Healthcare Financial Management Association CRCR:Questions and Answers 2026
A claim is denied for the following reasons EXCEPT: - ansThe submitted claim does not have the physician
signature
A common billing issue with hospital-based physician's is - ansThey are not contracted with the patient's health
plan to provide services
A decision on whether a patient should be admitted as an inpatient or become an outpatient observation
patient requires medical judgement based on all of the following EXCEPT: - ansThe patient's home care
coverage
A four-digit number code established by the National Uniform Billing Committee (NUBC) that
categorizes/classifies a line in the charge master is known as: - ansRevenue codes
A patient has met the $200 individual deductible and $900 of the $1000 co-insurance responsibility. The co-
insurance rate is 20%. The estimated insurance plan responsibility is $1975.00. What amount of coinsurance is
due from the patient? - ans$100.00
A portion of the accounts receivable inventory which has NOT qualified for billing includes: - ansAccounts
created during pre-registration but not activated
A scheduled inpatient represents an opportunity for the provider to do which of the following? - ansComplete
registration and insurance approval before service
Account Receivable (A/R) aging reports - ansIdentify past due accounts likely to become bad debit
Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite
discharge, the HFMA best practice is to: - ansSupport that choice, providing that the discussion does not
interfere with patient care or disrupt patient flow.
All Hospitals are required to establish a written financial assistance policy that applies to: - ansAll emergency
,and medically necessary care
All of following are steps in safeguarding collections EXCEPT: - ansPlacing collections in a lock-box for posting
review the next business day
All of the following are potential causes of credit balances EXCEPT: - ansA patient's choice to build up a credit
against future medical bills
Ambulance services are billed directly to the health plan for: - ansServices provided before a patient is admitted
and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her
home or to another facility.
An advantage of a pre-registration program in - ansThe opportunity to reduce processing times at the time of
service
an increase in the dollars aged greater than 90 days from date of service indicate what about accounts -
ansThey are not being processed in a timely manner
Any healthcare insurance plan that providers or insures comprehensive health maintenance and services for an
enrolled group of persons based on a monthly fee is known as a - ansHMO
Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment
services for an enrolled group of persons on a monthly fee is known as: - ansHMO
Any provider that has filed a timely cost report may appeal in an adverse final decision received from the
Medicare Administrative Contractor (MAC), the appeal may be filed with: - ansThe Provider Reimbursement
Review Board.
Applying the contracted payment amount to the amount of total charges yields: - ansAn estimated price for the
patient's responsibility
,Applying the contracted payment methodology to the total charges yields: - ansAn estimate price
Appropriate training for patient financial counseling staff must cover all of the following EXCEPT: -
ansDocumenting the conversation in the medical records
Before classifying and subsequently writing off an account to financial assistance or bad debit, the hospital
must establish policy define appropriate criteria, implement procedures for identifying accounts and: -
ansMonitor compliance
Chapter 11 Bankruptcy permits a debtor to: - ansWork out a court-supervised plan with creditors
Charges, as the most appropriate measurement of utilization, enables: - ansGeneration of timely and accurate
billing
Claims with the dates of service received later than one calendar year beyond the date of service will be: -
ansDenied by Medicare
Collecting patient liability dollars after service leads to what? - ansLower accounts receivable levels
Concurrent review and discharge planning - ansOccurs during service
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has
received what? - ansMedically necessary inpatient hospital services for at least 3 consecutive days before the
skilled nursing care admission.
Days in A/R calculated based on the value of: - ansThe total account receivable on a specific date
Departments that need to be included in Charge master maintenance include all EXCEPT - ansQuality Assurance
, During pre-registration, a search for the patient's MRI number is initiated using which of the following data
sets: - ansPatient's full legal name and date of birth or the patient's Social Security number
EMTLA and HFMA best practices specify that in an Emergency Department setting: - ansNo patient financial
discussions should occur before a patient is screened and stabilized
Every patient who is new to the healthcare provider must be offered what? - ansA printed copy of the provider
privacy notice
Examples of ethics violation that impact the revenue cycle include all of the following EXCEPT: - ansSeeking
payment options for self-pay
Fee for service plans pay claims based on a percentage of charges. How are patients out of pocket cost
calculated? - ansThey are calculated quarterly
For scheduled patients, important revenue cycle activities in the time-of -service stage DO NOT include: -
ansFinal bill is presented for payment
For scheduled payments, important revenue cycle activities in the time-of-service stage DO Not include: -
ansObtaining or updating patient and guarantor information
he HCCAHPS (Hospital Consumer Assessment of Healthcare Provider's and Systems) initiative was launched to:
- ansProvide a standardized method for evaluation patients' perspective on hospital care
HFMA best practices call for patient financial discussions to be reinforced: - ansBy issuing a new invoice to the
patient
HIPAA privacy rules require covered entities to take all, of the following actions EXCEPT: - ansUse only
designated software platforms to secure patient date.
