CRCR Practice Questions with
complete
solutions.
The 501(r) regulations require not-for-profit providers 501(c) (3) to do which
of the following activities?
A. Complete a community needs assessment and develop a discount
program for patient balances after insurance payment.
B. Pursue extraordinary collection activities with all patients eligible for
financial assistance.
C. Implement a financial assistance program for uninsured and underinsured
patients.
D. Discount all charges to self-pay patients to an amount generally billed to
all other patients. CORRECT ANSWER. A. Complete a community needs
assessment and develop a discount program for patient balances after
insurance payment
The accurate capture of charges remains critically important because:
A. Of the potential of fraud and abuse charges from erroneous billing.
B. Charges remain one of the few consistent indicators available to monitor
resource use.
C. Charges are means of measuring physician productivity.
D. Charges provide the data used in activity based costing. CORRECT
ANSWER. B.
Charges remain one of the few consistent indicators available to monitor
resource use
The ACO investment model will test the use of pre-paid shared savings to:
A. Invest in treatment protocols that reduce costs to Medicare
B. Attract physicians to participate in the ACO payment system.
C. Raise quality ratings in designated hospitals.
,D. Encourage new ACOs to form in rural and underserved areas. CORRECT
ANSWER.
D. Encourage new ACOs to form in rural and underserved areas
Across all care settings, if a patient consents to a financial discussion during
a medical encounter to expedite discharge, the HFMA best practice is to:
A. Have a patient financial responsibilities kit ready for the patient,
containing all of the required registration forms and instructions.
B. Make sure that the attending staff can answer questions and assist in
obtaining required patient financial data.
C. Support that choice, providing that the discussion does not interfere with
patient care or disrupt patient flow.
D. Decline such request as finance discussions can disrupt patient care and
patient flow. CORRECT ANSWER. C. Support that choice, providing that the
discussion does not interfere with patient care or disrupt patient flow
Activities completed when the scheduled, pre-registered patient arrives for
service includes:
A. Verifying insurance, activating the record and directing the patient to the
service area.
B. Scanning the driver's license or other phot identification and directing
the patient to the financial counselor.
C. Activating the record, obtaining signatures and finalizing financial issues.
D. Registering the patient and directing the patient to the service
area. CORRECT ANSWER. C. Activating the record, obtaining
signatures and
The activity which results in the accurate recording of patient bed and level
of care assessment, patient transfer and patient discharge status on a real-
time basis is known as:
A. Utilization review
B. Case Management
C. Census Management
D. Patient through-put CORRECT ANSWER. A.
Utilization review or
B. Case Management
An advantage of a pre-registration program is:
A. The markets value of such a program
B. The ability to eliminate no-show appointments.
C. The opportunity to reduce processing times at the time of service.
D. The opportunity to reduce corporate compliance failures within the
registration process. CORRECT ANSWER. C. The opportunity to reduce
processing times at the time of service.
The Affordable Care Act legislated the development of Health Insurance
Exchanges, where individuals and small businesses can:
A. Obtain price estimates for medical services
,B. 3Negotiate 3the 3price 3of 3medical 3services 3with 3providers
C. 3Purchase 3qualified 3health 3benefit 3plans 3regardless 3of 3insured's 3health 3status
D. 3Meet 3federal 3mandates 3for 3insurance 3coverage 3and 3obtain 3the
3corresponding 3tax 3deduction 3CORRECT 3ANSWER . C. 3Purchase 3qualified
3health 3benefit 3plans 3regardless 3of 3insured's 3health 3status.
All 3of 3the 3following 3are 3conditions 3that 3disqualify 3a 3procedure 3or 3service
3from 3being 3paid 3for 3by 3Medicare 3EXCEPT:
A. 3Offered 3in 3an 3outpatient 3setting
B. 3Medically 3unnecessary
C. 3Not 3delivered 3in 3a 3Medicare 3licensed 3care 3setting.
D. 3Services 3and 3procedures 3that 3are 3custodial 3in 3nature 3CORRECT
3ANSWER . C.
3Not 3delivered 3in 3a 3Medicare 3licensed 3care 3setting
All 3of 3the 3following 3are 3reference 3resources 3used 3to 3help 3guide 3in 3the
3application 3for 3business 3ethics 3EXCEPT:
A. 3Consumer 3satisfaction 3reports
B. 3Mission 3& 3Value 3Statements
C. 3Code 3of 3Ethics 3/ 3Code 3of 3Conduct
D. 3Compliance 3Office 3& 3Policies 3CORRECT 3ANSWER. A. 3Consumer 3satisfaction
3reports
All 3of 3the 3following 3are 3steps 3in 3safeguarding 3collections 3EXCEPT:
