HFMA CRCR and Practice Exam Test
Bank – 2026/2027 Updated Edition –
Verified Questions and Correct Detailed
Answers | Already Graded A+ |
Guaranteed Pass | Brand New
Version!!!!!!!
Through what document does a hospital establish compliance standards? - CORRECTANSWER
code of conduct
What is the purpose OIG work plant? - CORRECTANSWER 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? - CORRECTANSWER Non-diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do? - CORRECTANSWER 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 - CORRECTANSWER They must be billed separately to the part B Carrier
,what is a recurring or series registration? - CORRECTANSWER 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? - CORRECTANSWER Unscheduled patients
Which of the following statement apply to the observation patient type? - CORRECTANSWER It
is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient -
CORRECTANSWER Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? - CORRECTANSWER
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? - CORRECTANSWER 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: - CORRECTANSWER Documentation of the medical
necessity for the test
What is the advantage of a pre-registration program - CORRECTANSWER It reduces processing
times at the time of service
What date are required to establish a new MPI(Master patient Index) entry - CORRECTANSWER
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? - CORRECTANSWER 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 -
CORRECTANSWER 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? - CORRECTANSWER 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? - CORRECTANSWER Medical
screening and stabilizing treatment
Which of the following is a step in the discharge process? - CORRECTANSWER 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? - CORRECTANSWER 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? - CORRECTANSWER $100.00
When is a patient considered to be medically indigent? - CORRECTANSWER 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? - CORRECTANSWER
Sources of readily available funds , vehicles, campers, boats and saving accounts
Bank – 2026/2027 Updated Edition –
Verified Questions and Correct Detailed
Answers | Already Graded A+ |
Guaranteed Pass | Brand New
Version!!!!!!!
Through what document does a hospital establish compliance standards? - CORRECTANSWER
code of conduct
What is the purpose OIG work plant? - CORRECTANSWER 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? - CORRECTANSWER Non-diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do? - CORRECTANSWER 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 - CORRECTANSWER They must be billed separately to the part B Carrier
,what is a recurring or series registration? - CORRECTANSWER 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? - CORRECTANSWER Unscheduled patients
Which of the following statement apply to the observation patient type? - CORRECTANSWER It
is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient -
CORRECTANSWER Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? - CORRECTANSWER
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? - CORRECTANSWER 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: - CORRECTANSWER Documentation of the medical
necessity for the test
What is the advantage of a pre-registration program - CORRECTANSWER It reduces processing
times at the time of service
What date are required to establish a new MPI(Master patient Index) entry - CORRECTANSWER
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? - CORRECTANSWER 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 -
CORRECTANSWER 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? - CORRECTANSWER 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? - CORRECTANSWER Medical
screening and stabilizing treatment
Which of the following is a step in the discharge process? - CORRECTANSWER 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? - CORRECTANSWER 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? - CORRECTANSWER $100.00
When is a patient considered to be medically indigent? - CORRECTANSWER 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? - CORRECTANSWER
Sources of readily available funds , vehicles, campers, boats and saving accounts
