HFMA CRCR UPDATED ACTUAL
EXAM 2025 QUESTIONS WITH
CORRECT
DETAILED ANSWERS || ALREADY
GRADED A+ < LATEST VERSION >
1. What are non-emergency patients who come for service without prior
notification to the provider called? - ANSWER 🗸 Unscheduled patients
2. If the insurance verification response reports that a subscriber has a single
policy, what is the status of the subscriber's spouse? - ANSWER 🗸 Neither
enrolled not entitled to benefits
3. Regulation Z of the Consumer Credit Protection Act, also known as the
Truth in Lending Act, establishes what? - ANSWER 🗸 Disclosure rules for
consumer credit sales and consumer loans
4. What is a principal diagnosis? - ANSWER 🗸 Primary reason for the
patient's admission
5. Collecting patient liability dollars after service leads to what? - ANSWER 🗸
Lower accounts receivable levels
6. What is the daily out-of-pocket amount for each lifetime reserve day used? -
ANSWER 🗸 50% of the current deductible amount
,7. What service provided to a Medicare beneficiary in a rural health clinic
(RHC) is not billable as an RHC services? - ANSWER 🗸 Inpatient care
8. What code indicates the disposition of the patient at the conclusion of
service? - ANSWER 🗸 Patient discharge status code
9. What are hospitals required to do for Medicare credit balance accounts? -
ANSWER 🗸 They result in lost reimbursement and additional cost to collect
10.When an undue delay of payment results from a dispute between the patient
and the third party payer, who is responsible for payment? - ANSWER 🗸
Patient
11.Medicare guidelines require that when a test is ordered for a LCD or NCD
exists, the information provided on the order must include: - ANSWER 🗸 A
valid CPT or HCPCS code
12.With advances in internet security and encryption, revenue-cycle processes
are expanding to allow patients to do what? - ANSWER 🗸 Access their
information and perform functions on-line
13.What date is required on all CMS 1500 claim forms? - ANSWER 🗸 onset
date of current illness
14.What does scheduling allow provider staff to do - ANSWER 🗸 Review
appropriateness of the service request
15.What code is used to report the provider's most common semiprivate room
rate? - ANSWER 🗸 Condition code
16.Regulations and requirements for coding accountable care organizations,
which allows providers to begin creating these organizations, were finalized
in: - ANSWER 🗸 2012
,17.What is a primary responsibility of the Recover Audit Contractor? -
ANSWER 🗸 To correctly identify proper payments for Medicare Part A &
B claims
18.How must providers handle credit balances? - ANSWER 🗸 Comply with
state statutes concerning reporting credit balance
19.Insurance verification results in what? - ANSWER 🗸 The accurate
identification of the patient's eligibility and benefits
20.What form is used to bill Medicare for rural health clinics? - ANSWER 🗸
CMS 1500
21.What activities are completed when a scheduled pre-registered patient
arrives for service? - ANSWER 🗸 Registering the patient and directing the
patient to the service area
22.In addition to being supported by information found in the patient's chart, a
CMS 1500 claim must be coded using what? - ANSWER 🗸 HCPCS
(Healthcare Common Procedure Coding system)
23.What results from a denied claim? - ANSWER 🗸 The provider incurs
rework and appeal costs
24.Why does the financial counselor need pricing for services? - ANSWER 🗸
To calculate the patient's financial responsibility
25.What type of provider bills third-party payers using CMS 1500 form -
ANSWER 🗸 Hospital-based mammography centers
26.How are disputes with nongovernmental payers resolved? - ANSWER 🗸
Appeal conditions specified in the individual payer's contract
, 27.The important message from Medicare provides beneficiaries with
information concerning what? - ANSWER 🗸 Right to appeal a discharge
decision if the patient disagrees with the services
28.Why do managed care plans have agreements with hospitals, physicians, and
other healthcare providers to offer a range of services to plan members? -
ANSWER 🗸 To improve access to quality healthcare
29.If a patient remains an inpatient of an SNF (skilled nursing facility for more
than 30 days, what is the SNF permitted to do? - ANSWER 🗸 Submit
interim bills to the Medicare program.
