HFMA CRCR (ACTUAL) EXAM | 170
QUESTIONS AND VERIFIED SOLUTIONS
2025/2026
Through what document does a hospital establish compliance standards?
- ,,,answer,,,..code of conduct
What is the purpose OIG work plant? - ,,,answer,,,..Identify Acceptable
compliance programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the
three-day DRG window rule? - ,,,answer,,,..Non-diagnostic service
provided on Tuesday through Friday
What does a modifier allow a provider to do? - ,,,answer,,,..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 -
,,,answer,,,..They must be billed separately to the part B Carrier
what is a recurring or series registration? - ,,,answer,,,..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? - ,,,answer,,,..Unscheduled patients
Which of the following statement apply to the observation patient type? -
,,,answer,,,..It is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock
patient - ,,,answer,,,..Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? -
,,,answer,,,..Complete the scheduling process correctly based on service
requeste
The Time needed to prepare the patient before service is the difference
between the patients arrival time and which of the following? -
,,,answer,,,..Procedure time
Medicare guidelines require that when a test is ordered for a LCD or NCD
exists, the information provided on the order must include: -
,,,answer,,,..Documentation of the medical necessity for the test
What is the advantage of a pre-registration program - ,,,answer,,,..It
reduces processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry
- ,,,answer,,,..The responsible party's full legal name, date of birth, and
social security number
Which of the following statements is true about third-party payments? -
,,,answer,,,..The payments are received by the provider from the payer
responsible for reimbursing the provider for the patient's covered
services.
, Which provision protects the patient from medical expenses that exceed
the pre-set level - ,,,answer,,,..stop loss
what documentation must a primary care physician send to HMO patient
to authorize a visit to a specialist for additional testing or care? -
,,,answer,,,..Referral
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? - ,,,answer,,,..Medical screening and stabilizing
treatment
Which of the following is a step in the discharge process? -
,,,answer,,,..Have a case management service complete the discharge
plan
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? - ,,,answer,,,..To the approved APC payment rate
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? - ,,,answer,,,..$100.00
When is a patient considered to be medically indigent? - ,,,answer,,,..The
patient's outstanding medical bills exceed a defined dollar amount or
percentage of assets.
What patient assets are considered in the financial assistance
application? - ,,,answer,,,..Sources of readily available funds , vehicles,
campers, boats and saving accounts
QUESTIONS AND VERIFIED SOLUTIONS
2025/2026
Through what document does a hospital establish compliance standards?
- ,,,answer,,,..code of conduct
What is the purpose OIG work plant? - ,,,answer,,,..Identify Acceptable
compliance programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the
three-day DRG window rule? - ,,,answer,,,..Non-diagnostic service
provided on Tuesday through Friday
What does a modifier allow a provider to do? - ,,,answer,,,..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 -
,,,answer,,,..They must be billed separately to the part B Carrier
what is a recurring or series registration? - ,,,answer,,,..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? - ,,,answer,,,..Unscheduled patients
Which of the following statement apply to the observation patient type? -
,,,answer,,,..It is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock
patient - ,,,answer,,,..Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? -
,,,answer,,,..Complete the scheduling process correctly based on service
requeste
The Time needed to prepare the patient before service is the difference
between the patients arrival time and which of the following? -
,,,answer,,,..Procedure time
Medicare guidelines require that when a test is ordered for a LCD or NCD
exists, the information provided on the order must include: -
,,,answer,,,..Documentation of the medical necessity for the test
What is the advantage of a pre-registration program - ,,,answer,,,..It
reduces processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry
- ,,,answer,,,..The responsible party's full legal name, date of birth, and
social security number
Which of the following statements is true about third-party payments? -
,,,answer,,,..The payments are received by the provider from the payer
responsible for reimbursing the provider for the patient's covered
services.
, Which provision protects the patient from medical expenses that exceed
the pre-set level - ,,,answer,,,..stop loss
what documentation must a primary care physician send to HMO patient
to authorize a visit to a specialist for additional testing or care? -
,,,answer,,,..Referral
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? - ,,,answer,,,..Medical screening and stabilizing
treatment
Which of the following is a step in the discharge process? -
,,,answer,,,..Have a case management service complete the discharge
plan
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? - ,,,answer,,,..To the approved APC payment rate
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? - ,,,answer,,,..$100.00
When is a patient considered to be medically indigent? - ,,,answer,,,..The
patient's outstanding medical bills exceed a defined dollar amount or
percentage of assets.
What patient assets are considered in the financial assistance
application? - ,,,answer,,,..Sources of readily available funds , vehicles,
campers, boats and saving accounts
