CRCR HFMA EXAM QUESTIONS WITH 100% CORRECT
ANSWERS.
1) Through what document does a hospital establish compliance standards? --
_ _ _ _ _ _ _ _ _ _
Answer ✔✔ code of conduct _ _ _ _
2) What is the purpose OIG work plant? -- Answer ✔✔ Identify Acceptable
_ _ _ _ _ _ _ _ _ _ _ _
compliance programs in various provider setting _ _ _ _ _
3) 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 _
4) 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
_
5) 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 _ _ _ _ _
6) what is a recurring or series registration? -- Answer ✔✔ One registration record
_ _ _ _ _ _ _ _ _ _ _ _ _
is created for multiple days of service
_ _ _ _ _ _
7) What are nonemergency patients who come for service without prior notification
_ _ _ _ _ _ _ _ _ _
to the provider called? -- Answer ✔✔ Unscheduled patients
_ _ _ _ _ _ _ _ _
8) Which of the following statement apply to the observation patient type? --
_ _ _ _ _ _ _ _ _ _ _ _
Answer ✔✔ It is used to evaluate the need for an inpatient admission
_ _ _ _ _ _ _ _ _ _ _ _
,9) which services are hospice programs required to provide around the clock patient
_ _ _ _ _ _ _ _ _ _ _
-- Answer ✔✔ Physician, Nursing, Pharmacy
_ _ _ _ _ _
10) Scheduler instructions are used to prompt the scheduler to do what? -- Answer
_ _ _ _ _ _ _ _ _ _ _ _ _
✔✔ Complete the scheduling process correctly based on service requested
_ _ _ _ _ _ _ _ _
11) 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
12) 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 _ _ _ _ _ _ _
13) What is the advantage of a pre-registration program -- Answer ✔✔ It reduces
_ _ _ _ _ _ _ _ _ _ _ _ _
processing times at the time of service _ _ _ _ _ _
14) 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 _
15) 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.
_ _ _ _ _ _ _
16) Which provision protects the patient from medical expenses that exceed the pre-
_ _ _ _ _ _ _ _ _ _ _
set level -- Answer ✔✔ stop loss
_ _ _ _ _ _
17) 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
18) 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
_ _ _ _ _ _ _ _
, 19) Which of the following is a step in the discharge process? -- Answer ✔✔ Have a
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
case management service complete the discharge plan
_ _ _ _ _ _
20) The hospital has a 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 patients benefit package be applied? -- Answer ✔✔
_ _ _ _ _ _ _ _ _ _ _ _ _ _
To the approved APC payment rate
_ _ _ _ _
21) A patient has met the $200 individual deductible and $900 of the $1000 co-
_ _ _ _ _ _ _ _ _ _ _ _ _
insurance responsibility. The co-insurance rate is 20%. The estimated insurance
_ _ _ _ _ _ _ _ _ _
plan responsibility is $1975.00. What amount of coinsurance is due from the
_ _ _ _ _ _ _ _ _ _ _ _
patient? -- Answer ✔✔ $100.00 _ _ _ _
22) When is a patient considered to be medically indigent? -- Answer ✔✔ The
_ _ _ _ _ _ _ _ _ _ _ _ _
patient's outstanding medical bills exceed a defined dollar amount or percentage
_ _ _ _ _ _ _ _ _ _ _
of assets.
_
23) What patient assets are considered in the financial assistance application? --
_ _ _ _ _ _ _ _ _ _ _
Answer ✔✔ Sources of readily available funds , vehicles, campers, boats and
_ _ _ _ _ _ _ _ _ _ _ _
saving accounts _
24) If the patient cannot agree to payment arrangements, What is the next option? --
_ _ _ _ _ _ _ _ _ _ _ _ _ _
Answer ✔✔ Warn the patient that unpaid accounts are placed with collection
_ _ _ _ _ _ _ _ _ _ _ _
agencies for further processing _ _ _
25) What core financial activities are resolved within patient access? -- Answer ✔✔
_ _ _ _ _ _ _ _ _ _ _ _
scheduling , pre-registration, insurance verification and managed care processing
_ _ _ _ _ _ _ _
26) What is an unscheduled direct admission? -- Answer ✔✔ A patient who arrives at
_ _ _ _ _ _ _ _ _ _ _ _ _ _
the hospital via ambulance for treatment in the emergency department
_ _ _ _ _ _ _ _ _
27) When is it not appropriate to use observation status? -- Answer ✔✔ As a
_ _ _ _ _ _ _ _ _ _ _ _ _ _
substitute for an inpatient admission _ _ _ _
28) Patients who require periodic skilled nursing or therapeutic care receive services
_ _ _ _ _ _ _ _ _ _ _
from what type of program? -- Answer ✔✔ Home health agency
_ _ _ _ _ _ _ _ _ _
ANSWERS.
