HFMA CRCR EXAM Preparation Guide Questions
with Correct Answers Graded A+ 2026
What are collection agency fees based on? ANSWER >>> A percentage of dollars
collected
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
1
,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
2
,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
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? ANSWER >>> Disclosure rules for consumer credit sales and
consumer loans
What is a principal diagnosis? ANSWER >>> Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? ANSWER >>> Lower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? 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? ANSWER >>> Inpatient care
3
, What code indicates the disposition of the patient at the conclusion of service?
ANSWER >>> Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? 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? 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: ANSWER >>> A valid CPT or HCPCS
code
With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? ANSWER >>> Access their information and
perform functions on-line
What date is required on all CMS 1500 claim forms? ANSWER >>> onset date of
current illness
What does scheduling allow provider staff to do ANSWER >>> Review appropriateness
of the service request
What code is used to report the provider's most common semiprivate room rate?
ANSWER >>> Condition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: ANSWER >>> 2012
What is a primary responsibility of the Recover Audit Contractor? ANSWER >>> To
correctly identify proper payments for Medicare Part A & B claims
4
with Correct Answers Graded A+ 2026
What are collection agency fees based on? ANSWER >>> A percentage of dollars
collected
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
1
,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
2
,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
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? ANSWER >>> Disclosure rules for consumer credit sales and
consumer loans
What is a principal diagnosis? ANSWER >>> Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? ANSWER >>> Lower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? 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? ANSWER >>> Inpatient care
3
, What code indicates the disposition of the patient at the conclusion of service?
ANSWER >>> Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? 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? 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: ANSWER >>> A valid CPT or HCPCS
code
With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? ANSWER >>> Access their information and
perform functions on-line
What date is required on all CMS 1500 claim forms? ANSWER >>> onset date of
current illness
What does scheduling allow provider staff to do ANSWER >>> Review appropriateness
of the service request
What code is used to report the provider's most common semiprivate room rate?
ANSWER >>> Condition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: ANSWER >>> 2012
What is a primary responsibility of the Recover Audit Contractor? ANSWER >>> To
correctly identify proper payments for Medicare Part A & B claims
4
