HFMA CRCR EXAM WITH CORRECT
ANSWERS 2025
What are collection agency fees based on? correct answers A percentage
of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the
gender rule or what other rule? correct answers Birthday
In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers? correct answers
Case rates
What customer service improvements might improve the patient accounts
department? correct answers Holding staff accountable for customer service
during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to
do? correct answers Inform a Medicare beneficiary that Medicare may not
pay for the order or service
What type of account adjustment results from the patient's unwillingness
to pay for a self-pay balance? correct answers Bad debt adjustment
What is the initial hospice benefit? correct answers Two 90-day
periods and an unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient
claim? correct answers If the patient requires ambulance transportation to a
skilled nursing facility
How should a provider resolve a late-charge credit posted after an
account is billed? correct answers Post a late-charge adjustment to the
account
an increase in the dollars aged greater than 90 days from date of service
indicate what about accounts correct answers They are not being processed
in a timely manner
What is an advantage of a preregistration program? correct answers
It reduces processing times at the time of service
What are the two statutory exclusions from hospice coverage?
correct answers Medically unnecessary services and custodial care
,What core financial activities are resolved within patient access? correct
answers Scheduling, insurance verification, discharge processing, and
payment of point-of- service receipts
What statement applies to the scheduled outpatient? correct answers The
services do not involve an overnight stay
How is a mis-posted contractual allowance resolved? correct answers
Comparing the contract reimbursement rates with the contract on the
admittance advice to identify the correct amount
What type of patient status is used to evaluate the patient's need for
inpatient care? correct answers Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care
require that the beneficiary has received what? correct answers Medically
necessary inpatient hospital services for at least 3 consecutive days before
the skilled nursing care admission
When is the word "SAME" entered on the CMS 1500 billing form in Field
0$? correct answers When the patient is the insured
What are non-emergency patients who come for service without prior
notification to the provider called? correct answers Unscheduled patients
If the insurance verification response reports that a subscriber has a single
policy, what is the status of the subscriber's spouse? correct answers Neither
enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth
in Lending Act, establishes what? correct answers Disclosure rules for
consumer credit sales and consumer loans
What is a principal diagnosis? correct answers Primary reason for the
patient's admission
Collecting patient liability dollars after service leads to what? correct
answers Lower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day
used? correct answers 50% of the current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic
(RHC) is not billable as an RHC services? correct answers Inpatient care
What code indicates the disposition of the patient at the conclusion of
service? correct answers Patient discharge status code
,What are hospitals required to do for Medicare credit balance
accounts? correct answers They result in lost reimbursement and
additional cost to collect
When an undue delay of payment results from a dispute between the
patient and the third party payer, who is responsible for payment? correct
answers Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD
exists, the information provided on the order must include: correct answers
A valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle
processes are expanding to allow patients to do what? correct answers
Access their information and perform functions on-line
What date is required on all CMS 1500 claim forms? correct answers
onset date of current illness
What does scheduling allow provider staff to do correct
answers Review appropriateness of the service request
What code is used to report the provider's most common semiprivate room
rate? correct answers Condition code
Regulations and requirements for coding accountable care organizations,
which allows providers to begin creating these organizations, were finalized
in: correct answers 2012
What is a primary responsibility of the Recover Audit Contractor? correct
answers To correctly identify proper payments for Medicare Part A & B
claims
How must providers handle credit balances? correct answers Comply with
state statutes concerning reporting credit balance
Insurance verification results in what? correct answers The accurate
identification of the patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? correct answers
CMS 1500
What activities are completed when a scheduled pre-registered patient
arrives for service? correct answers Registering the patient and directing the
patient to the service area
In addition to being supported by information found in the patient's chart,
a CMS 1500 claim must be coded using what? correct answers HCPCS
(Healthcare Common Procedure Coding system)
, What results from a denied claim? correct answers The provider incurs
rework and appeal costs
Why does the financial counselor need pricing for services? correct
answers To calculate the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form
correct answers Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? correct
answers Appeal conditions specified in the individual payer's contract
The important message from Medicare provides beneficiaries with
information concerning what? correct answers Right to appeal a discharge
decision if the patient disagrees with the services
Why do managed care plans have agreements with hospitals, physicians,
and other healthcare providers to offer a range of services to plan
members? correct answers To improve access to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for
more than 30 days, what is the SNF permitted to do? correct answers
Submit interim bills to the Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare
for liability claims after what happens? correct answers 120 days passes,
but the claim then be withdrawn from the liability carrier
What data are required to establish a new MPI entry? correct answers The
patient's full legal name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay
as primary? correct answers Determine the correct payer and notify the
incorrect payer of the processing error
What do EMTALA regulations require on-call physicians to do? correct
answers Personally appear in the emergency department and attend to
the patient within a reasonable time
At the end of each shift, what must happen to cash, checks, and credit card
transaction documents? correct answers They must be balanced
What will cause a CMS 1500 claim to be rejected? correct answers The
provider is billing with a future date of service
ANSWERS 2025
What are collection agency fees based on? correct answers A percentage
of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the
gender rule or what other rule? correct answers Birthday
In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers? correct answers
Case rates
What customer service improvements might improve the patient accounts
department? correct answers Holding staff accountable for customer service
during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to
do? correct answers Inform a Medicare beneficiary that Medicare may not
pay for the order or service
What type of account adjustment results from the patient's unwillingness
to pay for a self-pay balance? correct answers Bad debt adjustment
What is the initial hospice benefit? correct answers Two 90-day
periods and an unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient
claim? correct answers If the patient requires ambulance transportation to a
skilled nursing facility
How should a provider resolve a late-charge credit posted after an
account is billed? correct answers Post a late-charge adjustment to the
account
an increase in the dollars aged greater than 90 days from date of service
indicate what about accounts correct answers They are not being processed
in a timely manner
What is an advantage of a preregistration program? correct answers
It reduces processing times at the time of service
What are the two statutory exclusions from hospice coverage?
