HFMA CRCR Exam Questions with 100%
Correct Answers | Graded A+
Through what document does a hospital establish compliance standards? -
✔✔code of conduct
What is the purpose OIG work plant? - ✔✔Identify Acceptable compliance
programs in various provider setting
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
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
IF outpatient diagnostic services are provided within three days of the
admission 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
what is a recurring or series registration? - ✔✔One registration record is created
for multiple days of service
1|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
,What are nonemergency patients who come for service without prior
notification to the provider called? - ✔✔Unscheduled patients
Which of the following statement apply to the observation patient type? - ✔✔It
is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock
patient - ✔✔Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? -
✔✔Complete the scheduling process correctly based on service requeste
The Time needed to prepare the patient before service is the difference
between the patients arrival time and which of the following? - ✔✔Procedure
time
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
What is the advantage of a pre-registration program - ✔✔It reduces processing
times at the time of service
2|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
, 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
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.
Which provision protects the patient from medical expenses that exceed the
pre-set level - ✔✔stop loss
what documentation must a primary care physician send to HMO patient to
authorize a visit to a specialist for additional testing or care? - ✔✔Referral
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
Which of the following is a step in the discharge process? - ✔✔Have a case
management service complete the discharge plan
The hospital has a APC based contract for the payment of outpatient services.
Total anticipated charges for the visit are $2,380. The approved APC payment
3|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
Correct Answers | Graded A+
Through what document does a hospital establish compliance standards? -
✔✔code of conduct
What is the purpose OIG work plant? - ✔✔Identify Acceptable compliance
programs in various provider setting
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
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
IF outpatient diagnostic services are provided within three days of the
admission 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
what is a recurring or series registration? - ✔✔One registration record is created
for multiple days of service
1|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
,What are nonemergency patients who come for service without prior
notification to the provider called? - ✔✔Unscheduled patients
Which of the following statement apply to the observation patient type? - ✔✔It
is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock
patient - ✔✔Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? -
✔✔Complete the scheduling process correctly based on service requeste
The Time needed to prepare the patient before service is the difference
between the patients arrival time and which of the following? - ✔✔Procedure
time
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
What is the advantage of a pre-registration program - ✔✔It reduces processing
times at the time of service
2|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
, 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
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.
Which provision protects the patient from medical expenses that exceed the
pre-set level - ✔✔stop loss
what documentation must a primary care physician send to HMO patient to
authorize a visit to a specialist for additional testing or care? - ✔✔Referral
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
Which of the following is a step in the discharge process? - ✔✔Have a case
management service complete the discharge plan
The hospital has a APC based contract for the payment of outpatient services.
Total anticipated charges for the visit are $2,380. The approved APC payment
3|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
