HFMA CRCR Exam Prep Study Questions and
Verified Answers – Latest Update 2026/2027
1. What do Case Managers do?: Monitor high resource cases to ensure ettective utilization
2. What is HIM responsible for?: all pt medical records: transcribe, coding, release to biling, answer
requests for documentation
3. What is utilization management responsible for?: manage cases: services correct, on time
4. What are the three types of utilization review?: Prospective, Concurrent, Retrospective
5. Where can home health services be offered?: Home, Assist Living, neighbors: just not SNF nor
Hospital
6. To receive -Care payments, what must a SNF have when receiving a pt from a
hosp?: A transfer agreement approved by -Care.
7. Can a home health agency employ another agency to provide services?: Yes, so
long as at least one employee of the original agency provides care.
8. What is the Net Collection Rate?: how much cash was collected as a % of available to collect?
9. What is the Net Collection Rate benchmarḳ?: 95%
10. What is the benchmarḳ for denials: <2% on first submission
11. Formual for cost to collect: total PFS eẋpenses/gross pt care collections
12. What is the benchmarḳ for cost to collect: 2.25%
13. What % of the UB-04 source of data is from pt access?: 40%
14. What % of the UB-04 source of data is from service depts?: 11%
15. What % of the UB-04 source of data is from HIM?: 20%
16. What % of the UB-04 source of data is from billing?: 20%
17. What % of the UB-04 source of data is not used?: 9%
18. What % of the CMS 1500 source of data is from pt access?: 53%
19. What % of the CMS 1500 source of data is from service?: 14%
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, 20. What % of the CMS 1500 source of data is from HIM: 7%
21. What % of the CMS 1500 source of data is from billing?: 26%
22. From whom is the UB-04 directed?: institutional: hospitals, SNF, hospice
23. From whom is the CMS 1500?: non-institutional: physicians, DME
24. In the FDCA, what is Title I: Truth in Lending Act
25. What is the Truth in Lending Act: 5 points must be triggered (such as interest will be charged), then
must disclose APR, total payments, late payment charges, etc.
26. What are the penalties for violating the FDCA?: creditors can be sued
27. Who enforces the FDCA for hospitals?: FTC
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Verified Answers – Latest Update 2026/2027
1. What do Case Managers do?: Monitor high resource cases to ensure ettective utilization
2. What is HIM responsible for?: all pt medical records: transcribe, coding, release to biling, answer
requests for documentation
3. What is utilization management responsible for?: manage cases: services correct, on time
4. What are the three types of utilization review?: Prospective, Concurrent, Retrospective
5. Where can home health services be offered?: Home, Assist Living, neighbors: just not SNF nor
Hospital
6. To receive -Care payments, what must a SNF have when receiving a pt from a
hosp?: A transfer agreement approved by -Care.
7. Can a home health agency employ another agency to provide services?: Yes, so
long as at least one employee of the original agency provides care.
8. What is the Net Collection Rate?: how much cash was collected as a % of available to collect?
9. What is the Net Collection Rate benchmarḳ?: 95%
10. What is the benchmarḳ for denials: <2% on first submission
11. Formual for cost to collect: total PFS eẋpenses/gross pt care collections
12. What is the benchmarḳ for cost to collect: 2.25%
13. What % of the UB-04 source of data is from pt access?: 40%
14. What % of the UB-04 source of data is from service depts?: 11%
15. What % of the UB-04 source of data is from HIM?: 20%
16. What % of the UB-04 source of data is from billing?: 20%
17. What % of the UB-04 source of data is not used?: 9%
18. What % of the CMS 1500 source of data is from pt access?: 53%
19. What % of the CMS 1500 source of data is from service?: 14%
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14
, 20. What % of the CMS 1500 source of data is from HIM: 7%
21. What % of the CMS 1500 source of data is from billing?: 26%
22. From whom is the UB-04 directed?: institutional: hospitals, SNF, hospice
23. From whom is the CMS 1500?: non-institutional: physicians, DME
24. In the FDCA, what is Title I: Truth in Lending Act
25. What is the Truth in Lending Act: 5 points must be triggered (such as interest will be charged), then
must disclose APR, total payments, late payment charges, etc.
26. What are the penalties for violating the FDCA?: creditors can be sued
27. Who enforces the FDCA for hospitals?: FTC
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