CRCR Exam Prep, Multiple Choice, Certified
Revenue Cycle Representative (2025/2026) -
Materials from HFMA EXAM 2025 UPDATE
Verified Questions And Answers | Guaranteed
Success!!
In what situation(s) should a provider NOT use a modifier? - CORRECT ANSWERS - CPT already
indicates 2-4 lesions
- CPT indicates multiple extremities
What are other names for Three-Day Payment Window? - CORRECT ANSWERS ALL OF THE
ABOVE
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
What happens during the post-service stage? - CORRECT ANSWERS Final coding, preparation
and submission of claims, payment processing, balance billing and resolution.
What are the below tasks part of?
- Educate patients
- Coordinate to avoid duplicate patient contacts
- Be consistent in key aspects of account resolution
- Follow best practices for communication - CORRECT ANSWERS Best practices created by the
Medical Debt Task Force
Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle initiative? - CORRECT
ANSWERS Process Compliance
,Which option is NOT a continuum of care provider?
A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility - CORRECT ANSWERS B. Health Plan Contracting
What is "implied certification"? - CORRECT ANSWERS When it is implied that a provider met all
compliance standards before submitting a claim
Which of the following are essential elements of an effective compliance program?
A. Established compliance standards and procedures.
B. Designation of a compliance officer employed within the Billing Department.
C. Oversight of personnel by high-level personnel.
D. Automatic dismissal of any employee excluded from participation in a federal healthcare program.
E. Reasonable methods to achieve compliance with standards, including monitoring systems and
hotlines. - CORRECT ANSWERS A. Established compliance standards and procedures.
C. Oversight of personnel by high-level personnel.
E. Reasonable methods to achieve compliance with standards, including monitoring systems and
hotlines.
When was Health Information Technology for Economic and Clinical Health (HITECH) Act signed into
law? - CORRECT ANSWERS FEB 17, 2009
,When did HITECH Act become effective? - CORRECT ANSWERS 2013
Annually, the OIG publishes a work plan of compliance issues and objectives that will be focused on
throughout the following year. Identify which option is NOT a work plan task mentioned in this course.
A. Payments to Physicians for Co-Surgery Procedures
B. Denials and Appeals in Medicare Part D
C. Medicare Hospital Payments for Claims Involving the Acute- and Post-Acute-Care Transfer Policies
D. Standard Unique Employer Identifier - CORRECT ANSWERS D. Standard Unique Employer
Identifier
What Plan are the tasks below a part of?
- Medicare Payments Made Outside of the Hospice Benefit
- Denials and Appeals in Medicare Part C and Part D
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits - CORRECT ANSWERS
The 2020 OIG Work Plan
When was the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act signed
into law? - CORRECT ANSWERS JUNE 25 2010
What is the Medicare DRG Three-Day Payment Window? - CORRECT ANSWERS All Diagnostic
services provided to a Medicare patient by a hospital on the Date of the patient's Inpatient admission or
during the 3 calendar days (or in the case of a non-IPPS hospital: 1 calendar day) immediately BEFORE
the Date of Admission are REQUIRED to be included on the bill for the IP stay (unless there is no Part A
coverage)
, Do Outpatient Non-Diagnostic Services qualify for separate payments if provided with the Three-Day
Payment Window? - CORRECT ANSWERS No
What is modifier 59? - CORRECT ANSWERS Used to identify CPTs OTHER THAN E&M services,
NOT normally reported together, but are appropriate under the circumstances.
Documentation must support a different session, different procedure or surgery, different site or organ
system, separate.
What is condition code 51? - CORRECT ANSWERS Code noted on the separate UB-04 OP claim,
thus indicating the charge is unrelated to the admission.
What kind of hospitals are the following:
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's hospitals for examples -
CORRECT ANSWERS Non-IPPS hospitals
What are the 3 types of medical necessity screenings and noncoverage notifications required in the
Medicare program? - CORRECT ANSWERS 1. Advanced Beneficiary Notice of Noncoverage
(ABN) for Part B services.
2. SNF ABN for Part A SNF services.
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
What is Medicare Part B ABN? - CORRECT ANSWERS Used to explain to a Medicare patient
that the ordered test or services probably WILL NOT be covered by the Medicare b/c the DX info
provided by the Dr. does NOT support the need for these services.
