HFMA CRCR EXAM LATEST 2023-
2024 EXAM 170+ QUESTIONS
AND CORRECT ANSWERS
(VERIFIED ANSWERS)
Through what document does a hospital establish compliance
standards? - -Code of Conduct
-What is the purpose of the OIG work plan? - -Communicate
Issues that will be reviewed during the year for compliance with
Medicare Regulations
-If a Medicare patient is admitted on Friday, what services fall
within the three-day DRG window rule? - -Diagnostic services
and related charges provided on Wednesday, Thursday and
Friday before admission.
-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 of a Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to
these charges? - -They must be combined with the inpatient bill
and paid under the MS-DRG (diagnosis related group) system.
-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? - -It reviews Medicare payments for beneficiaries
who have other insurance and assesses the effectiveness of
procedures in preventing inappropriate Medicare payments for
beneficiaries with other insurance coverage.
, -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 statements 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 on an
around-the-clock basis? - -Physician, nursing and pharmacy
-What is the purpose of the initial step in the outpatient testing
scheduling process? - -Identify the correct patient on the
providers database or add the patient to the database
-Scheduler instructions are used to prompt the scheduler to do
what? - -Complete the scheduling process correctly based on
service requested.
-The time needed to prepare the patient before service is the
difference between the patient's arrival time and which of the
following? - -Procedure time
-Medicare guidelines require that when a test is ordered for
which as LCD (local coverage determination) or NCD (national
coverage determination) exist, the information provided on the
order must include which of the following? - -Documentation of
the medical necessity of the test.
-What is an advantage of a preregistration program? - -It
reduces processing times at the time of service
-What data are required to establish a new MPI (master patient
index) entry? - -The patients full legal name, date of birth and
sex
, -Which HIPAA transition set provides electronic processing of
insurance verification requests and responses? - -The 270-271
Set
-A mother and father both cover their 16-year-old child as a
dependent on their health insurance plans, which both follow the
birthday rule. The mothers date of birth is January 19, 1968; the
father's date of birth is July 19, 1967. Whose plan is the primary
payer? - -The Mothers Plan
-What is a co-payment? - -The fixed amount that is due for a
specific service
-A patient's annual out-of-pocket limitation is $3000, excluding
the deductible. To date this calendar year, the patient has
satisfied the $500 deductible and has paid $2300 in coinsurance
to various providers. For the balance of the calendar year, what
is the maximum amount of coinsurance the patient will owe? - -
$3000 - $2300 = $700
-What type of plan allows the subscriber to pay lower premium
costs in return for a higher deductible? - -Consumer Directed
Health Plan
-What is a characteristic of a managed care contracting
methodology? - -Prospectively set rates for inpatient and
outpatient services.
-Which provision protects the patient from Medical expenses
that exceed a preset level? - -Stop Loss
-What document must a primary care physician send to an HMO
(health maintenance organization) patient to authorize a visit to
a specialist for additional testing or care? - -Referral
-What activities are completed when a scheduled, pre-registered
patient arrives for service? - -Activating the record, obtaining
signatures, and finalizing financial issues.
2024 EXAM 170+ QUESTIONS
AND CORRECT ANSWERS
(VERIFIED ANSWERS)
Through what document does a hospital establish compliance
standards? - -Code of Conduct
-What is the purpose of the OIG work plan? - -Communicate
Issues that will be reviewed during the year for compliance with
Medicare Regulations
-If a Medicare patient is admitted on Friday, what services fall
within the three-day DRG window rule? - -Diagnostic services
and related charges provided on Wednesday, Thursday and
Friday before admission.
-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 of a Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to
these charges? - -They must be combined with the inpatient bill
and paid under the MS-DRG (diagnosis related group) system.
-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? - -It reviews Medicare payments for beneficiaries
who have other insurance and assesses the effectiveness of
procedures in preventing inappropriate Medicare payments for
beneficiaries with other insurance coverage.
, -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 statements 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 on an
around-the-clock basis? - -Physician, nursing and pharmacy
-What is the purpose of the initial step in the outpatient testing
scheduling process? - -Identify the correct patient on the
providers database or add the patient to the database
-Scheduler instructions are used to prompt the scheduler to do
what? - -Complete the scheduling process correctly based on
service requested.
-The time needed to prepare the patient before service is the
difference between the patient's arrival time and which of the
following? - -Procedure time
-Medicare guidelines require that when a test is ordered for
which as LCD (local coverage determination) or NCD (national
coverage determination) exist, the information provided on the
order must include which of the following? - -Documentation of
the medical necessity of the test.
-What is an advantage of a preregistration program? - -It
reduces processing times at the time of service
-What data are required to establish a new MPI (master patient
index) entry? - -The patients full legal name, date of birth and
sex
, -Which HIPAA transition set provides electronic processing of
insurance verification requests and responses? - -The 270-271
Set
-A mother and father both cover their 16-year-old child as a
dependent on their health insurance plans, which both follow the
birthday rule. The mothers date of birth is January 19, 1968; the
father's date of birth is July 19, 1967. Whose plan is the primary
payer? - -The Mothers Plan
-What is a co-payment? - -The fixed amount that is due for a
specific service
-A patient's annual out-of-pocket limitation is $3000, excluding
the deductible. To date this calendar year, the patient has
satisfied the $500 deductible and has paid $2300 in coinsurance
to various providers. For the balance of the calendar year, what
is the maximum amount of coinsurance the patient will owe? - -
$3000 - $2300 = $700
-What type of plan allows the subscriber to pay lower premium
costs in return for a higher deductible? - -Consumer Directed
Health Plan
-What is a characteristic of a managed care contracting
methodology? - -Prospectively set rates for inpatient and
outpatient services.
-Which provision protects the patient from Medical expenses
that exceed a preset level? - -Stop Loss
-What document must a primary care physician send to an HMO
(health maintenance organization) patient to authorize a visit to
a specialist for additional testing or care? - -Referral
-What activities are completed when a scheduled, pre-registered
patient arrives for service? - -Activating the record, obtaining
signatures, and finalizing financial issues.
