HFMA CRCR ACTUAL EXAM LATEST 2024/2025 WITH
QUESTIONS AND VERIFIED CORRECT ANSWERS/ALREADY
GRADED A++
What type of patient status is used to evaluate the patients 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.
When is the word "SAME" entered on the CMS 1500 billing form in field 0 -
ANSWER When the patient is insured
If the insurance verification response reports that a subscriber has a single
policy, what is the status of the subscriber's spouse? - ANSWER Neither
enrolled not entitled to benefits
Regulation Z of the consumer Credit Protection Act, also known as the
Truth in lending Act establishes what? - ANSWER Disclosure rules for
consumer credit sales and consumer loans
What is a principle diagnosis? - ANSWER Primary reason for the patient’s
admission
Collecting patient liability dollars after service leads to what? - ANSWER
Lower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used?
- ANSWER 50% of the current deductible amount
What service provided to a Medicare beneficiary in a rural health
clinic(RHC) is not billable as an RHC service? - ANSWER Inpatient care
What code indicates the disposition of the patient at the conclusion of
service? - ANSWER Patient discharge status code
,What are hospitals required to do for Medicare credit balance accounts? -
ANSWER They result in lost reimbursement and additional cost to collect.
When an undue delay of payment results from a dispute between the
patient and the third party payer, who is responsible for payment? -
ANSWER Patient
With advances in internet security and encryption, revenue-cycle processes
are expanding to allow patients to do what? - ANSWER Access their
information and perform functions on-line
What date is required on all CMS 1500 claim forms? - ANSWER onset date
of current illness
What code is used to report the provider's most common semiprivate room
rate? - ANSWER Condition code
Regulations and requirements for coding accountable care organizations
which allows providers to begin creating these organizations were finalized
in - ANSWER 2012
What is a primary responsibility of the recover audit contractor? - ANSWER
To correctly identify proper payments for Medicare part A and B claims
How must providers handle credit balances? - ANSWER Comply with state
statutes concerning reporting credit balance
What activities are completed when a scheduled pre-registered patient
arrives for service? - ANSWER Registering the patient and directing the
patient to the service area
In addition to being supported by information found in the patient’s chart, a
CMS 1500 claim must be coded using what? - ANSWER HCPCS
What results from a denied claim? - ANSWER The provider incurs rework
and appeal costs
What Is a Common Billing Issue with Hospital-Based Physicians? -
ANSWER They are not contracted with the patient's health plan to provide
services
,What Are Collection Agency Fees Based On? - ANSWER A percentage of
dollars collected
What Are the Two Statutory Exclusions from Hospice Coverage? -
ANSWER Medically Unnecessary services and custodial care
What Is a Principle Diagnosis? - ANSWER Primary reason for the patient's
admission
What Results from a Denied Claim? - ANSWER The provider incurs rework
and appeal costs.
Pre-Service patient experience - ANSWER Scheduling, Pre-reg, insurance
verification,
pre-certification, price estimation, financial counseling, cashiering
(scheduled patients)
Time of service patient experience - ANSWER Arrival, validation and
activation, financial clearance, patient care delivery, clinical documentation
and revenue recognition, case/referral management. (scheduled and
unscheduled patients)
Post-service patient experience - ANSWER Claim processing, remittance
processing, denial processing, payer payment analysis, third-[arty follow
up, customer service, self-pay collection, collection agency. (after patient
discharge)
Healthcare dollars and sense - ANSWER Name given to ID 3 HFMA
revenue cycle initiatives: Financial counseling, price transparency, and
medical account resolution
Price transparency best practice - ANSWER ACA allows for open market
insurance with clear pricing info. Patient needs price transparency in
healthcare and a consumer guide with pricing information (1.2)
Consents are signed as part of the post-service process, true or false? -
ANSWER False
, In what manner do case managers assist revenue cycle staff? - ANSWER
By providing assistance with written appeals to health plans related to
utilization and other care issues
The importance of medical records maintained by HIM is that the patient
records: - ANSWER Are the primary source for clinical data required for
reimbursement by health plans and liability payers
Important Revenue Cycle Activities in the pre-service stage include: -
ANSWER Obtaining or updating patient and guarantor information
In the pre-service stage, the cost of the schedule services is identified and
the patient's health plan and benefits are used to calculate: - ANSWER The
amount the patient may be expected to pay after insurance.
The disadvantage of outsourcing includes all, of the following Except -
ANSWER Reduces internal staffing costs and a reliance on outsourced
staff.
Marinating routine contact with health plan or liability payer, making sure all
required information is provided and all needed approvals are obtained is
the responsibility of who: - ANSWER Case Management
A claim is denied for the following reasons EXCEPT: - ANSWER The
submitted claim does not have the physician signature
All Hospitals are required to establish a written financial assistance policy
that applies to: - ANSWER All emergency and medically necessary care
Examples of ethics violation that impact the revenue cycle include all of the
following EXCEPT: - ANSWER Seeking payment options for self-pay
Verbal orders from a physician for a service(s) are: - ANSWER Acceptable
if given to "qualified" staff as defined in a hospitals policies and procedures
Medicare has established guidelines called Local Coverage Determination
(LCD) and National Coverage Determination (NCD) that establish: -
ANSWER What serviced or healthcare items are covered under Medicare?
