HFMA CRCR Exam (Latest update 2025/26) with
questions and well detailed answers (GRADED A+)
What are collection agency fees based on? -CORRECT ANSWER A percentage of
dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? -CORRECT ANSWER Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? -CORRECT ANSWER Case rates
What customer service improvements might improve the patient accounts department?
-CORRECT ANSWER Holding staff accountable for customer service during
performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
CORRECT 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? -CORRECT ANSWER Bad debt adjustment
,What is the initial hospice benefit? -CORRECT ANSWER Two 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -
CORRECT 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? -
CORRECT 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 -CORRECT ANSWER They are not being processed in a timely
manner
What is an advantage of a preregistration program? -CORRECT ANSWER It reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? -CORRECT ANSWER
Medically unnecessary services and custodial care
,What core financial activities are resolved within patient access? -CORRECT ANSWER
Scheduling, insurance verification, discharge processing, and payment of point-of-
service receipts
What statement applies to the scheduled outpatient? -CORRECT ANSWER The
services do not involve an overnight stay
How is a mis-posted contractual allowance resolved? -CORRECT 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? -
CORRECT ANSWER Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? -CORRECT 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$? -
CORRECT ANSWER When the patient is the insured
, What are non-emergency patients who come for service without prior notification to the
provider called? -CORRECT 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? -CORRECT 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? -CORRECT ANSWER Disclosure rules for consumer credit
sales and consumer loans
What is a principal diagnosis? -CORRECT ANSWER Primary reason for the patient's
admission
Collecting patient liability dollars after service leads to what? -CORRECT ANSWER
Lower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? -CORRECT
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? -CORRECT ANSWER Inpatient care
questions and well detailed answers (GRADED A+)
What are collection agency fees based on? -CORRECT ANSWER A percentage of
dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? -CORRECT ANSWER Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? -CORRECT ANSWER Case rates
What customer service improvements might improve the patient accounts department?
-CORRECT ANSWER Holding staff accountable for customer service during
performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
CORRECT 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? -CORRECT ANSWER Bad debt adjustment
,What is the initial hospice benefit? -CORRECT ANSWER Two 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -
CORRECT 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? -
CORRECT 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 -CORRECT ANSWER They are not being processed in a timely
manner
What is an advantage of a preregistration program? -CORRECT ANSWER It reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? -CORRECT ANSWER
Medically unnecessary services and custodial care
,What core financial activities are resolved within patient access? -CORRECT ANSWER
Scheduling, insurance verification, discharge processing, and payment of point-of-
service receipts
What statement applies to the scheduled outpatient? -CORRECT ANSWER The
services do not involve an overnight stay
How is a mis-posted contractual allowance resolved? -CORRECT 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? -
CORRECT ANSWER Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? -CORRECT 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$? -
CORRECT ANSWER When the patient is the insured
, What are non-emergency patients who come for service without prior notification to the
provider called? -CORRECT 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? -CORRECT 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? -CORRECT ANSWER Disclosure rules for consumer credit
sales and consumer loans
What is a principal diagnosis? -CORRECT ANSWER Primary reason for the patient's
admission
Collecting patient liability dollars after service leads to what? -CORRECT ANSWER
Lower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? -CORRECT
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? -CORRECT ANSWER Inpatient care