correct answers Medically unnecessary services and custodial care
,What core financial activities are resolved within patient access? correct
answers Scheduling, insurance verification, discharge processing, and
payment of point-of- service receipts
What statement applies to the scheduled outpatient? correct answers The
services do not involve an overnight stay
How is a mis-posted contractual allowance resolved? correct answers
Comparing the contract reimbursement rates with the contract on the
admittance advice to identify the correct amount
What type of patient status is used to evaluate the patient's need for
inpatient care? correct answers Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care
require that the beneficiary has received what? correct answers Medically
necessary inpatient hospital services for at least 3 consecutive days before
the skilled nursing care admission
When is the word "SAME" entered on the CMS 1500 billing form in Field
0$? correct answers When the patient is the insured
What are non-emergency patients who come for service without prior
notification to the provider called? correct answers Unscheduled patients
If the insurance verification response reports that a subscriber has a single
policy, what is the status of the subscriber's spouse? correct answers Neither
enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth
in Lending Act, establishes what? correct answers Disclosure rules for
consumer credit sales and consumer loans
What is a principal diagnosis? correct answers Primary reason for the
patient's admission
Collecting patient liability dollars after service leads to what? correct
answers Lower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day
used? correct answers 50% of the current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic
(RHC) is not billable as an RHC services? correct answers Inpatient care
What code indicates the disposition of the patient at the conclusion of
service? correct answers Patient discharge status code
,What are hospitals required to do for Medicare credit balance
accounts? correct answers They result in lost reimbursement and
additional cost to collect
When an undue delay of payment results from a dispute between the
patient and the third party payer, who is responsible for payment? correct
answers Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD
exists, the information provided on the order must include: correct answers
A valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle
processes are expanding to allow patients to do what? correct answers
Access their information and perform functions on-line
What date is required on all CMS 1500 claim forms? correct answers
onset date of current illness
What does scheduling allow provider staff to do correct
answers Review appropriateness of the service request
What code is used to report the provider's most common semiprivate room
rate? correct answers Condition code
Regulations and requirements for coding accountable care organizations,
which allows providers to begin creating these organizations, were finalized
in: correct answers 2012
What is a primary responsibility of the Recover Audit Contractor? correct
answers To correctly identify proper payments for Medicare Part A & B
claims
How must providers handle credit balances? correct answers Comply with
state statutes concerning reporting credit balance
Insurance verification results in what? correct answers The accurate
identification of the patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? correct answers
CMS 1500
What activities are completed when a scheduled pre-registered patient
arrives for service? correct answers Registering the patient and directing the
patient to the service area
In addition to being supported by information found in the patient's chart,
a CMS 1500 claim must be coded using what? correct answers HCPCS
(Healthcare Common Procedure Coding system)
, What results from a denied claim? correct answers The provider incurs
rework and appeal costs
Why does the financial counselor need pricing for services? correct
answers To calculate the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form
correct answers Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? correct
answers Appeal conditions specified in the individual payer's contract
The important message from Medicare provides beneficiaries with
information concerning what? correct answers Right to appeal a discharge
decision if the patient disagrees with the services
Why do managed care plans have agreements with hospitals, physicians,
and other healthcare providers to offer a range of services to plan
members? correct answers To improve access to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for
more than 30 days, what is the SNF permitted to do? correct answers
Submit interim bills to the Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare
for liability claims after what happens? correct answers 120 days passes,
but the claim then be withdrawn from the liability carrier
What data are required to establish a new MPI entry? correct answers The
patient's full legal name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay
as primary? correct answers Determine the correct payer and notify the
incorrect payer of the processing error
What do EMTALA regulations require on-call physicians to do? correct
answers Personally appear in the emergency department and attend to
the patient within a reasonable time
At the end of each shift, what must happen to cash, checks, and credit card
transaction documents? correct answers They must be balanced
What will cause a CMS 1500 claim to be rejected? correct answers The
provider is billing with a future date of service
