HFMA CRCR LATEST EXAM 2024\2025
Study online at https://quizlet.com/_h5pvtw
Through what document does a hospital
code of conduct
establish compliance standards?
Identify Acceptable compliance pro-
What is the purpose OIG work plant?
grams in various provider setting
If a Medicare patient is admitted on
Non-diagnostic service provided on
Friday, what services fall within the
Tuesday through Friday
three-day DRG window rule?
Report a specific circumstance that af-
What does a modifier allow a provider to
fected a procedure or service without
do?
changing the code or its definition
IF outpatient diagnostic services are pro-
vided within three days of the admission
of a Medicare beneficiary to an IPPS They must be billed separately to the part
(Inpatient Prospective Payment System) B Carrier
hospital, what must happen to these
charges
One registration record is created for
what is a recurring or series registration?
multiple days of service
What are nonemergency patients who
come for service without prior notification Unscheduled patients
to the provider called?
Which of the following statement apply to It is used to evaluate the need for an
the observation patient type? inpatient admission
which services are hospice programs re-
quired to provide around the clock pa- Physician, Nursing, Pharmacy
tient
Scheduler instructions are used to Complete the scheduling process cor-
prompt the scheduler to do what? rectly based on service requeste
The Time needed to prepare the patient
before service is the difference between
Procedure time
the patients arrival time and which of the
following?
Medicare guidelines require that when a Documentation of the medical necessity
test is ordered for a LCD or NCD exists, for the test
, HFMA CRCR LATEST EXAM 2024\2025
Study online at https://quizlet.com/_h5pvtw
the information provided on the order
must include:
What is the advantage of a pre-registra- It reduces processing times at the time of
tion program service
What date are required to establish a The responsible party's full legal name,
new MPI(Master patient Index) entry date of birth, and social security number
The payments are received by the
Which of the following statements is true provider from the payer responsible for
about third-party payments? reimbursing the provider for the patient's
covered services.
Which provision protects the patient
from medical expenses that exceed the stop loss
pre-set level
what documentation must a primary care
physician send to HMO patient to autho-
Referral
rize a visit to a specialist for additional
testing or care?
Under EMTALA (Emergency Medical
Treatment and Labor Act) regulations,
Medical screening and stabilizing treat-
the provider may not ask about a pa-
ment
tient's insurance information if it would
delay what?
Which of the following is a step in the Have a case management service com-
discharge process? plete the discharge plan
The hospital has a APC based contract
for the payment of outpatient services.
Total anticipated charges for the visit are
To the approved APC payment rate
$2,380. The approved APC payment rate
is $780. Where will the patients benefit
package be applied?
A patient has met the $200 individual
deductible and $900 of the $1000 co-in-
surance responsibility. The co-insurance $100.00
rate is 20%. The estimated insurance
plan responsibility is $1975.00. What
, HFMA CRCR LATEST EXAM 2024\2025
Study online at https://quizlet.com/_h5pvtw
amount of coinsurance is due from the
patient?
The patient's outstanding medical bills
When is a patient considered to be med-
exceed a defined dollar amount or per-
ically indigent?
centage of assets.
Sources of readily available funds , ve-
What patient assets are considered in
hicles, campers, boats and saving ac-
the financial assistance application?
counts
Warn the patient that unpaid accounts
If the patient cannot agree to payment
are placed with collection agencies for
arrangements, What is the next option?
further processing
scheduling , pre-registration, insurance
What core financial activities are re-
verification and managed care process-
solved within patient access?
ing
A patient who arrives at the hospital via
What is an unscheduled direct admis-
ambulance for treatment in the emer-
sion?
gency department
When is it not appropriate to use obser-
As a substitute for an inpatient admission
vation status?
Patients who require periodic skilled
nursing or therapeutic care receive ser- Home health agency
vices from what type of program?
Every patient who is new to the health- A printed copy of the provider privacy
care provider must be offered what? notice
Which of the following statements apples The employer provides a traditional HMO
to self insured insurance plans? health plan
In addition to the member's identification
number, what information is recorded in Name
a 270 transaction
What process does a patient's health
plan use to retroactively collect pay-
Subrogation
ments from liability automobile or work-
er's compensation plan?