HIPPA has adopted Employer Identification Numbers (EINs) to be used in standard transactions to identify the
A claim is denied for the following reasons EXCEPT: - ansThe submitted claim does not have the physician
signature
A common billing issue with hospital-based physician's is - ansThey are not contracted with the patient's health
plan to provide services
A decision on whether a patient should be admitted as an inpatient or become an outpatient observation
patient requires medical judgement based on all of the following EXCEPT: - ansThe patient's home care
coverage
A four-digit number code established by the National Uniform Billing Committee (NUBC) that
categorizes/classifies a line in the charge master is known as: - ansRevenue codes
A patient has met the $200 individual deductible and $900 of the $1000 co-insurance responsibility. The co-
insurance rate is 20%. The estimated insurance plan responsibility is $1975.00. What amount of coinsurance is
due from the patient? - ans$100.00
A portion of the accounts receivable inventory which has NOT qualified for billing includes: - ansAccounts
created during pre-registration but not activated
A scheduled inpatient represents an opportunity for the provider to do which of the following? - ansComplete
registration and insurance approval before service
Account Receivable (A/R) aging reports - ansIdentify past due accounts likely to become bad debit
Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite
discharge, the HFMA best practice is to: - ansSupport that choice, providing that the discussion does not
interfere with patient care or disrupt patient flow.
All Hospitals are required to establish a written financial assistance policy that applies to: - ansAll emergency
,and medically necessary care
All of following are steps in safeguarding collections EXCEPT: - ansPlacing collections in a lock-box for posting
review the next business day
All of the following are potential causes of credit balances EXCEPT: - ansA patient's choice to build up a credit
against future medical bills
Ambulance services are billed directly to the health plan for: - ansServices provided before a patient is admitted
and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her
home or to another facility.
An advantage of a pre-registration program in - ansThe opportunity to reduce processing times at the time of
service
an increase in the dollars aged greater than 90 days from date of service indicate what about accounts -
ansThey are not being processed in a timely manner
Any healthcare insurance plan that providers or insures comprehensive health maintenance and services for an
enrolled group of persons based on a monthly fee is known as a - ansHMO
Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment
services for an enrolled group of persons on a monthly fee is known as: - ansHMO
Any provider that has filed a timely cost report may appeal in an adverse final decision received from the
Medicare Administrative Contractor (MAC), the appeal may be filed with: - ansThe Provider Reimbursement
Review Board.
Applying the contracted payment amount to the amount of total charges yields: - ansAn estimated price for the
patient's responsibility
,Applying the contracted payment methodology to the total charges yields: - ansAn estimate price
Appropriate training for patient financial counseling staff must cover all of the following EXCEPT: -
ansDocumenting the conversation in the medical records
Before classifying and subsequently writing off an account to financial assistance or bad debit, the hospital
must establish policy define appropriate criteria, implement procedures for identifying accounts and: -
ansMonitor compliance
Chapter 11 Bankruptcy permits a debtor to: - ansWork out a court-supervised plan with creditors
Charges, as the most appropriate measurement of utilization, enables: - ansGeneration of timely and accurate
billing
Claims with the dates of service received later than one calendar year beyond the date of service will be: -
ansDenied by Medicare
Collecting patient liability dollars after service leads to what? - ansLower accounts receivable levels
Concurrent review and discharge planning - ansOccurs during service
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has
received what? - ansMedically necessary inpatient hospital services for at least 3 consecutive days before the
skilled nursing care admission.
Days in A/R calculated based on the value of: - ansThe total account receivable on a specific date
Departments that need to be included in Charge master maintenance include all EXCEPT - ansQuality Assurance
, During pre-registration, a search for the patient's MRI number is initiated using which of the following data
sets: - ansPatient's full legal name and date of birth or the patient's Social Security number
EMTLA and HFMA best practices specify that in an Emergency Department setting: - ansNo patient financial
discussions should occur before a patient is screened and stabilized
Every patient who is new to the healthcare provider must be offered what? - ansA printed copy of the provider
privacy notice
Examples of ethics violation that impact the revenue cycle include all of the following EXCEPT: - ansSeeking
payment options for self-pay
Fee for service plans pay claims based on a percentage of charges. How are patients out of pocket cost
calculated? - ansThey are calculated quarterly
For scheduled patients, important revenue cycle activities in the time-of -service stage DO NOT include: -
ansFinal bill is presented for payment
For scheduled payments, important revenue cycle activities in the time-of-service stage DO Not include: -
ansObtaining or updating patient and guarantor information
he HCCAHPS (Hospital Consumer Assessment of Healthcare Provider's and Systems) initiative was launched to:
- ansProvide a standardized method for evaluation patients' perspective on hospital care
HFMA best practices call for patient financial discussions to be reinforced: - ansBy issuing a new invoice to the
patient
HIPAA privacy rules require covered entities to take all, of the following actions EXCEPT: - ansUse only
designated software platforms to secure patient date.
HIPPA has adopted Employer Identification Numbers (EINs) to be used in standard transactions to identify the
