1|Page
HFMA CRCR FINAL AND PRACTICE EXAM TEST
BANK – 2025/2026 EDITION – VERIFIED 100%
QUESTIONS AND ANS
How is a mis-posted contractual allowance resolved? - SOLUTION=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?
- SOLUTION=Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require
that the beneficiary has received what? - SOLUTION=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$? -
SOLUTION=When the patient is the insured
What are non-emergency patients who come for service without prior notification
to the provider called? - SOLUTION=Unscheduled patients
,2|Page
If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse? - SOLUTION=Neither enrolled not
entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
Lending Act, establishes what? - SOLUTION=Disclosure rules for consumer credit
sales and consumer loans
What is a principal diagnosis? - SOLUTION=Primary reason for the patient's
admission
Collecting patient liability dollars after service leads to what? -
SOLUTION=Lower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? -
SOLUTION=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? - SOLUTION=Inpatient care
What are collection agency fees based on? - SOLUTION=A percentage of dollars
collected
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Self-funded benefit plans may choose to coordinate benefits using the gender rule
or what other rule? - SOLUTION=Birthday
In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers? - SOLUTION=Case rates
What customer service improvements might improve the patient accounts
department? - SOLUTION=Holding staff accountable for customer service during
performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
SOLUTION=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? - SOLUTION=Bad debt adjustment
What is the initial hospice benefit? - SOLUTION=Two 90-day periods and an
unlimited number of subsequent periods
, 4|Page
When does a hospital add ambulance charges to the Medicare inpatient claim? -
SOLUTION=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? - SOLUTION=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 - SOLUTION=They are not being processed in a timely
manner
What is an advantage of a preregistration program? - SOLUTION=It reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? -
SOLUTION=Medically unnecessary services and custodial care
What core financial activities are resolved within patient access? -
SOLUTION=Scheduling, insurance verification, discharge processing, and
payment of point-of-service receipts
What statement applies to the scheduled outpatient? - SOLUTION=The services
do not involve an overnight stay
HFMA CRCR FINAL AND PRACTICE EXAM TEST
BANK – 2025/2026 EDITION – VERIFIED 100%
QUESTIONS AND ANS
How is a mis-posted contractual allowance resolved? - SOLUTION=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?
- SOLUTION=Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require
that the beneficiary has received what? - SOLUTION=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$? -
SOLUTION=When the patient is the insured
What are non-emergency patients who come for service without prior notification
to the provider called? - SOLUTION=Unscheduled patients
,2|Page
If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse? - SOLUTION=Neither enrolled not
entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
Lending Act, establishes what? - SOLUTION=Disclosure rules for consumer credit
sales and consumer loans
What is a principal diagnosis? - SOLUTION=Primary reason for the patient's
admission
Collecting patient liability dollars after service leads to what? -
SOLUTION=Lower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? -
SOLUTION=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? - SOLUTION=Inpatient care
What are collection agency fees based on? - SOLUTION=A percentage of dollars
collected
,3|Page
Self-funded benefit plans may choose to coordinate benefits using the gender rule
or what other rule? - SOLUTION=Birthday
In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers? - SOLUTION=Case rates
What customer service improvements might improve the patient accounts
department? - SOLUTION=Holding staff accountable for customer service during
performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
SOLUTION=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? - SOLUTION=Bad debt adjustment
What is the initial hospice benefit? - SOLUTION=Two 90-day periods and an
unlimited number of subsequent periods
, 4|Page
When does a hospital add ambulance charges to the Medicare inpatient claim? -
SOLUTION=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? - SOLUTION=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 - SOLUTION=They are not being processed in a timely
manner
What is an advantage of a preregistration program? - SOLUTION=It reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? -
SOLUTION=Medically unnecessary services and custodial care
What core financial activities are resolved within patient access? -
SOLUTION=Scheduling, insurance verification, discharge processing, and
payment of point-of-service receipts
What statement applies to the scheduled outpatient? - SOLUTION=The services
do not involve an overnight stay
