decision if the patient disagrees
with the plan
d) Obligation to reimburse the hospital for any services not
covered by the
Medicare program - ANSWER-C
All of the following are potential causes of credit balances
EXCEPT
a) Duplicate payments
b) Primary and secondary payers both paying as primary
,2|Page
c) Inaccurate upfront collections based on incorrect liability
estimates
d) A patient's choice to build up a credit against future medical
bills - ANSWER-D
Medicare Part B has an annual deductible, and the beneficiary
is responsible for
a) A co-insurance payment for all Part B covered services
b) Physicians office fees
c) Tests outside of an inpatient setting
d) Prescriptions - ANSWER-A
The importance of medical records being maintained by HIM is
that the patient records
a) Are the primary source for clinical data required for
reimbursement by
health plans and liability payers
b) Are the strongest evidence and defense in the event of a
Medicare audit
c) Are evidence used in assessing the quality of care
d) Are the evidence cited in quality review - ANSWER-A
,3|Page
A decision on whether a patient should be admitted as an
inpatient or become an
outpatient observation patient requires medical judgments
based on all of the following
EXCEPT
a) The patient's home care coverage
b) Current medical needs
c) The likelihood of an adverse event occurring to the patient
d) The patient's medical history - ANSWER-A
Medicare has established guidelines called the Local Coverage
Determinations (LCD) and
National Coverage Determinations (NCD) that establish
a) Provider and physician reimbursement for specific diagnoses
and tests
b) Prospective Medicare patient financial responsibilities for a
given
diagnosis
c) Reasonable and customary prices for services in a given area
, 4|Page
d) What services or healthcare items are covered under
Medicare - ANSWER-D
What are some core elements if a board-approved financial
assistance policy?
a) Payment requirements, staffing hours, and admission policies
b) Case management, payment methods, and discharge policies
c) Deposit requirements, pre-registration calling hours, and
charity care
policy
d) Eligibility, application process, and nonpayment collection
activities - ANSWER-D
The ICD-10 codes set and CPT/HCPCS code sets combines
provide
a) Pricing floors for services
b) The financial data required for activity-based costing
c) Patients an overview of services covered by their health
insurance plan
d) The specificity and coding needed to support reimbursement
claims - ANSWER-D
HFMA CRCR (Certified Revenue Cycle Representative) Exam
||Just Out!!!
The important Message from Medicare provides beneficiaries
information concerning
their
a) Understanding of billing issues and the deductibles and/or
co-insurance
due for the current visit
b) Right to refuse to use lifetime reserve days for the current
stay
c) Right to appeal a discharge decision if the patient disagrees
with the plan
d) Obligation to reimburse the hospital for any services not
covered by the
Medicare program - ANSWER-C
All of the following are potential causes of credit balances
EXCEPT
a) Duplicate payments
b) Primary and secondary payers both paying as primary
,2|Page
c) Inaccurate upfront collections based on incorrect liability
estimates
d) A patient's choice to build up a credit against future medical
bills - ANSWER-D
Medicare Part B has an annual deductible, and the beneficiary
is responsible for
a) A co-insurance payment for all Part B covered services
b) Physicians office fees
c) Tests outside of an inpatient setting
d) Prescriptions - ANSWER-A
The importance of medical records being maintained by HIM is
that the patient records
a) Are the primary source for clinical data required for
reimbursement by
health plans and liability payers
b) Are the strongest evidence and defense in the event of a
Medicare audit
c) Are evidence used in assessing the quality of care
d) Are the evidence cited in quality review - ANSWER-A
,3|Page
A decision on whether a patient should be admitted as an
inpatient or become an
outpatient observation patient requires medical judgments
based on all of the following
EXCEPT
a) The patient's home care coverage
b) Current medical needs
c) The likelihood of an adverse event occurring to the patient
d) The patient's medical history - ANSWER-A
Medicare has established guidelines called the Local Coverage
Determinations (LCD) and
National Coverage Determinations (NCD) that establish
a) Provider and physician reimbursement for specific diagnoses
and tests
b) Prospective Medicare patient financial responsibilities for a
given
diagnosis
c) Reasonable and customary prices for services in a given area
, 4|Page
d) What services or healthcare items are covered under
Medicare - ANSWER-D
What are some core elements if a board-approved financial
assistance policy?
a) Payment requirements, staffing hours, and admission policies
b) Case management, payment methods, and discharge policies
c) Deposit requirements, pre-registration calling hours, and
charity care
policy
d) Eligibility, application process, and nonpayment collection
activities - ANSWER-D
The ICD-10 codes set and CPT/HCPCS code sets combines
provide
a) Pricing floors for services
b) The financial data required for activity-based costing
c) Patients an overview of services covered by their health
insurance plan
d) The specificity and coding needed to support reimbursement
claims - ANSWER-D
