HFMA CRCR STUDY GUIDE COMPREHENSIVE
REVIEW WITH FULL SOLUTIONS AND TESTED
QUESTIONS 2026
◍ 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
REVIEW WITH FULL SOLUTIONS AND TESTED
QUESTIONS 2026
◍ 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
