HFMA CRCR EXAM STUDY GUIDE 2026
PRACTICE QUESTIONS AND SOLUTIONS
◉Self-funded benefit plans may choose to coordinate benefits using the
gender rule or what other rule? Answer: Birthday
◉In what type of payment methodology is a lump sum or bundled
payment negotiated between the payer and some or all providers?
Answer: Case rates
◉What customer service improvements might improve the patient
accounts department? Answer: Holding staff accountable for customer
service during performance reviews
◉What is an ABN (Advance Beneficiary Notice of Non-coverage)
required to do? Answer: 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? Answer: Bad debt
adjustment
,◉What is the initial hospice benefit? Answer: Two 90-day periods and
an unlimited number of subsequent periods
◉When does a hospital add ambulance charges to the Medicare
inpatient claim? Answer: 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? Answer: 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 Answer: They are not being
processed in a timely manner
◉What is an advantage of a preregistration program? Answer: It
reduces processing times at the time of service
◉What are the two statutory exclusions from hospice coverage?
Answer: Medically unnecessary services and custodial care
◉What core financial activities are resolved within patient access?
Answer: Scheduling, insurance verification, discharge processing, and
payment of point-of-service receipts
,◉What statement applies to the scheduled outpatient? Answer: The
services do not involve an overnight stay
◉How is a mis-posted contractual allowance resolved? Answer:
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? Answer: Observation
◉Coverage rules for Medicare beneficiaries receiving skilled nursing
care require that the beneficiary has received what? Answer: 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$? Answer: When the patient is the insured
◉What are non-emergency patients who come for service without prior
notification to the provider called? Answer: Unscheduled patients
◉If the insurance verification response reports that a subscriber has a
single policy, what is the status of the subscriber's spouse? Answer:
Neither enrolled not entitled to benefits
, ◉Regulation Z of the Consumer Credit Protection Act, also known as
the Truth in Lending Act, establishes what? Answer: Disclosure rules
for consumer credit sales and consumer loans
◉What is a principal diagnosis? Answer: Primary reason for the
patient's admission
◉Collecting patient liability dollars after service leads to what?
Answer: Lower accounts receivable levels
◉What is the daily out-of-pocket amount for each lifetime reserve day
used? Answer: 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? Answer: Inpatient care
◉What code indicates the disposition of the patient at the conclusion of
service? Answer: Patient discharge status code
◉What are hospitals required to do for Medicare credit balance
accounts? Answer: They result in lost reimbursement and additional
cost to collect
PRACTICE QUESTIONS AND SOLUTIONS
◉Self-funded benefit plans may choose to coordinate benefits using the
gender rule or what other rule? Answer: Birthday
◉In what type of payment methodology is a lump sum or bundled
payment negotiated between the payer and some or all providers?
Answer: Case rates
◉What customer service improvements might improve the patient
accounts department? Answer: Holding staff accountable for customer
service during performance reviews
◉What is an ABN (Advance Beneficiary Notice of Non-coverage)
required to do? Answer: 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? Answer: Bad debt
adjustment
,◉What is the initial hospice benefit? Answer: Two 90-day periods and
an unlimited number of subsequent periods
◉When does a hospital add ambulance charges to the Medicare
inpatient claim? Answer: 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? Answer: 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 Answer: They are not being
processed in a timely manner
◉What is an advantage of a preregistration program? Answer: It
reduces processing times at the time of service
◉What are the two statutory exclusions from hospice coverage?
Answer: Medically unnecessary services and custodial care
◉What core financial activities are resolved within patient access?
Answer: Scheduling, insurance verification, discharge processing, and
payment of point-of-service receipts
,◉What statement applies to the scheduled outpatient? Answer: The
services do not involve an overnight stay
◉How is a mis-posted contractual allowance resolved? Answer:
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? Answer: Observation
◉Coverage rules for Medicare beneficiaries receiving skilled nursing
care require that the beneficiary has received what? Answer: 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$? Answer: When the patient is the insured
◉What are non-emergency patients who come for service without prior
notification to the provider called? Answer: Unscheduled patients
◉If the insurance verification response reports that a subscriber has a
single policy, what is the status of the subscriber's spouse? Answer:
Neither enrolled not entitled to benefits
, ◉Regulation Z of the Consumer Credit Protection Act, also known as
the Truth in Lending Act, establishes what? Answer: Disclosure rules
for consumer credit sales and consumer loans
◉What is a principal diagnosis? Answer: Primary reason for the
patient's admission
◉Collecting patient liability dollars after service leads to what?
Answer: Lower accounts receivable levels
◉What is the daily out-of-pocket amount for each lifetime reserve day
used? Answer: 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? Answer: Inpatient care
◉What code indicates the disposition of the patient at the conclusion of
service? Answer: Patient discharge status code
◉What are hospitals required to do for Medicare credit balance
accounts? Answer: They result in lost reimbursement and additional
cost to collect
