HFMA CRCR COMPREHENSIVE EXAM
STUDY GUIDE COMPLETE QUESTIONS AND
SOLUTIONS
●● Self-funded benefit plans may choose to coordinate benefits using
the gender rule or what other rule?
Answer: Birthday
●● In what type of payment methodology is a lump sum or bundled
payment negotiated between the payer and some or all providers?
Answer: Case rates
●● What customer service improvements might improve the patient
accounts department?
Answer: Holding staff accountable for customer service during
performance reviews
●● What is an ABN (Advance Beneficiary Notice of Non-coverage)
required to do?
Answer: Inform a Medicare beneficiary that Medicare may not pay for
the order or service
,●● What type of account adjustment results from the patient's
unwillingness to pay for a self-pay balance?
Answer: Bad debt adjustment
●● What is the initial hospice benefit?
Answer: Two 90-day periods and an unlimited number of subsequent
periods
●● When does a hospital add ambulance charges to the Medicare
inpatient claim?
Answer: If the patient requires ambulance transportation to a skilled
nursing facility
●● How should a provider resolve a late-charge credit posted after an
account is billed?
Answer: Post a late-charge adjustment to the account
●● an increase in the dollars aged greater than 90 days from date of
service indicate what about accounts
Answer: They are not being processed in a timely manner
●● What is an advantage of a preregistration program?
Answer: It reduces processing times at the time of service
, ●● What are the two statutory exclusions from hospice coverage?
Answer: Medically unnecessary services and custodial care
●● What core financial activities are resolved within patient access?
Answer: Scheduling, insurance verification, discharge processing, and
payment of point-of-service receipts
●● What statement applies to the scheduled outpatient?
Answer: The services do not involve an overnight stay
●● How is a mis-posted contractual allowance resolved?
Answer: Comparing the contract reimbursement rates with the contract
on the admittance advice to identify the correct amount
●● What type of patient status is used to evaluate the patient's need for
inpatient care?
Answer: Observation
●● Coverage rules for Medicare beneficiaries receiving skilled nursing
care require that the beneficiary has received what?
Answer: Medically necessary inpatient hospital services for at least 3
consecutive days before the skilled nursing care admission
STUDY GUIDE COMPLETE QUESTIONS AND
SOLUTIONS
●● Self-funded benefit plans may choose to coordinate benefits using
the gender rule or what other rule?
Answer: Birthday
●● In what type of payment methodology is a lump sum or bundled
payment negotiated between the payer and some or all providers?
Answer: Case rates
●● What customer service improvements might improve the patient
accounts department?
Answer: Holding staff accountable for customer service during
performance reviews
●● What is an ABN (Advance Beneficiary Notice of Non-coverage)
required to do?
Answer: Inform a Medicare beneficiary that Medicare may not pay for
the order or service
,●● What type of account adjustment results from the patient's
unwillingness to pay for a self-pay balance?
Answer: Bad debt adjustment
●● What is the initial hospice benefit?
Answer: Two 90-day periods and an unlimited number of subsequent
periods
●● When does a hospital add ambulance charges to the Medicare
inpatient claim?
Answer: If the patient requires ambulance transportation to a skilled
nursing facility
●● How should a provider resolve a late-charge credit posted after an
account is billed?
Answer: Post a late-charge adjustment to the account
●● an increase in the dollars aged greater than 90 days from date of
service indicate what about accounts
Answer: They are not being processed in a timely manner
●● What is an advantage of a preregistration program?
Answer: It reduces processing times at the time of service
, ●● What are the two statutory exclusions from hospice coverage?
Answer: Medically unnecessary services and custodial care
●● What core financial activities are resolved within patient access?
Answer: Scheduling, insurance verification, discharge processing, and
payment of point-of-service receipts
●● What statement applies to the scheduled outpatient?
Answer: The services do not involve an overnight stay
●● How is a mis-posted contractual allowance resolved?
Answer: Comparing the contract reimbursement rates with the contract
on the admittance advice to identify the correct amount
●● What type of patient status is used to evaluate the patient's need for
inpatient care?
Answer: Observation
●● Coverage rules for Medicare beneficiaries receiving skilled nursing
care require that the beneficiary has received what?
Answer: Medically necessary inpatient hospital services for at least 3
consecutive days before the skilled nursing care admission
