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