HFMA CRCR EXAM STUDY GUIDE
HFMA CRCR EXAM STUDY
GUIDE. GRADED A+. QUESTIONS
AND 100% VERIFIED ANSWERS.
LATEST 2025/2026 UPDATE
,HFMA CRCR EXAM STUDY GUIDE
What is the advantage of a pre-registration program - Correct answer-It reduces
processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry -
Correct 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? - Correct
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 - Correct 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? - Correct 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? - Correct answer-Medical screening and stabilizing treatment
Which of the following is a step in the discharge process? - Correct 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? - Correct
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? - Correct answer-$100.00
When is a patient considered to be medically indigent? - Correct 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? -
Correct answer-Sources of readily available funds , vehicles, campers, boats
, HFMA CRCR EXAM STUDY GUIDE
and saving accounts
If the patient cannot agree to payment arrangements, What is the next option? -
Correct answer-Warn the patient that unpaid accounts are placed with collection
agencies for further processing
What core financial activities are resolved within patient access? - Correct
answer- scheduling , pre-registration, insurance verification and managed care
processing
What is an unscheduled direct admission? - Correct answer-A patient who arrives
at the hospital via ambulance for treatment in the emergency department
When is it not appropriate to use observation status? - Correct answer-As a
substitute for an inpatient admission
Patients who require periodic skilled nursing or therapeutic care receive services
from what type of program? - Correct answer-Home health agency
Every patient who is new to the healthcare provider must be offered what? -
Correct answer-A printed copy of the provider privacy notice
Which of the following statements apples to self insured insurance plans? -
Correct answer-The employer provides a traditional HMO health plan
In addition to the member's identification number, what information is recorded
in a 270 transaction - Correct answer-Name
What process does a patient's health plan use to retroactively collect payments
from liability automobile or worker's compensation plan? - Correct answer-
Subrogation
In what type of payment methodology is a lump sum of bundled payment
negotiated between the payer and some or all providers? - Correct answer-
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? - Correct ao fnswer-Site service
limitation
Which of the following statements applies to private rooms? - Correct answer-If
the medical necessity for a private room is documented in the chart. The patients
HFMA CRCR EXAM STUDY
GUIDE. GRADED A+. QUESTIONS
AND 100% VERIFIED ANSWERS.
LATEST 2025/2026 UPDATE
,HFMA CRCR EXAM STUDY GUIDE
What is the advantage of a pre-registration program - Correct answer-It reduces
processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry -
Correct 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? - Correct
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 - Correct 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? - Correct 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? - Correct answer-Medical screening and stabilizing treatment
Which of the following is a step in the discharge process? - Correct 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? - Correct
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? - Correct answer-$100.00
When is a patient considered to be medically indigent? - Correct 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? -
Correct answer-Sources of readily available funds , vehicles, campers, boats
, HFMA CRCR EXAM STUDY GUIDE
and saving accounts
If the patient cannot agree to payment arrangements, What is the next option? -
Correct answer-Warn the patient that unpaid accounts are placed with collection
agencies for further processing
What core financial activities are resolved within patient access? - Correct
answer- scheduling , pre-registration, insurance verification and managed care
processing
What is an unscheduled direct admission? - Correct answer-A patient who arrives
at the hospital via ambulance for treatment in the emergency department
When is it not appropriate to use observation status? - Correct answer-As a
substitute for an inpatient admission
Patients who require periodic skilled nursing or therapeutic care receive services
from what type of program? - Correct answer-Home health agency
Every patient who is new to the healthcare provider must be offered what? -
Correct answer-A printed copy of the provider privacy notice
Which of the following statements apples to self insured insurance plans? -
Correct answer-The employer provides a traditional HMO health plan
In addition to the member's identification number, what information is recorded
in a 270 transaction - Correct answer-Name
What process does a patient's health plan use to retroactively collect payments
from liability automobile or worker's compensation plan? - Correct answer-
Subrogation
In what type of payment methodology is a lump sum of bundled payment
negotiated between the payer and some or all providers? - Correct answer-
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? - Correct ao fnswer-Site service
limitation
Which of the following statements applies to private rooms? - Correct answer-If
the medical necessity for a private room is documented in the chart. The patients
