2025 HFMA CRCR EXAM 1 ACTUAL EXAM QUESTIONS AND CORRECT ANSWERS | LATEST UPDATE | ALREADY GRADED A+

2025 HFMA CRCR EXAM 1 ACTUAL EXAM QUESTIONS AND CORRECT ANSWERS | LATEST UPDATE | ALREADY GRADED A+ What are collection agency fees based on? - CORRECT ANSA percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - CORRECT ANSBirthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - CORRECT ANSCase rates What customer service improvements might improve the patient accounts department? - CORRECT ANSHolding staff accountable for customer service during performance reviews What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - CORRECT ANSInform 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 ANSBad debt adjustment What is the initial hospice benefit? - CORRECT ANSTwo 90-day periods and an unlimited number of subsequent periods 2 When does a hospital add ambulance charges to the Medicare inpatient claim? - CORRECT ANSIf 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 ANSPost 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 ANSThey are not being processed in a timely manner What is an advantage of a preregistration program? - CORRECT ANSIt reduces processing times at the time of service What are the two statutory exclusions from hospice coverage? - CORRECT ANSMedically unnecessary services and custodial care What core financial activities are resolved within patient access? - CORRECT ANSScheduling, insurance verification, discharge processing, and payment of point-of-service receipts What statement applies to the scheduled outpatient? - CORRECT ANSThe services do not involve an overnight stay 3 How is a mis-posted contractual allowance resolved? - CORRECT ANSComparing 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 ANSObservation Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has received what? - CORRECT ANSMedically 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 ANSWhen the patient is the insured What are non-emergency patients who come for service without prior notification to the provider called? - CORRECT ANSUnscheduled patients If the insurance verification response reports that a subscriber has a single policy, what is the status of the subscriber's spouse? - CORRECT ANSNeither enrolled not entitled to benefits Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act, establishes what? - CORRECT ANSDisclosure rules for consumer credit sales and consumer loans 4 What is a principal diagnosis? - CORRECT ANSPrimary reason for the patient's admission Collecting patient liability dollars after service leads to what? - CORRECT ANSLower accounts receivable levels What is the daily out-of-pocket amount for each lifetime reserve day used? - CORRECT ANS50% 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 ANSInpatient care What code indicates the disposition of the patient at the conclusion of service? - CORRECT ANSPatient discharge status code What are hospitals required to do for Medicare credit balance accounts? - CORRECT ANSThey 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? - CORRECT ANSPatient Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include: - CORRECT ANSA valid CPT or HCPCS code 5 With advances in internet security and encryption, revenue-cycle processes are expanding to allow patients to do what? - CORRECT ANSAccess their information and perform functions on-line What date is required on all CMS 1500 claim forms? - CORRECT ANSonset date of current illness What does scheduling allow provider staff to do - CORRECT ANSReview appropriateness of the service request What code is used to report the provider's most common semiprivate room rate? - CORRECT ANSCondition code Regulations and requirements for coding accountable care organizations, which allows providers to begin creating these organizations, were finalized in: - CORRECT ANS2012 What is a primary responsibility of the Recover Audit Contractor? - CORRECT ANSTo correctly identify proper payments for Medicare Part A & B claims How must providers handle credit balances? - CORRECT ANSComply with state statutes concerning reporting credit balance Insurance verification results in what? - CORRECT ANSThe accurate identification of the patient's eligibility and benefits 6 What form is used to bill Medicare for rural health clinics? - CORRECT ANSCMS 1500 What activities are completed when a scheduled pre-registered patient arrives for service? - CORRECT ANSRegistering 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 ANSHCPCS (Healthcare Common Procedure Coding system) What results from a denied claim? - CORRECT ANSThe provider incurs rework and appeal costs Why does the financial counselor need pricing for services? - CORRECT ANSTo calculate the patient's financial responsibility What type of provider bills third-party payers using CMS 1500 form - CORRECT ANSHospital-based mammography centers How are disputes with nongovernmental payers resolved? - CORRECT ANSAppeal conditions specified in the individual payer's contract