A. 3Placing 3collections 3in 3a 3lock-box 3for 3posting 3review 3the 3next 3business 3day.
B. 3Posting 3the 3payment 3to 3the 3patient's 3account
C. 3Completing 3balancing 3activities
D. 3Issuing 3receipts 3CORRECT 3ANSWER. A. 3Placing 3collections 3in 3a 3lock-box
3for 3posting 3review 3the 3next 3business 3day
All 3of 3the 3following 3are 3steps 3in 3verifying 3insurance 3EXCEPT:
A. 3Sequencing 3plans 3involved 3in 3a 3coordination 3of 3benefits 3(COB) 3situation.
B. 3The 3patient 3signing 3the 3statement 3of 3financial 3responsibility.
C. 3Identifying 3and 3documenting 3the 3patient's 3health 3plan 3benefits
D. 3Confirming 3the 3patient's 3eligibility 3for 3benefits 3CORRECT 3ANSWER. 3 B. 3The
3patient 3signing 3the 3statement 3of 3financial 3responsibility
All 3of 3the 3following 3information 3is 3used 3to 3identify 3a 3patient 3EXCEPT:
A. 3Date 3of 3Birth
B. 3Gender
C. 3Social 3Security 3Number
D. 3Address 3CORRECT 3ANSWER. D. 3Address
All 3of 3the 3following 3information 3should 3be 3reviewed 3as 3part 3of 3schedule
3finalization 3EXCEPT:
A. 3The 3estimated 3patient 3financial 3obligations
B. 3The 3service 3to 3be 3provided
C. 3The 3arrival 3time 3and 3procedure 3time
, D. 3The 3patient's 3preparation 3instructions 3CORRECT 3ANSWER. A. 3The
3estimated 3patient 3financial 3obligations
Ambulance 3services 3are 3billed 3directly 3to 3the 3health 3plan 3for 3:
A. 3All 3pre-admission 3emergency 3transports
B. 3Transport 3deemed 3medically 3necessary 3by 3the 3attending 3paramedic-
ambulance 3crew
C. 3Services 3provided 3before 3a 3patient 3is 3admitted 3and 3for 3ambulance 3rides
3arranged 3to 3pick 3up 3the 3patient 3from 3the 3hospital 3after 3discharge 3to 3take
3him/her 3home 3or 3to 3another 3facility
D. 3The 3portion 3of 3the 3bill 3outside 3of 3the 3patient's 3self-pay 3CORRECT 3ANSWER.
C.
3Services 3provided 3before 3a 3patient 3is 3admitted 3and 3for 3ambulance 3rides
3arranged 3to 3pick 3up 3the 3patient 3from 3the 3hospital 3after 3discharge 3to 3take
3him/her 3home 3or 3the 3another 3facility
Any 3healthcare 3insurance 3plan 3that 3provides 3or 3ensures 3comprehensive
3health 3maintenance 3and 3treatment 3services 3for 3an 3enrolled 3group 3of
3persons 3on 3a 3monthly 3fee 3is 3known 3as 3a:
A. 3HMO
B. 3PPO
C. 3MSO
D. 3GPO 3CORRECT 3ANSWER. A. 3HMO
Any 3provider 3that 3has 3filed 3a 3timely 3cost 3report 3may 3appeal 3an 3adverse
3final 3decision 3received 3from 3the 3Medicare 3Administrative 3Contractor
3(MAC). 3This 3appeal 3may 3be 3filed 3with:
A. 3The 3Provider 3Reimbursement 3Review 3Board
B. 3The 3Department 3of 3Health 3and 3Human 3Services 3Provider 3Relations 3Division
C. 3A 3court 3appointed 3federal 3mediator
D. 3The 3Office 3of 3the 3Inspector 3General 3CORRECT 3ANSWER. A. 3The
3Provider 3Reimbursement 3Review 3Board
Applying 3the 3contracted 3payment 3methodology 3to 3the 3total 3charges 3yields:
A. 3An 3estimated 3price
B. 3An 3anticipated 3health 3plan 3payment
C. 3A 3price 3justified 3revenue 3accrual
D. 3A 3pricing 3agreement 3CORRECT 3ANSWER. A. 3An 3estimated 3price
Appropriate 3training 3for 3the 3patient 3financial 3counselling 3staff 3must 3cover
3all 3of 3the 3following 3EXCEPT:
A. 3Patient 3financial 3communications 3best 3practices 3specific 3to 3staff 3role
B. 3Financial 3assistance 3policies
C. 3Documenting 3the 3conversation 3in 3the 3medical 3record
D. 3Available 3patient 3financing 3options 3CORRECT 3ANSWER. C.
3Documenting 3the 3conversation 3in 3the 3medical 3record
The 3basis 3for 3qualification 3in 3Medicaid 3is 3typically:
A. 3The 3Federal 3Poverty 3Guidelines
complete
solutions.
