HFMA COMPREHENSIVE REVIEW 2026
QUESTIONS WITH ANSWERS GRADED A+
◉Self-funded benefit plans may choose to coordinate benefits using
the gender rule or what other rule? Answer: Birthday
◉In what type of payment methodology is a lump sum or bundled
payment negotiated between the payer and some or all providers?
Answer: Case rates
◉What customer service improvements might improve the patient
accounts department? Answer: Holding staff accountable for
customer service during performance reviews
◉What is an ABN (Advance Beneficiary Notice of Non-coverage)
required to do? 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? Answer: Bad debt
adjustment
,◉What is the initial hospice benefit? Answer: Two 90-day periods
and an unlimited number of subsequent periods
◉When does a hospital add ambulance charges to the Medicare
inpatient claim? 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? 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 Answer: They are not being
processed in a timely manner
◉What is an advantage of a preregistration program? Answer: It
reduces processing times at the time of service
◉What are the two statutory exclusions from hospice coverage?
Answer: Medically unnecessary services and custodial care
◉What core financial activities are resolved within patient access?
Answer: Scheduling, insurance verification, discharge processing,
and payment of point-of-service receipts
, ◉What statement applies to the scheduled outpatient? Answer: The
services do not involve an overnight stay
◉How is a mis-posted contractual allowance resolved? 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? Answer: Observation
◉Coverage rules for Medicare beneficiaries receiving skilled nursing
care require that the beneficiary has received what? 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$? Answer: When the patient is the insured
◉What are non-emergency patients who come for service without
prior notification to the provider called? 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?
Answer: Neither enrolled not entitled to benefits
QUESTIONS WITH ANSWERS GRADED A+
◉Self-funded benefit plans may choose to coordinate benefits using
the gender rule or what other rule? Answer: Birthday
◉In what type of payment methodology is a lump sum or bundled
payment negotiated between the payer and some or all providers?
Answer: Case rates
◉What customer service improvements might improve the patient
accounts department? Answer: Holding staff accountable for
customer service during performance reviews
◉What is an ABN (Advance Beneficiary Notice of Non-coverage)
required to do? 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? Answer: Bad debt
adjustment
,◉What is the initial hospice benefit? Answer: Two 90-day periods
and an unlimited number of subsequent periods
◉When does a hospital add ambulance charges to the Medicare
inpatient claim? 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? 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 Answer: They are not being
processed in a timely manner
◉What is an advantage of a preregistration program? Answer: It
reduces processing times at the time of service
◉What are the two statutory exclusions from hospice coverage?
Answer: Medically unnecessary services and custodial care
◉What core financial activities are resolved within patient access?
Answer: Scheduling, insurance verification, discharge processing,
and payment of point-of-service receipts
, ◉What statement applies to the scheduled outpatient? Answer: The
services do not involve an overnight stay
◉How is a mis-posted contractual allowance resolved? 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? Answer: Observation
◉Coverage rules for Medicare beneficiaries receiving skilled nursing
care require that the beneficiary has received what? 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$? Answer: When the patient is the insured
◉What are non-emergency patients who come for service without
prior notification to the provider called? 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?
Answer: Neither enrolled not entitled to benefits
