HFMA
HFMA CRCR NEW EXAM ALL
QUESTIONS AND WELL ELABORATED
ANSWERS 2025
Ans-A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? - Correct Ans-Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - Correct Ans-Case rates
What customer service improvements might improve the patient accounts department?
- Correct Ans-Holding staff accountable for customer service during performance
reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
Correct Ans-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? - Correct Ans-Bad debt adjustment
What is the initial hospice benefit? - Correct Ans-Two 90-day periods and an unlimited
number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -
Correct Ans-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? -
Correct Ans-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 - Correct Ans-They are not being processed in a timely manner
What is an advantage of a preregistration program? - Correct Ans-It reduces processing
times at the time of service
What are the two statutory exclusions from hospice coverage? - Correct Ans-Medically
unnecessary services and custodial care
What core financial activities are resolved within patient access? - Correct Ans-
Scheduling, insurance verification, discharge processing, and payment of point-of-
service receipts
HFMA
,HFMA
What statement applies to the scheduled outpatient? - Correct Ans-The services do not
involve an overnight stay
How is a mis-posted contractual allowance resolved? - Correct Ans-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? -
Correct Ans-Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - Correct Ans-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$? - Correct
Ans-When the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - Correct Ans-Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what
is the status of the subscriber's spouse? - Correct Ans-Neither enrolled not entitled to
benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - Correct Ans-Disclosure rules for consumer credit sales and
consumer loans
What is a principal diagnosis? - Correct Ans-Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - Correct Ans-Lower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - Correct
Ans-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? - Correct Ans-Inpatient care
What code indicates the disposition of the patient at the conclusion of service? - Correct
Ans-Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - Correct Ans-
They result in lost reimbursement and additional cost to collect
HFMA
,HFMA
When an undue delay of payment results from a dispute between the patient and the
third party payer, who is responsible for payment? - Correct Ans-Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - Correct Ans-A valid CPT or HCPCS
code
With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - Correct Ans-Access their information and
perform functions on-line
What date is required on all CMS 1500 claim forms? - Correct Ans-onset date of current
illness
What does scheduling allow provider staff to do - Correct Ans-Review appropriateness
of the service request
What code is used to report the provider's most common semiprivate room rate? -
Correct Ans-Condition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: - Correct Ans-2012
What is a primary responsibility of the Recover Audit Contractor? - Correct Ans-To
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - Correct Ans-Comply with state statutes
concerning reporting credit balance
Insurance verification results in what? - Correct Ans-The accurate identification of the
patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - Correct Ans-CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for
service? - Correct Ans-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? - Correct Ans-HCPCS (Healthcare Common
Procedure Coding system)
What results from a denied claim? - Correct Ans-The provider incurs rework and appeal
costs
HFMA
, HFMA
Why does the financial counselor need pricing for services? - Correct Ans-To calculate
the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - Correct Ans-
Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? - Correct Ans-Appeal
conditions specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - Correct Ans-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? - Correct Ans-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? - Correct Ans-Submit interim bills to the
Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - Correct Ans-120 days passes, but the claim then be
withdrawn from the liability carrier
What data are required to establish a new MPI entry? - Correct Ans-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? -
Correct Ans-Determine the correct payer and notify the incorrect payer of the
processing error
What do EMTALA regulations require on-call physicians to do? - Correct Ans-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? - Correct Ans-They must be balanced
What will cause a CMS 1500 claim to be rejected? - Correct Ans-The provider is billing
with a future date of service
Under Medicare regulations, which of the following is not included on a valid physician's
order for services? - Correct Ans-The cost of the test
how are HCPCS codes and the appropriate modifiers used? - Correct Ans-To report the
level 1, 2, or 3 code that correctly describes the service provided
HFMA
HFMA CRCR NEW EXAM ALL
QUESTIONS AND WELL ELABORATED
ANSWERS 2025
Ans-A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? - Correct Ans-Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - Correct Ans-Case rates
What customer service improvements might improve the patient accounts department?
- Correct Ans-Holding staff accountable for customer service during performance
reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
Correct Ans-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? - Correct Ans-Bad debt adjustment
What is the initial hospice benefit? - Correct Ans-Two 90-day periods and an unlimited
number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -
Correct Ans-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? -
Correct Ans-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 - Correct Ans-They are not being processed in a timely manner
What is an advantage of a preregistration program? - Correct Ans-It reduces processing
times at the time of service
What are the two statutory exclusions from hospice coverage? - Correct Ans-Medically
unnecessary services and custodial care
What core financial activities are resolved within patient access? - Correct Ans-
Scheduling, insurance verification, discharge processing, and payment of point-of-
service receipts
HFMA
,HFMA
What statement applies to the scheduled outpatient? - Correct Ans-The services do not
involve an overnight stay
How is a mis-posted contractual allowance resolved? - Correct Ans-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? -
Correct Ans-Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - Correct Ans-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$? - Correct
Ans-When the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - Correct Ans-Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what
is the status of the subscriber's spouse? - Correct Ans-Neither enrolled not entitled to
benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - Correct Ans-Disclosure rules for consumer credit sales and
consumer loans
What is a principal diagnosis? - Correct Ans-Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - Correct Ans-Lower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - Correct
Ans-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? - Correct Ans-Inpatient care
What code indicates the disposition of the patient at the conclusion of service? - Correct
Ans-Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - Correct Ans-
They result in lost reimbursement and additional cost to collect
HFMA
,HFMA
When an undue delay of payment results from a dispute between the patient and the
third party payer, who is responsible for payment? - Correct Ans-Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - Correct Ans-A valid CPT or HCPCS
code
With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - Correct Ans-Access their information and
perform functions on-line
What date is required on all CMS 1500 claim forms? - Correct Ans-onset date of current
illness
What does scheduling allow provider staff to do - Correct Ans-Review appropriateness
of the service request
What code is used to report the provider's most common semiprivate room rate? -
Correct Ans-Condition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: - Correct Ans-2012
What is a primary responsibility of the Recover Audit Contractor? - Correct Ans-To
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - Correct Ans-Comply with state statutes
concerning reporting credit balance
Insurance verification results in what? - Correct Ans-The accurate identification of the
patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - Correct Ans-CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for
service? - Correct Ans-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? - Correct Ans-HCPCS (Healthcare Common
Procedure Coding system)
What results from a denied claim? - Correct Ans-The provider incurs rework and appeal
costs
HFMA
, HFMA
Why does the financial counselor need pricing for services? - Correct Ans-To calculate
the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - Correct Ans-
Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? - Correct Ans-Appeal
conditions specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - Correct Ans-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? - Correct Ans-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? - Correct Ans-Submit interim bills to the
Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - Correct Ans-120 days passes, but the claim then be
withdrawn from the liability carrier
What data are required to establish a new MPI entry? - Correct Ans-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? -
Correct Ans-Determine the correct payer and notify the incorrect payer of the
processing error
What do EMTALA regulations require on-call physicians to do? - Correct Ans-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? - Correct Ans-They must be balanced
What will cause a CMS 1500 claim to be rejected? - Correct Ans-The provider is billing
with a future date of service
Under Medicare regulations, which of the following is not included on a valid physician's
order for services? - Correct Ans-The cost of the test
how are HCPCS codes and the appropriate modifiers used? - Correct Ans-To report the
level 1, 2, or 3 code that correctly describes the service provided
HFMA