QUESTIONS AND VERIFIED CORRECT ANSWERS/ALREADY
GRADED A++
What type of patient status is used to evaluate the patients 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.
When is the word "SAME" entered on the CMS 1500 billing form in field 0 -
ANSWER When the patient is insured
If the insurance verification response reports that a subscriber has a single
policy, what is the status of the subscriber's spouse? - ANSWER Neither
enrolled not entitled to benefits
Regulation Z of the consumer Credit Protection Act, also known as the
Truth in lending Act establishes what? - ANSWER Disclosure rules for
consumer credit sales and consumer loans
What is a principle diagnosis? - ANSWER Primary reason for the patient’s
admission
Collecting patient liability dollars after service leads to what? - ANSWER
Lower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used?
- ANSWER 50% of the current deductible amount
What service provided to a Medicare beneficiary in a rural health
clinic(RHC) is not billable as an RHC service? - ANSWER Inpatient care
What code indicates the disposition of the patient at the conclusion of
service? - ANSWER Patient discharge status code
,What are hospitals required to do for Medicare credit balance accounts? -
ANSWER They result in lost reimbursement and additional cost to collect.
When an undue delay of payment results from a dispute between the
patient and the third party payer, who is responsible for payment? -
ANSWER Patient
With advances in internet security and encryption, revenue-cycle processes
are expanding to allow patients to do what? - ANSWER Access their
information and perform functions on-line
What date is required on all CMS 1500 claim forms? - ANSWER onset date
of current illness
What code is used to report the provider's most common semiprivate room
rate? - ANSWER Condition code
Regulations and requirements for coding accountable care organizations
which allows providers to begin creating these organizations were finalized
in - ANSWER 2012
What is a primary responsibility of the recover audit contractor? - ANSWER
To correctly identify proper payments for Medicare part A and B claims
How must providers handle credit balances? - ANSWER Comply with state
statutes concerning reporting credit balance
What activities are completed when a scheduled pre-registered patient
arrives for service? - ANSWER Registering the patient and directing the
patient to the service area
In addition to being supported by information found in the patient’s chart, a
CMS 1500 claim must be coded using what? - ANSWER HCPCS
What results from a denied claim? - ANSWER The provider incurs rework
and appeal costs
What Is a Common Billing Issue with Hospital-Based Physicians? -
ANSWER They are not contracted with the patient's health plan to provide
services
,What Are Collection Agency Fees Based On? - ANSWER A percentage of
dollars collected
What Are the Two Statutory Exclusions from Hospice Coverage? -
ANSWER Medically Unnecessary services and custodial care
What Is a Principle Diagnosis? - ANSWER Primary reason for the patient's
admission
What Results from a Denied Claim? - ANSWER The provider incurs rework
and appeal costs.
Pre-Service patient experience - ANSWER Scheduling, Pre-reg, insurance
verification,
pre-certification, price estimation, financial counseling, cashiering
(scheduled patients)
Time of service patient experience - ANSWER Arrival, validation and
activation, financial clearance, patient care delivery, clinical documentation
and revenue recognition, case/referral management. (scheduled and
unscheduled patients)
Post-service patient experience - ANSWER Claim processing, remittance
processing, denial processing, payer payment analysis, third-[arty follow
up, customer service, self-pay collection, collection agency. (after patient
discharge)
Healthcare dollars and sense - ANSWER Name given to ID 3 HFMA
revenue cycle initiatives: Financial counseling, price transparency, and
medical account resolution
Price transparency best practice - ANSWER ACA allows for open market
insurance with clear pricing info. Patient needs price transparency in
healthcare and a consumer guide with pricing information (1.2)
Consents are signed as part of the post-service process, true or false? -
ANSWER False
, In what manner do case managers assist revenue cycle staff? - ANSWER
By providing assistance with written appeals to health plans related to
utilization and other care issues
The importance of medical records maintained by HIM is that the patient
records: - ANSWER Are the primary source for clinical data required for
reimbursement by health plans and liability payers
Important Revenue Cycle Activities in the pre-service stage include: -
ANSWER Obtaining or updating patient and guarantor information
In the pre-service stage, the cost of the schedule services is identified and
the patient's health plan and benefits are used to calculate: - ANSWER The
amount the patient may be expected to pay after insurance.
The disadvantage of outsourcing includes all, of the following Except -
ANSWER Reduces internal staffing costs and a reliance on outsourced
staff.
Marinating routine contact with health plan or liability payer, making sure all
required information is provided and all needed approvals are obtained is
the responsibility of who: - ANSWER Case Management
A claim is denied for the following reasons EXCEPT: - ANSWER The
submitted claim does not have the physician signature
All Hospitals are required to establish a written financial assistance policy
that applies to: - ANSWER All emergency and medically necessary care
Examples of ethics violation that impact the revenue cycle include all of the
following EXCEPT: - ANSWER Seeking payment options for self-pay
Verbal orders from a physician for a service(s) are: - ANSWER Acceptable
if given to "qualified" staff as defined in a hospitals policies and procedures
Medicare has established guidelines called Local Coverage Determination
(LCD) and National Coverage Determination (NCD) that establish: -
ANSWER What serviced or healthcare items are covered under Medicare?
