HFMA CRCR EXAM LATEST VERSION 2026 EXAM 170
QUESTION AND CORRECT DETAILED ANSWERS WITH
RATIONALES.
The hospital has a APC based contract for the payment of outpatient QUESTION
The hospital has an APC-based contract for the payment of outpatient services. Total
anticipated charges for the visit are $2,380. The approved APC payment rate is $780.
Where will the patient's benefit package be applied?
CORRECT ANS: To the approved APC payment rate
EXPERT RATIONALE
Under the Ambulatory Payment Classification (APC) system, Medicare and other payers
reimburse based on a predetermined fixed payment rate for specific outpatient services.
The patient's benefit package, including deductibles, coinsurance, and copayments, is
applied to this approved APC payment rate, not to the total charged amount. This is
because the contract is based on the APC rate, and the patient's financial responsibility
is calculated as a percentage of the allowed amount.
QUESTION
A patient has met the $200 individual deductible and $900 of the $1000 coinsurance
responsibility. The co-insurance rate is 20%. The estimated insurance plan responsibility
is $1975.00. What amount of coinsurance is due from the patient?
CORRECT ANS: $100.00
EXPERT RATIONALE
The patient has a coinsurance responsibility of $1,000. They have already paid $900
towards this amount. Therefore, the remaining coinsurance due from the patient is
$1,000 - $900 = $100. The deductible has already been met and does not factor into
this remaining coinsurance calculation.
,QUESTION
When is a patient considered to be medically indigent?
CORRECT ANS: The patient's outstanding medical bills exceed a defined dollar amount
or percentage of assets.
EXPERT RATIONALE
Medical indigence is a term used to describe a patient who cannot afford to pay their
medical bills because the cost of their healthcare exceeds their financial resources. The
determination is based on the patient's assets and income, and is often defined by a
specific threshold, such as when medical bills exceed a certain percentage of the
patient's income or assets.
QUESTION
What patient assets are considered in the financial assistance application?
CORRECT ANS: Sources of readily available funds, vehicles, campers, boats and saving
accounts
EXPERT RATIONALE
When a patient applies for financial assistance, the provider evaluates the patient's
available financial resources to determine their ability to pay. This typically includes all
liquid assets and sources of readily available funds, such as savings accounts, as well as
non-essential personal assets such as vehicles, campers, and boats. These assets are
considered because they could be liquidated to pay for healthcare expenses.
QUESTION
If the patient cannot agree to payment arrangements, what is the next option?
CORRECT ANS: Warn the patient that unpaid accounts are placed with collection
agencies for further processing
EXPERT RATIONALE
If a patient is unable or unwilling to agree to a payment plan, the provider's next step is
to inform the patient that the account will be turned over to a third-party collection
,agency for processing. This is a standard practice to recover the debt. The warning is
part of the process and should be documented.
QUESTION
What core financial activities are resolved within patient access?
CORRECT ANS: scheduling, pre-registration, insurance verification and managed care
processing
EXPERT RATIONALE
Patient Access is a critical department in the revenue cycle. Its core financial functions
include scheduling appointments to ensure efficient operations, pre-registering patients
to gather demographic and insurance information, verifying insurance coverage and
benefits, and processing managed care requirements like referrals and authorizations.
QUESTION
What is an unscheduled direct admission?
CORRECT ANS: A patient who arrives at the hospital via ambulance for treatment in the
emergency department
EXPERT RATIONALE
An unscheduled direct admission is a patient who is admitted to the hospital without a
prior appointment. This typically occurs when a patient arrives via ambulance or is
brought to the emergency department (ED) for urgent or emergent care. The admission
is triggered by the patient's acute need for services.
QUESTION
When is it not appropriate to use observation status?
CORRECT ANS: As a substitute for an inpatient admission
, EXPERT RATIONALE
Observation status is designed for patients who require short-term monitoring and
evaluation to determine if they need to be admitted as an inpatient. It is not
appropriate to use observation status as a substitute for a full inpatient admission when
the patient clearly requires a higher level of care. Using observation inappropriately can
lead to billing issues and patient dissatisfaction.
QUESTION
Patients who require periodic skilled nursing or therapeutic care receive services from
what type of program?
CORRECT ANS: Home health agency
EXPERT RATIONALE
Home health agencies provide intermittent, part-time, skilled nursing care and
therapeutic services to patients in their homes. These services are typically ordered by a
physician and are provided on a periodic basis for patients who are homebound and
need skilled care. This is distinct from long-term care or hospice.
QUESTION
Every patient who is new to the healthcare provider must be offered what?
CORRECT ANS: A printed copy of the provider privacy notice
EXPERT RATIONALE
Under the Health Insurance Portability and Accountability Act (HIPAA), all new patients
must be offered a copy of the provider's Notice of Privacy Practices. This document
outlines how the provider will use and disclose the patient's protected health
information (PHI) and the patient's rights regarding their PHI.
