HFMA Study Guide Exam Questions and
Answers with Verified Solutions | Latest
Updated 2026
Through what document does a Code of Conduct
hospital establish compliance
standards?
What is the purpose of the OIG Communicate issues that will be reviewed
work during
plan? the year for compliance with Medicare
regulations
If a Medicare patient is admitted Diagnostic services and related charges
on provided
Friday, what services fall within the on the Wednesday, Thursday and Friday
three-day DRG window rule? before
admission
What does a modifier allow a Report a specific circumstance that
provider to do? affected a
procedure or service without changing the
code or
its definition
,If outpatient diagnostic services They must be combined with the inpatient
are bill and
provided within three days of the paid under the MS-DRG (diagnosis-related
admission of a Medicare group)
beneficiary system
to an IPPS (Inpatient Prospective
Payment System) hospital, what
must
happen to these charges?
Why is the OIG (Office of It reviews Medicare payments for
Inspector beneficiaries who
General) pursuing the Medicare have other insurance and assesses the
Secondary Payer (MSP) initiative? effectiveness of procedures in preventing
inappropriate Medicare payments for
beneficiaries
with other insurance coverage
What is a recurring or series One registration record is created for
registration? multiple days
of service
What are non-emergency patients Unscheduled patients
who come for service without prior
notification to the provider called?
Which of the following statements It is used to evaluate the need for an
apply to the observation patient inpatient
type? admission
, Which services are hospice Physician, nursing, and pharmacy
programs required to provide on
an
around-the-clock basis?
What is the purpose of the initial Identify the correct patient in the provider's
step database or add the patient to the
in the outpatient testing scheduling database
process?
Scheduler instructions are used to Complete the scheduling process correctly
prompt the scheduler to do what? based
on service requested
The time needed to prepare the Schedule time
patient before service is the
difference between the patient's
arrival time and which of the
following?
Medicare guidelines require that Documentation of the medical necessity
when a test is ordered for which for the
an test
LCD (local coverage
determination)
or NCD (national coverage
determination) exists, the
information
provided on the order must include
which of the following?
What is an advantage of a It reduces processing times at the time of
preregistration program? service
Answers with Verified Solutions | Latest
Updated 2026
Through what document does a Code of Conduct
hospital establish compliance
standards?
What is the purpose of the OIG Communicate issues that will be reviewed
work during
plan? the year for compliance with Medicare
regulations
If a Medicare patient is admitted Diagnostic services and related charges
on provided
Friday, what services fall within the on the Wednesday, Thursday and Friday
three-day DRG window rule? before
admission
What does a modifier allow a Report a specific circumstance that
provider to do? affected a
procedure or service without changing the
code or
its definition
,If outpatient diagnostic services They must be combined with the inpatient
are bill and
provided within three days of the paid under the MS-DRG (diagnosis-related
admission of a Medicare group)
beneficiary system
to an IPPS (Inpatient Prospective
Payment System) hospital, what
must
happen to these charges?
Why is the OIG (Office of It reviews Medicare payments for
Inspector beneficiaries who
General) pursuing the Medicare have other insurance and assesses the
Secondary Payer (MSP) initiative? effectiveness of procedures in preventing
inappropriate Medicare payments for
beneficiaries
with other insurance coverage
What is a recurring or series One registration record is created for
registration? multiple days
of service
What are non-emergency patients Unscheduled patients
who come for service without prior
notification to the provider called?
Which of the following statements It is used to evaluate the need for an
apply to the observation patient inpatient
type? admission
, Which services are hospice Physician, nursing, and pharmacy
programs required to provide on
an
around-the-clock basis?
What is the purpose of the initial Identify the correct patient in the provider's
step database or add the patient to the
in the outpatient testing scheduling database
process?
Scheduler instructions are used to Complete the scheduling process correctly
prompt the scheduler to do what? based
on service requested
The time needed to prepare the Schedule time
patient before service is the
difference between the patient's
arrival time and which of the
following?
Medicare guidelines require that Documentation of the medical necessity
when a test is ordered for which for the
an test
LCD (local coverage
determination)
or NCD (national coverage
determination) exists, the
information
provided on the order must include
which of the following?
What is an advantage of a It reduces processing times at the time of
preregistration program? service