The 501(r) regulations require not-for-profit providers 501(c) (3) to do which
of the following activities?
A. Complete a community needs assessment and develop a discount
program for patient balances after insurance payment.
B. Pursue extraordinary collection activities with all patients eligible for
financial assistance.
C. Implement a financial assistance program for uninsured and underinsured
patients.
D. Discount all charges to self-pay patients to an amount generally billed to
all other patients. CORRECT ANSWER. A. Complete a community needs
assessment and develop a discount program for patient balances after
insurance payment
The accurate capture of charges remains critically important because:
A. Of the potential of fraud and abuse charges from erroneous billing.
B. Charges remain one of the few consistent indicators available to monitor
resource use.
C. Charges are means of measuring physician productivity.
D. Charges provide the data used in activity based costing. CORRECT
ANSWER. B.
Charges remain one of the few consistent indicators available to monitor
resource use
The ACO investment model will test the use of pre-paid shared savings to:
A. Invest in treatment protocols that reduce costs to Medicare
B. Attract physicians to participate in the ACO payment system.
C. Raise quality ratings in designated hospitals.
,D. Encourage new ACOs to form in rural and underserved areas. CORRECT
ANSWER.
D. Encourage new ACOs to form in rural and underserved areas
Across all care settings, if a patient consents to a financial discussion during
a medical encounter to expedite discharge, the HFMA best practice is to:
A. Have a patient financial responsibilities kit ready for the patient,
containing all of the required registration forms and instructions.
B. Make sure that the attending staff can answer questions and assist in
obtaining required patient financial data.
C. Support that choice, providing that the discussion does not interfere with
patient care or disrupt patient flow.
D. Decline such request as finance discussions can disrupt patient care and
patient flow. CORRECT ANSWER. C. Support that choice, providing that the
discussion does not interfere with patient care or disrupt patient flow
Activities completed when the scheduled, pre-registered patient arrives for
service includes:
A. Verifying insurance, activating the record and directing the patient to the
service area.
B. Scanning the driver's license or other phot identification and directing
the patient to the financial counselor.
C. Activating the record, obtaining signatures and finalizing financial issues.
D. Registering the patient and directing the patient to the service
area. CORRECT ANSWER. C. Activating the record, obtaining
signatures and
The activity which results in the accurate recording of patient bed and level
of care assessment, patient transfer and patient discharge status on a real-
time basis is known as:
A. Utilization review
B. Case Management
C. Census Management
D. Patient through-put CORRECT ANSWER. A.
Utilization review or
B. Case Management
An advantage of a pre-registration program is:
A. The markets value of such a program
B. The ability to eliminate no-show appointments.
C. The opportunity to reduce processing times at the time of service.
D. The opportunity to reduce corporate compliance failures within the
registration process. CORRECT ANSWER. C. The opportunity to reduce
processing times at the time of service.
The Affordable Care Act legislated the development of Health Insurance
Exchanges, where individuals and small businesses can:
A. Obtain price estimates for medical services
,B. 3Negotiate 3the 3price 3of 3medical 3services 3with 3providers
C. 3Purchase 3qualified 3health 3benefit 3plans 3regardless 3of 3insured's 3health 3status
D. 3Meet 3federal 3mandates 3for 3insurance 3coverage 3and 3obtain 3the
3corresponding 3tax 3deduction 3CORRECT 3ANSWER . C. 3Purchase 3qualified
3health 3benefit 3plans 3regardless 3of 3insured's 3health 3status.
All 3of 3the 3following 3are 3conditions 3that 3disqualify 3a 3procedure 3or 3service
3from 3being 3paid 3for 3by 3Medicare 3EXCEPT:
A. 3Offered 3in 3an 3outpatient 3setting
B. 3Medically 3unnecessary
C. 3Not 3delivered 3in 3a 3Medicare 3licensed 3care 3setting.
D. 3Services 3and 3procedures 3that 3are 3custodial 3in 3nature 3CORRECT
3ANSWER . C.
3Not 3delivered 3in 3a 3Medicare 3licensed 3care 3setting
All 3of 3the 3following 3are 3reference 3resources 3used 3to 3help 3guide 3in 3the
3application 3for 3business 3ethics 3EXCEPT:
A. 3Consumer 3satisfaction 3reports
B. 3Mission 3& 3Value 3Statements
C. 3Code 3of 3Ethics 3/ 3Code 3of 3Conduct
D. 3Compliance 3Office 3& 3Policies 3CORRECT 3ANSWER. A. 3Consumer 3satisfaction
3reports
All 3of 3the 3following 3are 3steps 3in 3safeguarding 3collections 3EXCEPT:
