HFMA CRCR 2025 UPDATE ACTUAL EXAM WITH FREQUENTLY TESTED
QUESTIONS & VERIFIED ANSWERS WITH RATIONALES 100% ACCURATE &
GRADED A+
Through what document does a hospital establish compliance standards?
code of conduct
What is the purpose OIG work plant?
Identify Acceptable compliance programs in various provider setting
What does scheduling allow provider staff to do?
Review the appropriateness of the service requested
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG
window rule?
Non-diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do?
Report a specific circumstance that affected a procedure or service without changing the code
or its definition
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
They must be billed separately to the part B Carrier
what is a recurring or series registration?
One registration record is created for multiple days of service
What are nonemergency patients who come for service without prior notification to the
provider called?
Unscheduled patients
Which of the following statement apply to the observation patient type?
It is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient
Physician, Nursing, Pharmacy
,What process does a patient's health plan use to retroactively collect payments from liability
automobile or worker's compensation plan?
Subrogation
In what type of payment methodology is a lump sum of bundled payment negotiated
between the payer and some or all providers?
DRG/Case rate
What Restriction does a managed care plan place on locations that must be used if the plan is
to pay for the service provided?
Site of service limitation
Which of the following statements applies to private rooms?
If the medical necessity for a private room is documented in the chart. The patient’s insurance
will be billed for the differential
Which of the following is true about screening a beneficiary of possible MSP (Medicare
secondary payer) situations?
It is necessary to ask the patient each of the MSP questions
Which of the following is not true of Medicare Advantage Plans?
A patient must have both Medicare Part A and B benefits to be eligible for a Medicare
Advantage plan
Which of the following is a valid reason for a payer to deny a claim?
Failure to complete authorization
Which of the following statements is NOT a possible consequence of selecting the wrong
patient in the MPI (master patient index)
Claim is paid in full
Which of the following statements is true of a Medicare Advantage Plan?
This plan supplements Part A and Part B benefits
Which is the following is not a characteristic of Medicaid HMO plan?
Medicaid-eligible patients are never required to join a Medicaid HMO plan
Which of the following is violation of the EMTALA?
, Registration staff members routinely contact managed care plans for prior authorizations before
the patients are seen by the on-duty physician
Which of the following statements is true of the important message from Medicare
notification requirements?
Notification can be issued no earlier than 7 days before admission and no more than 2 days
before discharge.
What is the self-pay balance after insurance
The portion of the adjudicated claim that is due from the patient
Which of the following options is an alternative to valid long term payment plans
Bank loans
The patient has the following benefit plan $400 per family member deductible, to a maximum
of $1200 per year and $2000 per family member co insurance, to a family maximum of $6000
per year excluding the deductible. Five family members are enrolled in this benefit plan. What
is the maximum out of pocket expense that that family could incur during the calendar year?
$6000
What type of plan restricts benefits for non-emergency care to approve providers only?
A POS (point of service) plan
When an adult patient is covered by both his own and his spouse health insurance plan,
which of the statements is true?
The patient’s insurance plan is primary
Mrs. Jones, a Medicare beneficiary was admitted to the hospital on June 20,2010. As of the
admission date, she had only used 8 inpatient days in the current benefit period. If she is not
discharge on what date will Mr. jones exhaust her full coverage days.
August 9, 2010
In order to meet eligibility guidelines for healthcare benefits, Medicaid beneficiaries must fall
into a specified need category and meet what other types of requirements
Income and assets
Fee for service plans pay claims based on a percentage of charges. How are patients out of
pocket cost calculated?
QUESTIONS & VERIFIED ANSWERS WITH RATIONALES 100% ACCURATE &
GRADED A+
Through what document does a hospital establish compliance standards?
code of conduct
What is the purpose OIG work plant?
Identify Acceptable compliance programs in various provider setting
What does scheduling allow provider staff to do?
Review the appropriateness of the service requested
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG
window rule?
Non-diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do?
Report a specific circumstance that affected a procedure or service without changing the code
or its definition
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
They must be billed separately to the part B Carrier
what is a recurring or series registration?
One registration record is created for multiple days of service
What are nonemergency patients who come for service without prior notification to the
provider called?
Unscheduled patients
Which of the following statement apply to the observation patient type?
It is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient
Physician, Nursing, Pharmacy
,What process does a patient's health plan use to retroactively collect payments from liability
automobile or worker's compensation plan?
Subrogation
In what type of payment methodology is a lump sum of bundled payment negotiated
between the payer and some or all providers?
DRG/Case rate
What Restriction does a managed care plan place on locations that must be used if the plan is
to pay for the service provided?
Site of service limitation
Which of the following statements applies to private rooms?
If the medical necessity for a private room is documented in the chart. The patient’s insurance
will be billed for the differential
Which of the following is true about screening a beneficiary of possible MSP (Medicare
secondary payer) situations?
It is necessary to ask the patient each of the MSP questions
Which of the following is not true of Medicare Advantage Plans?
A patient must have both Medicare Part A and B benefits to be eligible for a Medicare
Advantage plan
Which of the following is a valid reason for a payer to deny a claim?
Failure to complete authorization
Which of the following statements is NOT a possible consequence of selecting the wrong
patient in the MPI (master patient index)
Claim is paid in full
Which of the following statements is true of a Medicare Advantage Plan?
This plan supplements Part A and Part B benefits
Which is the following is not a characteristic of Medicaid HMO plan?
Medicaid-eligible patients are never required to join a Medicaid HMO plan
Which of the following is violation of the EMTALA?
, Registration staff members routinely contact managed care plans for prior authorizations before
the patients are seen by the on-duty physician
Which of the following statements is true of the important message from Medicare
notification requirements?
Notification can be issued no earlier than 7 days before admission and no more than 2 days
before discharge.
What is the self-pay balance after insurance
The portion of the adjudicated claim that is due from the patient
Which of the following options is an alternative to valid long term payment plans
Bank loans
The patient has the following benefit plan $400 per family member deductible, to a maximum
of $1200 per year and $2000 per family member co insurance, to a family maximum of $6000
per year excluding the deductible. Five family members are enrolled in this benefit plan. What
is the maximum out of pocket expense that that family could incur during the calendar year?
$6000
What type of plan restricts benefits for non-emergency care to approve providers only?
A POS (point of service) plan
When an adult patient is covered by both his own and his spouse health insurance plan,
which of the statements is true?
The patient’s insurance plan is primary
Mrs. Jones, a Medicare beneficiary was admitted to the hospital on June 20,2010. As of the
admission date, she had only used 8 inpatient days in the current benefit period. If she is not
discharge on what date will Mr. jones exhaust her full coverage days.
August 9, 2010
In order to meet eligibility guidelines for healthcare benefits, Medicaid beneficiaries must fall
into a specified need category and meet what other types of requirements
Income and assets
Fee for service plans pay claims based on a percentage of charges. How are patients out of
pocket cost calculated?
