HFMA CRCR LATEST EXAM 2025-2026 QUESTIONS AND
CORRECT DETAILED ANSWERS VERIFIED BY EXPERTS
ALREADY GRADED A+
Through what document does a hospital establish compliance
standards?
ANSWER;code of conduct
What is the purpose OIG work plant?
ANSWER;Identify Acceptable compliance programs in various
provider setting
If a Medicare patient is admitted on Friday, what services fall
within the three-day DRG window rule?
ANSWER;Non-diagnostic service provided on Tuesday through
Friday
What does a modifier allow a provider to do?
ANSWER;Report a specific circumstance that affected a
procedure or service without changing the code or its definition
IF outpatient diagnostic services are provided within three days
of the admission of a Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to
these charges
They must be billed separately to the part B Carrier
,what is a recurring or series registration?
ANSWER;One registration record is created for multiple days of
service
What are nonemergency patients who come for service without
prior notification to the provider called?
ANSWER;Unscheduled patients
Which of the following statement apply to the observation
patient type?
ANSWER;It is used to evaluate the need for an inpatient
admission
which services are hospice programs required to provide
around the clock patient
Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do
what?
ANSWER;Complete the scheduling process correctly based on
service requeste
The Time needed to prepare the patient before service is the
difference between the patients arrival time and which of the
following?
ANSWER;Procedure time
Medicare guidelines require that when a test is ordered for a
LCD or NCD exists, the information provided on the order must
include:
Documentation of the medical necessity for the test
, What is the advantage of a pre-registration program
It reduces processing times at the time of service
What date are required to establish a new MPI(Master patient
Index) entry
The responsible party's full legal name, date of birth, and social
security number
Which of the following statements is true about third-party
payments?
ANSWER;The payments are received by the provider from the
payer responsible for reimbursing the provider for the patient's
covered services.
Which provision protects the patient from medical expenses
that exceed the pre-set level
stop loss
what documentation must a primary care physician send to
HMO patient to authorize a visit to a specialist for additional
testing or care?
ANSWER;Referral
Under EMTALA (Emergency Medical Treatment and Labor Act)
regulations, the provider may not ask about a patient's
insurance information if it would delay what?
Medical screening and stabilizing treatment
Which of the following is a step in the discharge process?
ANSWER;Have a case management service complete the
discharge plan
The hospital has a APC based contract for the payment of
outpatient services. Total anticipated charges for the visit are
CORRECT DETAILED ANSWERS VERIFIED BY EXPERTS
ALREADY GRADED A+
Through what document does a hospital establish compliance
standards?
ANSWER;code of conduct
What is the purpose OIG work plant?
ANSWER;Identify Acceptable compliance programs in various
provider setting
If a Medicare patient is admitted on Friday, what services fall
within the three-day DRG window rule?
ANSWER;Non-diagnostic service provided on Tuesday through
Friday
What does a modifier allow a provider to do?
ANSWER;Report a specific circumstance that affected a
procedure or service without changing the code or its definition
IF outpatient diagnostic services are provided within three days
of the admission of a Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to
these charges
They must be billed separately to the part B Carrier
,what is a recurring or series registration?
ANSWER;One registration record is created for multiple days of
service
What are nonemergency patients who come for service without
prior notification to the provider called?
ANSWER;Unscheduled patients
Which of the following statement apply to the observation
patient type?
ANSWER;It is used to evaluate the need for an inpatient
admission
which services are hospice programs required to provide
around the clock patient
Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do
what?
ANSWER;Complete the scheduling process correctly based on
service requeste
The Time needed to prepare the patient before service is the
difference between the patients arrival time and which of the
following?
ANSWER;Procedure time
Medicare guidelines require that when a test is ordered for a
LCD or NCD exists, the information provided on the order must
include:
Documentation of the medical necessity for the test
, What is the advantage of a pre-registration program
It reduces processing times at the time of service
What date are required to establish a new MPI(Master patient
Index) entry
The responsible party's full legal name, date of birth, and social
security number
Which of the following statements is true about third-party
payments?
ANSWER;The payments are received by the provider from the
payer responsible for reimbursing the provider for the patient's
covered services.
Which provision protects the patient from medical expenses
that exceed the pre-set level
stop loss
what documentation must a primary care physician send to
HMO patient to authorize a visit to a specialist for additional
testing or care?
ANSWER;Referral
Under EMTALA (Emergency Medical Treatment and Labor Act)
regulations, the provider may not ask about a patient's
insurance information if it would delay what?
Medical screening and stabilizing treatment
Which of the following is a step in the discharge process?
ANSWER;Have a case management service complete the
discharge plan
The hospital has a APC based contract for the payment of
outpatient services. Total anticipated charges for the visit are