A. 3Placing 3collections 3in 3a 3lock-box 3for 3posting 3review 3the 3next 3business 3day.
B. 3Posting 3the 3payment 3to 3the 3patient's 3account
C. 3Completing 3balancing 3activities
D. 3Issuing 3receipts 3CORRECT 3ANSWER. A. 3Placing 3collections 3in 3a 3lock-box
3for 3posting 3review 3the 3next 3business 3day
All 3of 3the 3following 3are 3steps 3in 3verifying 3insurance 3EXCEPT:
A. 3Sequencing 3plans 3involved 3in 3a 3coordination 3of 3benefits 3(COB) 3situation.
B. 3The 3patient 3signing 3the 3statement 3of 3financial 3responsibility.
C. 3Identifying 3and 3documenting 3the 3patient's 3health 3plan 3benefits
D. 3Confirming 3the 3patient's 3eligibility 3for 3benefits 3CORRECT 3ANSWER. 3 B. 3The
3patient 3signing 3the 3statement 3of 3financial 3responsibility
All 3of 3the 3following 3information 3is 3used 3to 3identify 3a 3patient 3EXCEPT:
A. 3Date 3of 3Birth
B. 3Gender
C. 3Social 3Security 3Number
D. 3Address 3CORRECT 3ANSWER. D. 3Address
All 3of 3the 3following 3information 3should 3be 3reviewed 3as 3part 3of 3schedule
3finalization 3EXCEPT:
A. 3The 3estimated 3patient 3financial 3obligations
B. 3The 3service 3to 3be 3provided
C. 3The 3arrival 3time 3and 3procedure 3time
, D. 3The 3patient's 3preparation 3instructions 3CORRECT 3ANSWER. A. 3The
3estimated 3patient 3financial 3obligations
Ambulance 3services 3are 3billed 3directly 3to 3the 3health 3plan 3for 3:
A. 3All 3pre-admission 3emergency 3transports
B. 3Transport 3deemed 3medically 3necessary 3by 3the 3attending 3paramedic-
ambulance 3crew
C. 3Services 3provided 3before 3a 3patient 3is 3admitted 3and 3for 3ambulance 3rides
3arranged 3to 3pick 3up 3the 3patient 3from 3the 3hospital 3after 3discharge 3to 3take
3him/her 3home 3or 3to 3another 3facility
D. 3The 3portion 3of 3the 3bill 3outside 3of 3the 3patient's 3self-pay 3CORRECT 3ANSWER.
C.
3Services 3provided 3before 3a 3patient 3is 3admitted 3and 3for 3ambulance 3rides
3arranged 3to 3pick 3up 3the 3patient 3from 3the 3hospital 3after 3discharge 3to 3take
3him/her 3home 3or 3the 3another 3facility
Any 3healthcare 3insurance 3plan 3that 3provides 3or 3ensures 3comprehensive
3health 3maintenance 3and 3treatment 3services 3for 3an 3enrolled 3group 3of
3persons 3on 3a 3monthly 3fee 3is 3known 3as 3a:
A. 3HMO
B. 3PPO
C. 3MSO
D. 3GPO 3CORRECT 3ANSWER. A. 3HMO
Any 3provider 3that 3has 3filed 3a 3timely 3cost 3report 3may 3appeal 3an 3adverse
3final 3decision 3received 3from 3the 3Medicare 3Administrative 3Contractor
3(MAC). 3This 3appeal 3may 3be 3filed 3with:
A. 3The 3Provider 3Reimbursement 3Review 3Board
B. 3The 3Department 3of 3Health 3and 3Human 3Services 3Provider 3Relations 3Division
C. 3A 3court 3appointed 3federal 3mediator
D. 3The 3Office 3of 3the 3Inspector 3General 3CORRECT 3ANSWER. A. 3The
3Provider 3Reimbursement 3Review 3Board
Applying 3the 3contracted 3payment 3methodology 3to 3the 3total 3charges 3yields:
A. 3An 3estimated 3price
B. 3An 3anticipated 3health 3plan 3payment
C. 3A 3price 3justified 3revenue 3accrual
D. 3A 3pricing 3agreement 3CORRECT 3ANSWER. A. 3An 3estimated 3price
Appropriate 3training 3for 3the 3patient 3financial 3counselling 3staff 3must 3cover
3all 3of 3the 3following 3EXCEPT:
A. 3Patient 3financial 3communications 3best 3practices 3specific 3to 3staff 3role
B. 3Financial 3assistance 3policies
C. 3Documenting 3the 3conversation 3in 3the 3medical 3record
D. 3Available 3patient 3financing 3options 3CORRECT 3ANSWER. C.
3Documenting 3the 3conversation 3in 3the 3medical 3record
The 3basis 3for 3qualification 3in 3Medicaid 3is 3typically:
A. 3The 3Federal 3Poverty 3Guidelines
