HFMA CRCR Questions with Detailed Verified Answers

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HFMA CRCR Questions with Detailed
Verified Answers

Question: Through what document does a hospital establish compliance
standards?


Ans: code of conduct


Question: What is the purpose OIG work plant?


Ans: Identify Acceptable compliance programs in various provider setting


Question: If a Medicare patient is admitted on Friday, what services fall
within the three-day DRG window rule?


Ans: Non-diagnostic service provided on Tuesday through Friday


Question: What does a modifier allow a provider to do?


Ans: Report a specific circumstance that affected a procedure or service
without changing the code or its definition


Question: 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

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Ans: They must be billed separately to the part B Carrier


Question: what is a recurring or series registration?


Ans: One registration record is created for multiple days of service


Question: What are nonemergency patients who come for service without
prior notification to the provider called?


Ans: Unscheduled patients


Question: Which of the following statement apply to the observation patient
type?


Ans: It is used to evaluate the need for an inpatient admission


Question: which services are hospice programs required to provide around
the clock patient


Ans: Physician, Nursing, Pharmacy


Question: Scheduler instructions are used to prompt the scheduler to do
what?


Ans: Complete the scheduling process correctly based on service requeste


Question: The Time needed to prepare the patient before service is the
difference between the patients arrival time and which of the following?

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Ans: Procedure time


Question: Medicare guidelines require that when a test is ordered for a LCD
or NCD exists, the information provided on the order must include:


Ans: Documentation of the medical necessity for the test


Question: What is the advantage of a pre-registration program


Ans: It reduces processing times at the time of service


Question: What date are required to establish a new MPI(Master patient
Index) entry


Ans: The responsible party's full legal name, date of birth, and social security
number


Question: Which of the following statements is true about third-party
payments?


Ans: The payments are received by the provider from the payer responsible
for reimbursing the provider for the patient's covered services.


Question: Which provision protects the patient from medical expenses that
exceed the pre-set level


Ans: stop loss

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Question: what documentation must a primary care physician send to HMO
patient to authorize a visit to a specialist for additional testing or care?


Ans: Referral


Question: 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?


Ans: Medical screening and stabilizing treatment


Question: Which of the following is a step in the discharge process?


Ans: Have a case management service complete the discharge plan


Question: 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?


Ans: To the approved APC payment rate


Question: 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?


Ans: $100.00