Study online at https://quizlet.com/_h5pvtw
Through what document does a hospital
code of conduct
establish compliance standards?
Identify Acceptable compliance pro-
What is the purpose OIG work plant?
grams in various provider setting
If a Medicare patient is admitted on
Non-diagnostic service provided on
Friday, what services fall within the
Tuesday through Friday
three-day DRG window rule?
Report a specific circumstance that af-
What does a modifier allow a provider to
fected a procedure or service without
do?
changing the code or its definition
IF outpatient diagnostic services are pro-
vided within three days of the admission
of a Medicare beneficiary to an IPPS They must be billed separately to the part
(Inpatient Prospective Payment System) B Carrier
hospital, what must happen to these
charges
One registration record is created for
what is a recurring or series registration?
multiple days of service
What are nonemergency patients who
come for service without prior notification Unscheduled patients
to the provider called?
Which of the following statement apply to It is used to evaluate the need for an
the observation patient type? inpatient admission
which services are hospice programs re-
quired to provide around the clock pa- Physician, Nursing, Pharmacy
tient
Scheduler instructions are used to Complete the scheduling process cor-
prompt the scheduler to do what? rectly based on service requeste
The Time needed to prepare the patient
before service is the difference between
Procedure time
the patients arrival time and which of the
following?
Medicare guidelines require that when a Documentation of the medical necessity
test is ordered for a LCD or NCD exists, for the test
, HFMA CRCR LATEST EXAM 2024\2025
Study online at https://quizlet.com/_h5pvtw
the information provided on the order
must include:
What is the advantage of a pre-registra- It reduces processing times at the time of
tion program service
What date are required to establish a The responsible party's full legal name,
new MPI(Master patient Index) entry date of birth, and social security number
The payments are received by the
Which of the following statements is true provider from the payer responsible for
about third-party payments? reimbursing the provider for the patient's
covered services.
Which provision protects the patient
from medical expenses that exceed the stop loss
pre-set level
what documentation must a primary care
physician send to HMO patient to autho-
Referral
rize a visit to a specialist for additional
testing or care?
Under EMTALA (Emergency Medical
Treatment and Labor Act) regulations,
Medical screening and stabilizing treat-
the provider may not ask about a pa-
ment
tient's insurance information if it would
delay what?
Which of the following is a step in the Have a case management service com-
discharge process? plete the discharge plan
The hospital has a APC based contract
for the payment of outpatient services.
Total anticipated charges for the visit are
To the approved APC payment rate
$2,380. The approved APC payment rate
is $780. Where will the patients benefit
package be applied?
A patient has met the $200 individual
deductible and $900 of the $1000 co-in-
surance responsibility. The co-insurance $100.00
rate is 20%. The estimated insurance
plan responsibility is $1975.00. What
, HFMA CRCR LATEST EXAM 2024\2025
Study online at https://quizlet.com/_h5pvtw
amount of coinsurance is due from the
patient?
The patient's outstanding medical bills
When is a patient considered to be med-
exceed a defined dollar amount or per-
ically indigent?
centage of assets.
Sources of readily available funds , ve-
What patient assets are considered in
hicles, campers, boats and saving ac-
the financial assistance application?
counts
Warn the patient that unpaid accounts
If the patient cannot agree to payment
are placed with collection agencies for
arrangements, What is the next option?
further processing
scheduling , pre-registration, insurance
What core financial activities are re-
verification and managed care process-
solved within patient access?
ing
A patient who arrives at the hospital via
What is an unscheduled direct admis-
ambulance for treatment in the emer-
sion?
gency department
When is it not appropriate to use obser-
As a substitute for an inpatient admission
vation status?
Patients who require periodic skilled
nursing or therapeutic care receive ser- Home health agency
vices from what type of program?
Every patient who is new to the health- A printed copy of the provider privacy
care provider must be offered what? notice
Which of the following statements apples The employer provides a traditional HMO
to self insured insurance plans? health plan
In addition to the member's identification
number, what information is recorded in Name
a 270 transaction
What process does a patient's health
plan use to retroactively collect pay-
Subrogation
ments from liability automobile or work-
er's compensation plan?