30.90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare
for liability claims after what happens? - ANSWER 🗸 120 days passes, but
the claim then be withdrawn from the liability carrier
31.What data are required to establish a new MPI entry? - ANSWER 🗸 The
patient's full legal name, date of birth, and sex
32.What should the provider do if both of the patient's insurance plans pay as
primary? - ANSWER 🗸 Determine the correct payer and notify the incorrect
payer of the processing error
33.What do EMTALA regulations require on-call physicians to do? -
ANSWER 🗸 Personally appear in the emergency department and attend to
the patient within a reasonable time
34.At the end of each shift, what must happen to cash, checks, and credit card
transaction documents? - ANSWER 🗸 They must be balanced
35.What will cause a CMS 1500 claim to be rejected? - ANSWER 🗸 The
provider is billing with a future date of service
36.Under Medicare regulations, which of the following is not included on a
valid physician's order for services? - ANSWER 🗸 The cost of the test
EXAM 2025 QUESTIONS WITH
CORRECT
DETAILED ANSWERS || ALREADY
GRADED A+ < LATEST VERSION >
1. What are non-emergency patients who come for service without prior
notification to the provider called? - ANSWER 🗸 Unscheduled patients
2. If the insurance verification response reports that a subscriber has a single
policy, what is the status of the subscriber's spouse? - ANSWER 🗸 Neither
enrolled not entitled to benefits
3. Regulation Z of the Consumer Credit Protection Act, also known as the
Truth in Lending Act, establishes what? - ANSWER 🗸 Disclosure rules for
consumer credit sales and consumer loans
4. What is a principal diagnosis? - ANSWER 🗸 Primary reason for the
patient's admission
5. Collecting patient liability dollars after service leads to what? - ANSWER 🗸
Lower accounts receivable levels
6. What is the daily out-of-pocket amount for each lifetime reserve day used? -
ANSWER 🗸 50% of the current deductible amount
,7. What service provided to a Medicare beneficiary in a rural health clinic
(RHC) is not billable as an RHC services? - ANSWER 🗸 Inpatient care
8. What code indicates the disposition of the patient at the conclusion of
service? - ANSWER 🗸 Patient discharge status code
9. What are hospitals required to do for Medicare credit balance accounts? -
ANSWER 🗸 They result in lost reimbursement and additional cost to collect
10.When an undue delay of payment results from a dispute between the patient
and the third party payer, who is responsible for payment? - ANSWER 🗸
Patient
11.Medicare guidelines require that when a test is ordered for a LCD or NCD
exists, the information provided on the order must include: - ANSWER 🗸 A
valid CPT or HCPCS code
12.With advances in internet security and encryption, revenue-cycle processes
are expanding to allow patients to do what? - ANSWER 🗸 Access their
information and perform functions on-line
13.What date is required on all CMS 1500 claim forms? - ANSWER 🗸 onset
date of current illness
14.What does scheduling allow provider staff to do - ANSWER 🗸 Review
appropriateness of the service request
15.What code is used to report the provider's most common semiprivate room
rate? - ANSWER 🗸 Condition code
16.Regulations and requirements for coding accountable care organizations,
which allows providers to begin creating these organizations, were finalized
in: - ANSWER 🗸 2012
,17.What is a primary responsibility of the Recover Audit Contractor? -
ANSWER 🗸 To correctly identify proper payments for Medicare Part A &
B claims
18.How must providers handle credit balances? - ANSWER 🗸 Comply with
state statutes concerning reporting credit balance
19.Insurance verification results in what? - ANSWER 🗸 The accurate
identification of the patient's eligibility and benefits
20.What form is used to bill Medicare for rural health clinics? - ANSWER 🗸
CMS 1500
21.What activities are completed when a scheduled pre-registered patient
arrives for service? - ANSWER 🗸 Registering the patient and directing the
patient to the service area
22.In addition to being supported by information found in the patient's chart, a
CMS 1500 claim must be coded using what? - ANSWER 🗸 HCPCS
(Healthcare Common Procedure Coding system)
23.What results from a denied claim? - ANSWER 🗸 The provider incurs
rework and appeal costs
24.Why does the financial counselor need pricing for services? - ANSWER 🗸
To calculate the patient's financial responsibility
25.What type of provider bills third-party payers using CMS 1500 form -
ANSWER 🗸 Hospital-based mammography centers
26.How are disputes with nongovernmental payers resolved? - ANSWER 🗸
Appeal conditions specified in the individual payer's contract
, 27.The important message from Medicare provides beneficiaries with
information concerning what? - ANSWER 🗸 Right to appeal a discharge
decision if the patient disagrees with the services
28.Why do managed care plans have agreements with hospitals, physicians, and
other healthcare providers to offer a range of services to plan members? -
ANSWER 🗸 To improve access to quality healthcare
29.If a patient remains an inpatient of an SNF (skilled nursing facility for more
than 30 days, what is the SNF permitted to do? - ANSWER 🗸 Submit
interim bills to the Medicare program.
30.90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare
for liability claims after what happens? - ANSWER 🗸 120 days passes, but
the claim then be withdrawn from the liability carrier
31.What data are required to establish a new MPI entry? - ANSWER 🗸 The
patient's full legal name, date of birth, and sex
32.What should the provider do if both of the patient's insurance plans pay as
primary? - ANSWER 🗸 Determine the correct payer and notify the incorrect
payer of the processing error
33.What do EMTALA regulations require on-call physicians to do? -
ANSWER 🗸 Personally appear in the emergency department and attend to
the patient within a reasonable time
34.At the end of each shift, what must happen to cash, checks, and credit card
transaction documents? - ANSWER 🗸 They must be balanced
35.What will cause a CMS 1500 claim to be rejected? - ANSWER 🗸 The
provider is billing with a future date of service
36.Under Medicare regulations, which of the following is not included on a
valid physician's order for services? - ANSWER 🗸 The cost of the test
