Description: This document contains a complete set of verified
questions and answers for the HFMA CRCR (Certified Revenue
Cycle Representative) Final Practice Exam. It covers essential
revenue cycle management topics including compliance
standards, Medicare and Medicaid rules, billing procedures,
patient access, claims processing, denial management, and
payment methodologies. The content is designed to help
candidates prepare effectively for the CRCR certification by
providing realistic, exam-style Q&A.
Questions and Answers:
Through what document does a hospital establish compliance
standards? _Code of conduct
What is the purpose OIG work plant? _Identify
Acceptable compliance programs in various provider setting
,Ifa Medicare patient is admitted on Friday, what services fall
within the three-day DRG window rule? _Non-diagnostic
service provided on Tuesday through Friday
What does a modifier allow a provider to do? _Report a
specific circumstance that affected a procedure or service without
changing the code or its definition
IF outpatient diagnostic services are provided within three days
of the admission ofa Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to
these charges _They must be billed separately to the part
B Carrier
what is a recurring or series registration? _One
registration record is created for multiple days of service
What are nonemergency patients who come for service without
prior notification to the provider called? _Unscheduled
patients
,Which of the following statement apply to the observation patient
type? _It is used to evaluate the need for an inpatient
admission
which services are hospice programs required to provide around
the clock patient _Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do
what? _Complete the scheduling process correctly based
on service requeste
The Time needed to prepare the patient before service is the
difference between the patients arrival time and which of the
following? _Procedure time
Medicare guidelines require that when a test is ordered for a LCD
or NCD exists, the information provided on the order must
include: _Documentation of the medical necessity for the
test
What is the advantage ofa pre-registration program -It
reduces processing times at the time of service
, What date are required to establish a new MPI(Master patient
Index) entry -The responsible party's full legal name,
date of birth, and social security number
Which of the following statements is true about third-party
payments? _The payments are received by the provider
from the payer responsible for reimbursing the provider for the
patient's covered services.
Which provision protects the patient from medical expenses that
exceed the pre-set level _stop loss
what documentation must a primary care physician send to HMO
patient to authorize a visit to a specialist for additional testing or
care? _Referral
Under EMTALA (Emergency Medical Treatment and Labor Act)
regulations, the provider may not ask about a patient's insurance
information if it would delay what? _Medical screening
and stabilizing treatment
questions and answers for the HFMA CRCR (Certified Revenue
Cycle Representative) Final Practice Exam. It covers essential
revenue cycle management topics including compliance
standards, Medicare and Medicaid rules, billing procedures,
patient access, claims processing, denial management, and
payment methodologies. The content is designed to help
candidates prepare effectively for the CRCR certification by
providing realistic, exam-style Q&A.
Questions and Answers:
Through what document does a hospital establish compliance
standards? _Code of conduct
What is the purpose OIG work plant? _Identify
Acceptable compliance programs in various provider setting
,Ifa Medicare patient is admitted on Friday, what services fall
within the three-day DRG window rule? _Non-diagnostic
service provided on Tuesday through Friday
What does a modifier allow a provider to do? _Report a
specific circumstance that affected a procedure or service without
changing the code or its definition
IF outpatient diagnostic services are provided within three days
of the admission ofa Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to
these charges _They must be billed separately to the part
B Carrier
what is a recurring or series registration? _One
registration record is created for multiple days of service
What are nonemergency patients who come for service without
prior notification to the provider called? _Unscheduled
patients
,Which of the following statement apply to the observation patient
type? _It is used to evaluate the need for an inpatient
admission
which services are hospice programs required to provide around
the clock patient _Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do
what? _Complete the scheduling process correctly based
on service requeste
The Time needed to prepare the patient before service is the
difference between the patients arrival time and which of the
following? _Procedure time
Medicare guidelines require that when a test is ordered for a LCD
or NCD exists, the information provided on the order must
include: _Documentation of the medical necessity for the
test
What is the advantage ofa pre-registration program -It
reduces processing times at the time of service
, What date are required to establish a new MPI(Master patient
Index) entry -The responsible party's full legal name,
date of birth, and social security number
Which of the following statements is true about third-party
payments? _The payments are received by the provider
from the payer responsible for reimbursing the provider for the
patient's covered services.
Which provision protects the patient from medical expenses that
exceed the pre-set level _stop loss
what documentation must a primary care physician send to HMO
patient to authorize a visit to a specialist for additional testing or
care? _Referral
Under EMTALA (Emergency Medical Treatment and Labor Act)
regulations, the provider may not ask about a patient's insurance
information if it would delay what? _Medical screening
and stabilizing treatment
