1 of 25
HFMA CRCR EXAM LATEST EXAM 180 QUESTIONS AND CORRECT
ANSWERS 2025/2026
If a medical service authorization, who is typically responsible for obtaining the
authorization: - ......ANSWER........The provider scheduling
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
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 - ......ANSWER........They must be billed separately to the
part B Carrier
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
If the patient cannot agree to payment arrangements, what is the next option?
- ......ANSWER........Warn the patient that unpaid accounts are placed with collection
agencies for further processing
Important Revenue Cycle Activities in the pre-service stage include:
- ......ANSWER........Obtaining or updating patient and guarantor information
,2 of 25
In addition to being supported by information found in the patient's chart, a CMS 1500
claim must be coded using what? - ......ANSWER........HCPCS
In addition to the member's identification number, what information is recorded in a 270
transaction - ......ANSWER........Name
To meet eligibility guidelines for healthcare benefits, Medicaid beneficiaries must fall into a
specified need category and meet what other types of requirements
- ......ANSWER........Income and assets
In the pre-service stage, the cost of the schedule services is identified, and the patient's
health plan and benefits are used to calculate: - ......ANSWER........The amount the patient
may be expected to pay after insurance.
in the pre-service stage, the requested service is screened for medical necessity, health
plan coverage and benefits are verified and: - ......ANSWER........Pre-authorization are
obtained
In what type of payment methodology is a lump sum of bundled payment negotiated
between the payer and some or all providers? - ......ANSWER........DRG/Case rate
Indemnity plans usually reimburse what? - ......ANSWER........A certain percentage of
charges after patient meets policy's annual deductible.
, 3 of 25
Insurance verification results in which of the following: - ......ANSWER........The accurate
identification of the patient's eligibility and benefits
Internal controls addressing coding and reimbursement charges are put in place to guard
against: - ......ANSWER........Compliance fraud by "upcoding"
It is important to calculate reserves to ensure: - ......ANSWER........A stable financial
operations and accurate financial reporting
Local Coverage Determination (LCD) and National Coverage Determinations (NCD) are
Medicare established guidelines used to determine: - ......ANSWER........Which diagnosis,
signs, or symptoms are reimbursable
Marinating routine contact with health plan or liability payer, making sure all required
information is provided and all needed approvals are obtained is the responsibility of who:
- ......ANSWER........Case Management
Medicare benefits provide coverage for: - ......ANSWER........Inpatient hospital services,
skilled nursing care. And home health care
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - ......ANSWER........Documentation of the
medical necessity for the test
HFMA CRCR EXAM LATEST EXAM 180 QUESTIONS AND CORRECT
ANSWERS 2025/2026
If a medical service authorization, who is typically responsible for obtaining the
authorization: - ......ANSWER........The provider scheduling
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
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 - ......ANSWER........They must be billed separately to the
part B Carrier
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
If the patient cannot agree to payment arrangements, what is the next option?
- ......ANSWER........Warn the patient that unpaid accounts are placed with collection
agencies for further processing
Important Revenue Cycle Activities in the pre-service stage include:
- ......ANSWER........Obtaining or updating patient and guarantor information
,2 of 25
In addition to being supported by information found in the patient's chart, a CMS 1500
claim must be coded using what? - ......ANSWER........HCPCS
In addition to the member's identification number, what information is recorded in a 270
transaction - ......ANSWER........Name
To meet eligibility guidelines for healthcare benefits, Medicaid beneficiaries must fall into a
specified need category and meet what other types of requirements
- ......ANSWER........Income and assets
In the pre-service stage, the cost of the schedule services is identified, and the patient's
health plan and benefits are used to calculate: - ......ANSWER........The amount the patient
may be expected to pay after insurance.
in the pre-service stage, the requested service is screened for medical necessity, health
plan coverage and benefits are verified and: - ......ANSWER........Pre-authorization are
obtained
In what type of payment methodology is a lump sum of bundled payment negotiated
between the payer and some or all providers? - ......ANSWER........DRG/Case rate
Indemnity plans usually reimburse what? - ......ANSWER........A certain percentage of
charges after patient meets policy's annual deductible.
, 3 of 25
Insurance verification results in which of the following: - ......ANSWER........The accurate
identification of the patient's eligibility and benefits
Internal controls addressing coding and reimbursement charges are put in place to guard
against: - ......ANSWER........Compliance fraud by "upcoding"
It is important to calculate reserves to ensure: - ......ANSWER........A stable financial
operations and accurate financial reporting
Local Coverage Determination (LCD) and National Coverage Determinations (NCD) are
Medicare established guidelines used to determine: - ......ANSWER........Which diagnosis,
signs, or symptoms are reimbursable
Marinating routine contact with health plan or liability payer, making sure all required
information is provided and all needed approvals are obtained is the responsibility of who:
- ......ANSWER........Case Management
Medicare benefits provide coverage for: - ......ANSWER........Inpatient hospital services,
skilled nursing care. And home health care
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - ......ANSWER........Documentation of the
medical necessity for the test