QUESTION
Which of the following statements applies to self-insured insurance plans?
QUESTION AND CORRECT DETAILED ANSWERS WITH
RATIONALES.
The hospital has a APC based contract for the payment of outpatient QUESTION
The hospital has an APC-based contract for the payment of outpatient services. Total
anticipated charges for the visit are $2,380. The approved APC payment rate is $780.
Where will the patient's benefit package be applied?
CORRECT ANS: To the approved APC payment rate
EXPERT RATIONALE
Under the Ambulatory Payment Classification (APC) system, Medicare and other payers
reimburse based on a predetermined fixed payment rate for specific outpatient services.
The patient's benefit package, including deductibles, coinsurance, and copayments, is
applied to this approved APC payment rate, not to the total charged amount. This is
because the contract is based on the APC rate, and the patient's financial responsibility
is calculated as a percentage of the allowed amount.
QUESTION
A patient has met the $200 individual deductible and $900 of the $1000 coinsurance
responsibility. The co-insurance rate is 20%. The estimated insurance plan responsibility
is $1975.00. What amount of coinsurance is due from the patient?
CORRECT ANS: $100.00
EXPERT RATIONALE
The patient has a coinsurance responsibility of $1,000. They have already paid $900
towards this amount. Therefore, the remaining coinsurance due from the patient is
$1,000 - $900 = $100. The deductible has already been met and does not factor into
this remaining coinsurance calculation.
,QUESTION
When is a patient considered to be medically indigent?
CORRECT ANS: The patient's outstanding medical bills exceed a defined dollar amount
or percentage of assets.
EXPERT RATIONALE
Medical indigence is a term used to describe a patient who cannot afford to pay their
medical bills because the cost of their healthcare exceeds their financial resources. The
determination is based on the patient's assets and income, and is often defined by a
specific threshold, such as when medical bills exceed a certain percentage of the
patient's income or assets.
QUESTION
What patient assets are considered in the financial assistance application?
CORRECT ANS: Sources of readily available funds, vehicles, campers, boats and saving
accounts
EXPERT RATIONALE
When a patient applies for financial assistance, the provider evaluates the patient's
available financial resources to determine their ability to pay. This typically includes all
liquid assets and sources of readily available funds, such as savings accounts, as well as
non-essential personal assets such as vehicles, campers, and boats. These assets are
considered because they could be liquidated to pay for healthcare expenses.
QUESTION
If the patient cannot agree to payment arrangements, what is the next option?
CORRECT ANS: Warn the patient that unpaid accounts are placed with collection
agencies for further processing
EXPERT RATIONALE
If a patient is unable or unwilling to agree to a payment plan, the provider's next step is
to inform the patient that the account will be turned over to a third-party collection
,agency for processing. This is a standard practice to recover the debt. The warning is
part of the process and should be documented.
QUESTION
What core financial activities are resolved within patient access?
CORRECT ANS: scheduling, pre-registration, insurance verification and managed care
processing
EXPERT RATIONALE
Patient Access is a critical department in the revenue cycle. Its core financial functions
include scheduling appointments to ensure efficient operations, pre-registering patients
to gather demographic and insurance information, verifying insurance coverage and
benefits, and processing managed care requirements like referrals and authorizations.
QUESTION
What is an unscheduled direct admission?
CORRECT ANS: A patient who arrives at the hospital via ambulance for treatment in the
emergency department
EXPERT RATIONALE
An unscheduled direct admission is a patient who is admitted to the hospital without a
prior appointment. This typically occurs when a patient arrives via ambulance or is
brought to the emergency department (ED) for urgent or emergent care. The admission
is triggered by the patient's acute need for services.
QUESTION
When is it not appropriate to use observation status?
CORRECT ANS: As a substitute for an inpatient admission
, EXPERT RATIONALE
Observation status is designed for patients who require short-term monitoring and
evaluation to determine if they need to be admitted as an inpatient. It is not
appropriate to use observation status as a substitute for a full inpatient admission when
the patient clearly requires a higher level of care. Using observation inappropriately can
lead to billing issues and patient dissatisfaction.
QUESTION
Patients who require periodic skilled nursing or therapeutic care receive services from
what type of program?
CORRECT ANS: Home health agency
EXPERT RATIONALE
Home health agencies provide intermittent, part-time, skilled nursing care and
therapeutic services to patients in their homes. These services are typically ordered by a
physician and are provided on a periodic basis for patients who are homebound and
need skilled care. This is distinct from long-term care or hospice.
QUESTION
Every patient who is new to the healthcare provider must be offered what?
CORRECT ANS: A printed copy of the provider privacy notice
EXPERT RATIONALE
Under the Health Insurance Portability and Accountability Act (HIPAA), all new patients
must be offered a copy of the provider's Notice of Privacy Practices. This document
outlines how the provider will use and disclose the patient's protected health
information (PHI) and the patient's rights regarding their PHI.
QUESTION
Which of the following statements applies to self-insured insurance plans?
