HFMA CRCR EXAM LATEST EXAM 170+
QUESTIONS AND CORRECT
ANSWERS(VERIFIED ANSWERS)
What are collection agency fees based on? ...ANSWER...A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other
rule? ...ANSWER...Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated between the payer
and some or all providers? ...ANSWER...Case rates
What customer service improvements might improve the patient accounts
department? ...ANSWER...Holding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? ...ANSWER...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? ...ANSWER...Bad debt adjustment
What is the initial hospice benefit? ...ANSWER...Two 90-day periods and an unlimited number of
subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? ...ANSWER...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? ...ANSWER...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 ...ANSWER...They are not being processed in a timely manner
What is an advantage of a preregistration program? ...ANSWER...It reduces processing times at the time
of service
What are the two statutory exclusions from hospice coverage? ...ANSWER...Medically unnecessary
services and custodial care
What core financial activities are resolved within patient access? ...ANSWER...Scheduling, insurance
verification, discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? ...ANSWER...The services do not involve an
overnight stay
How is a mis-posted contractual allowance resolved? ...ANSWER...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? ...ANSWER...Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has
received what? ...ANSWER...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$? ...ANSWER...When the
patient is the insured
What are non-emergency patients who come for service without prior notification to the provider
called? ...ANSWER...Unscheduled patients
,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
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
What is a principal diagnosis? ...ANSWER...Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? ...ANSWER...Lower accounts receivable
levels
What is the daily out-of-pocket amount for each lifetime reserve day used? ...ANSWER...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? ...ANSWER...Inpatient care
What code indicates the disposition of the patient at the conclusion of service? ...ANSWER...Patient
discharge status code
What are hospitals required to do for Medicare credit balance accounts? ...ANSWER...They result in lost
reimbursement and additional cost to collect
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
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
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
, What date is required on all CMS 1500 claim forms? ...ANSWER...onset date of current illness
What does scheduling allow provider staff to do ...ANSWER...Review appropriateness of the service
request
What code is used to report the provider's most common semiprivate room rate? ...ANSWER...Condition
code
Regulations and requirements for coding accountable care organizations, which allows providers to
begin creating these organizations, were finalized in: ...ANSWER...2012
What is a primary responsibility of the Recover Audit Contractor? ...ANSWER...To correctly identify
proper payments for Medicare Part A & B claims
How must providers handle credit balances? ...ANSWER...Comply with state statutes concerning
reporting credit balance
Insurance verification results in what? ...ANSWER...The accurate identification of the patient's eligibility
and benefits
What form is used to bill Medicare for rural health clinics? ...ANSWER...CMS 1500
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
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)
What results from a denied claim? ...ANSWER...The provider incurs rework and appeal costs
QUESTIONS AND CORRECT
ANSWERS(VERIFIED ANSWERS)
What are collection agency fees based on? ...ANSWER...A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other
rule? ...ANSWER...Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated between the payer
and some or all providers? ...ANSWER...Case rates
What customer service improvements might improve the patient accounts
department? ...ANSWER...Holding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? ...ANSWER...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? ...ANSWER...Bad debt adjustment
What is the initial hospice benefit? ...ANSWER...Two 90-day periods and an unlimited number of
subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? ...ANSWER...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? ...ANSWER...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 ...ANSWER...They are not being processed in a timely manner
What is an advantage of a preregistration program? ...ANSWER...It reduces processing times at the time
of service
What are the two statutory exclusions from hospice coverage? ...ANSWER...Medically unnecessary
services and custodial care
What core financial activities are resolved within patient access? ...ANSWER...Scheduling, insurance
verification, discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? ...ANSWER...The services do not involve an
overnight stay
How is a mis-posted contractual allowance resolved? ...ANSWER...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? ...ANSWER...Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has
received what? ...ANSWER...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$? ...ANSWER...When the
patient is the insured
What are non-emergency patients who come for service without prior notification to the provider
called? ...ANSWER...Unscheduled patients
,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
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
What is a principal diagnosis? ...ANSWER...Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? ...ANSWER...Lower accounts receivable
levels
What is the daily out-of-pocket amount for each lifetime reserve day used? ...ANSWER...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? ...ANSWER...Inpatient care
What code indicates the disposition of the patient at the conclusion of service? ...ANSWER...Patient
discharge status code
What are hospitals required to do for Medicare credit balance accounts? ...ANSWER...They result in lost
reimbursement and additional cost to collect
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
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
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
, What date is required on all CMS 1500 claim forms? ...ANSWER...onset date of current illness
What does scheduling allow provider staff to do ...ANSWER...Review appropriateness of the service
request
What code is used to report the provider's most common semiprivate room rate? ...ANSWER...Condition
code
Regulations and requirements for coding accountable care organizations, which allows providers to
begin creating these organizations, were finalized in: ...ANSWER...2012
What is a primary responsibility of the Recover Audit Contractor? ...ANSWER...To correctly identify
proper payments for Medicare Part A & B claims
How must providers handle credit balances? ...ANSWER...Comply with state statutes concerning
reporting credit balance
Insurance verification results in what? ...ANSWER...The accurate identification of the patient's eligibility
and benefits
What form is used to bill Medicare for rural health clinics? ...ANSWER...CMS 1500
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
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)
What results from a denied claim? ...ANSWER...The provider incurs rework and appeal costs
