HFMA CRCR EXAM PREP |
COMPREHENSIVE STUDY GUIDE |
2026/2027
What are collection agency fees based on? - correct answer-A percentage of
dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender
rule or what other rule? - correct answer-Birthday
In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers? - correct answer-Case
rates
What customer service improvements might improve the patient accounts
department? - correct answer-Holding staff accountable for customer service
during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
correct 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? - correct answer-Bad debt adjustment
What is the initial hospice benefit? - correct answer-Two 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -
correct 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? - correct 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 - correct answer-They are not being processed in a timely
manner
What is an advantage of a preregistration program? - correct answer-It reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? - correct answer-
Medically unnecessary services and custodial care
What core financial activities are resolved within patient access? - correct
answer-Scheduling, insurance verification, discharge processing, and payment of
point-of-service receipts
,What statement applies to the scheduled outpatient? - correct answer-The
services do not involve an overnight stay
How is a mis-posted contractual allowance resolved? - correct 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? - correct answer-Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require
that the beneficiary has received what? - correct 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$? -
correct answer-When the patient is the insured
What are non-emergency patients who come for service without prior notification
to the provider called? - correct 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? - correct answer-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 answer-Disclosure rules for consumer
credit sales and consumer loans
, What is a principal diagnosis? - correct answer-Primary reason for the patient's
admission
Collecting patient liability dollars after service leads to what? - correct answer-
Lower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? -
correct answer-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 answer-Inpatient care
What code indicates the disposition of the patient at the conclusion of service? -
correct answer-Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - correct
answer-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 answer-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 answer-A valid CPT
or HCPCS code
COMPREHENSIVE STUDY GUIDE |
2026/2027
What are collection agency fees based on? - correct answer-A percentage of
dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender
rule or what other rule? - correct answer-Birthday
In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers? - correct answer-Case
rates
What customer service improvements might improve the patient accounts
department? - correct answer-Holding staff accountable for customer service
during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
correct 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? - correct answer-Bad debt adjustment
What is the initial hospice benefit? - correct answer-Two 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -
correct 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? - correct 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 - correct answer-They are not being processed in a timely
manner
What is an advantage of a preregistration program? - correct answer-It reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? - correct answer-
Medically unnecessary services and custodial care
What core financial activities are resolved within patient access? - correct
answer-Scheduling, insurance verification, discharge processing, and payment of
point-of-service receipts
,What statement applies to the scheduled outpatient? - correct answer-The
services do not involve an overnight stay
How is a mis-posted contractual allowance resolved? - correct 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? - correct answer-Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require
that the beneficiary has received what? - correct 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$? -
correct answer-When the patient is the insured
What are non-emergency patients who come for service without prior notification
to the provider called? - correct 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? - correct answer-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 answer-Disclosure rules for consumer
credit sales and consumer loans
, What is a principal diagnosis? - correct answer-Primary reason for the patient's
admission
Collecting patient liability dollars after service leads to what? - correct answer-
Lower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? -
correct answer-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 answer-Inpatient care
What code indicates the disposition of the patient at the conclusion of service? -
correct answer-Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - correct
answer-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 answer-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 answer-A valid CPT
or HCPCS code