1) Through what document does a hospital establish compliance standards? --
_ _ _ _ _ _ _ _ _ _
Answer ✔✔ code of conduct _ _ _ _
2) What is the purpose OIG work plant? -- Answer ✔✔ Identify Acceptable
_ _ _ _ _ _ _ _ _ _ _ _
compliance programs in various provider setting _ _ _ _ _
3) 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 _
4) 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
_
5) 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 _ _ _ _ _
6) what is a recurring or series registration? -- Answer ✔✔ One registration record
_ _ _ _ _ _ _ _ _ _ _ _ _
is created for multiple days of service
_ _ _ _ _ _
7) What are nonemergency patients who come for service without prior notification
_ _ _ _ _ _ _ _ _ _
to the provider called? -- Answer ✔✔ Unscheduled patients
_ _ _ _ _ _ _ _ _
8) Which of the following statement apply to the observation patient type? --
_ _ _ _ _ _ _ _ _ _ _ _
Answer ✔✔ It is used to evaluate the need for an inpatient admission
_ _ _ _ _ _ _ _ _ _ _ _
,9) which services are hospice programs required to provide around the clock patient
_ _ _ _ _ _ _ _ _ _ _
-- Answer ✔✔ Physician, Nursing, Pharmacy
_ _ _ _ _ _
10) Scheduler instructions are used to prompt the scheduler to do what? -- Answer
_ _ _ _ _ _ _ _ _ _ _ _ _
✔✔ Complete the scheduling process correctly based on service requested
_ _ _ _ _ _ _ _ _
11) 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
12) 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 _ _ _ _ _ _ _
13) What is the advantage of a pre-registration program -- Answer ✔✔ It reduces
_ _ _ _ _ _ _ _ _ _ _ _ _
processing times at the time of service _ _ _ _ _ _
14) 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 _
15) 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.
_ _ _ _ _ _ _
16) Which provision protects the patient from medical expenses that exceed the pre-
_ _ _ _ _ _ _ _ _ _ _
set level -- Answer ✔✔ stop loss
_ _ _ _ _ _
17) 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
18) 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
_ _ _ _ _ _ _ _
, 19) Which of the following is a step in the discharge process? -- Answer ✔✔ Have a
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
case management service complete the discharge plan
_ _ _ _ _ _
20) The hospital has a 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 patients benefit package be applied? -- Answer ✔✔
_ _ _ _ _ _ _ _ _ _ _ _ _ _
To the approved APC payment rate
_ _ _ _ _
21) A patient has met the $200 individual deductible and $900 of the $1000 co-
_ _ _ _ _ _ _ _ _ _ _ _ _
insurance responsibility. The co-insurance rate is 20%. The estimated insurance
_ _ _ _ _ _ _ _ _ _
plan responsibility is $1975.00. What amount of coinsurance is due from the
_ _ _ _ _ _ _ _ _ _ _ _
patient? -- Answer ✔✔ $100.00 _ _ _ _
22) When is a patient considered to be medically indigent? -- Answer ✔✔ The
_ _ _ _ _ _ _ _ _ _ _ _ _
patient's outstanding medical bills exceed a defined dollar amount or percentage
_ _ _ _ _ _ _ _ _ _ _
of assets.
_
23) What patient assets are considered in the financial assistance application? --
_ _ _ _ _ _ _ _ _ _ _
Answer ✔✔ Sources of readily available funds , vehicles, campers, boats and
_ _ _ _ _ _ _ _ _ _ _ _
saving accounts _
24) If the patient cannot agree to payment arrangements, What is the next option? --
_ _ _ _ _ _ _ _ _ _ _ _ _ _
Answer ✔✔ Warn the patient that unpaid accounts are placed with collection
_ _ _ _ _ _ _ _ _ _ _ _
agencies for further processing _ _ _
25) What core financial activities are resolved within patient access? -- Answer ✔✔
_ _ _ _ _ _ _ _ _ _ _ _
scheduling , pre-registration, insurance verification and managed care processing
_ _ _ _ _ _ _ _
26) What is an unscheduled direct admission? -- Answer ✔✔ A patient who arrives at
_ _ _ _ _ _ _ _ _ _ _ _ _ _
the hospital via ambulance for treatment in the emergency department
_ _ _ _ _ _ _ _ _
27) When is it not appropriate to use observation status? -- Answer ✔✔ As a
_ _ _ _ _ _ _ _ _ _ _ _ _ _
substitute for an inpatient admission _ _ _ _
28) Patients who require periodic skilled nursing or therapeutic care receive services
_ _ _ _ _ _ _ _ _ _ _
from what type of program? -- Answer ✔✔ Home health agency
_ _ _ _ _ _ _ _ _ _
