CSBI HFMA 2026 EXAM REVIEW FULL
QUESTIONS AND CORRECT ANSWERS
◉What is the purpose OIG work plant? Answer: Identify Acceptable
compliance programs in various provider setting
◉If a Medicare patient is admitted on Friday, what services fall
within the three-day DRG window rule? Answer: Non-diagnostic
service provided on Tuesday through Friday
◉What does a modifier allow a provider to do? Answer: 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 of a Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to these
charges Answer: They must be billed separately to the part B Carrier
◉what is a recurring or series registration? Answer: 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? Answer: Unscheduled
patients
◉Which of the following statement apply to the observation patient
type? Answer: It is used to evaluate the need for an inpatient
admission
◉which services are hospice programs required to provide around
the clock patient Answer: Physician, Nursing, Pharmacy
◉Scheduler instructions are used to prompt the scheduler to do
what? Answer: 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? Answer: 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:
Answer: Documentation of the medical necessity for the test
◉What is the advantage of a pre-registration program Answer: It
reduces processing times at the time of service
, ◉What date are required to establish a new MPI(Master patient
Index) entry Answer: 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? Answer: 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 Answer: 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? Answer: 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? Answer: Medical screening and
stabilizing treatment
◉Which of the following is a step in the discharge process? Answer:
Have a case management service complete the discharge plan
QUESTIONS AND CORRECT ANSWERS
◉What is the purpose OIG work plant? Answer: Identify Acceptable
compliance programs in various provider setting
◉If a Medicare patient is admitted on Friday, what services fall
within the three-day DRG window rule? Answer: Non-diagnostic
service provided on Tuesday through Friday
◉What does a modifier allow a provider to do? Answer: 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 of a Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to these
charges Answer: They must be billed separately to the part B Carrier
◉what is a recurring or series registration? Answer: 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? Answer: Unscheduled
patients
◉Which of the following statement apply to the observation patient
type? Answer: It is used to evaluate the need for an inpatient
admission
◉which services are hospice programs required to provide around
the clock patient Answer: Physician, Nursing, Pharmacy
◉Scheduler instructions are used to prompt the scheduler to do
what? Answer: 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? Answer: 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:
Answer: Documentation of the medical necessity for the test
◉What is the advantage of a pre-registration program Answer: It
reduces processing times at the time of service
, ◉What date are required to establish a new MPI(Master patient
Index) entry Answer: 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? Answer: 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 Answer: 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? Answer: 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? Answer: Medical screening and
stabilizing treatment
◉Which of the following is a step in the discharge process? Answer:
Have a case management service complete the discharge plan