Revenue Cycle Representative (2025/2026) -
Materials from HFMA EXAM 2025 UPDATE
Verified Questions And Answers | Guaranteed
Success!!
In what situation(s) should a provider NOT use a modifier? - CORRECT ANSWERS - CPT already
indicates 2-4 lesions
- CPT indicates multiple extremities
What are other names for Three-Day Payment Window? - CORRECT ANSWERS ALL OF THE
ABOVE
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
What happens during the post-service stage? - CORRECT ANSWERS Final coding, preparation
and submission of claims, payment processing, balance billing and resolution.
What are the below tasks part of?
- Educate patients
- Coordinate to avoid duplicate patient contacts
- Be consistent in key aspects of account resolution
- Follow best practices for communication - CORRECT ANSWERS Best practices created by the
Medical Debt Task Force
Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle initiative? - CORRECT
ANSWERS Process Compliance
,Which option is NOT a continuum of care provider?
A. Physician
B. Health Plan Contracting
C. Hospice
D. Skilled Nursing Facility - CORRECT ANSWERS B. Health Plan Contracting
What is "implied certification"? - CORRECT ANSWERS When it is implied that a provider met all
compliance standards before submitting a claim
Which of the following are essential elements of an effective compliance program?
A. Established compliance standards and procedures.
B. Designation of a compliance officer employed within the Billing Department.
C. Oversight of personnel by high-level personnel.
D. Automatic dismissal of any employee excluded from participation in a federal healthcare program.
E. Reasonable methods to achieve compliance with standards, including monitoring systems and
hotlines. - CORRECT ANSWERS A. Established compliance standards and procedures.
C. Oversight of personnel by high-level personnel.
E. Reasonable methods to achieve compliance with standards, including monitoring systems and
hotlines.
When was Health Information Technology for Economic and Clinical Health (HITECH) Act signed into
law? - CORRECT ANSWERS FEB 17, 2009
,When did HITECH Act become effective? - CORRECT ANSWERS 2013
Annually, the OIG publishes a work plan of compliance issues and objectives that will be focused on
throughout the following year. Identify which option is NOT a work plan task mentioned in this course.
A. Payments to Physicians for Co-Surgery Procedures
B. Denials and Appeals in Medicare Part D
C. Medicare Hospital Payments for Claims Involving the Acute- and Post-Acute-Care Transfer Policies
D. Standard Unique Employer Identifier - CORRECT ANSWERS D. Standard Unique Employer
Identifier
What Plan are the tasks below a part of?
- Medicare Payments Made Outside of the Hospice Benefit
- Denials and Appeals in Medicare Part C and Part D
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits - CORRECT ANSWERS
The 2020 OIG Work Plan
When was the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act signed
into law? - CORRECT ANSWERS JUNE 25 2010
What is the Medicare DRG Three-Day Payment Window? - CORRECT ANSWERS All Diagnostic
services provided to a Medicare patient by a hospital on the Date of the patient's Inpatient admission or
during the 3 calendar days (or in the case of a non-IPPS hospital: 1 calendar day) immediately BEFORE
the Date of Admission are REQUIRED to be included on the bill for the IP stay (unless there is no Part A
coverage)
, Do Outpatient Non-Diagnostic Services qualify for separate payments if provided with the Three-Day
Payment Window? - CORRECT ANSWERS No
What is modifier 59? - CORRECT ANSWERS Used to identify CPTs OTHER THAN E&M services,
NOT normally reported together, but are appropriate under the circumstances.
Documentation must support a different session, different procedure or surgery, different site or organ
system, separate.
What is condition code 51? - CORRECT ANSWERS Code noted on the separate UB-04 OP claim,
thus indicating the charge is unrelated to the admission.
What kind of hospitals are the following:
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's hospitals for examples -
CORRECT ANSWERS Non-IPPS hospitals
What are the 3 types of medical necessity screenings and noncoverage notifications required in the
Medicare program? - CORRECT ANSWERS 1. Advanced Beneficiary Notice of Noncoverage
(ABN) for Part B services.
2. SNF ABN for Part A SNF services.
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
What is Medicare Part B ABN? - CORRECT ANSWERS Used to explain to a Medicare patient
that the ordered test or services probably WILL NOT be covered by the Medicare b/c the DX info
provided by the Dr. does NOT support the need for these services.
