HFMA CRCR EXAM LATEST EXAM 500+ QUESTIONS
AND CORRECT ANSWERS(VERIFIED ANSWERS)
Sue Smith came into the hospital. Her insurance provider sent an EFT directly into the
hospital's account at the bank. John, the hospital representative, receives an electronic
Level 2 ERA. What should he do next? - ANSWERS-**A. Manually match the ERA to
the patient account.
B. Nothing unless there is an error.
What is EFT? - ANSWERS-**A. The electronic transfer of funds from payer to payee
through the banking system.
B. The establishment of internal audits by personnel outside the involved department.
C. A standardized healthcare claim payment/advice known as the 835 format.
D. A process that requires the separation of duties when processing patient payments.
Which statement is false regarding credit balances? - ANSWERS-A. A small credit
policy should be matched by a similar policy for small debit balances.
B. Tracking reports should be developed to identify internal charge credits versus
external charge credits.
C. Hospital generated statements should be sent to patients regarding small credit
balances.
**D. There are no CMS hospital compliance requirements regarding credit balances.
Which option is NOT a type of denial? - ANSWERS-A. Technical
B. Clinical
C. Underpayment
**D. Contractual Adjustment
Which option is NOT a lien type? - ANSWERS-A. Judicial
**B. Subrogation
C. Statutory
D. Agreement (Consensus)
Based on what you have just read, which activity is not considered when initiating self-
pay follow-up and account resolution activities? - ANSWERS-A. Poverty Guidelines
B. Financial Profile
C. Presumptive Financial Assistance Determination
**D. Patient Open Balance Billing
What are collection agency fees based on? - ANSWERS-A percentage of dollars
collected
,Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? - ANSWERS-Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - ANSWERS-Case rates
What customer service improvements might improve the patient accounts department?
- ANSWERS-Holding staff accountable for customer service during performance
reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
ANSWERS-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? - ANSWERS-Bad debt adjustment
What is the initial hospice benefit? - ANSWERS-Two 90-day periods and an unlimited
number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -
ANSWERS-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? -
ANSWERS-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 - ANSWERS-They are not being processed in a timely manner
What is an advantage of a preregistration program? - ANSWERS-It reduces processing
times at the time of service
What are the two statutory exclusions from hospice coverage? - ANSWERS-Medically
unnecessary services and custodial care
What core financial activities are resolved within patient access? - ANSWERS-
Scheduling, insurance verification, discharge processing, and payment of point-of-
service receipts
What statement applies to the scheduled outpatient? - ANSWERS-The services do not
involve an overnight stay
How is a mis-posted contractual allowance resolved? - ANSWERS-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? -
ANSWERS-Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - ANSWERS-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$? -
ANSWERS-When the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - ANSWERS-Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what
is the status of the subscriber's spouse? - ANSWERS-Neither enrolled not entitled to
benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - ANSWERS-Disclosure rules for consumer credit sales and
consumer loans
What is a principal diagnosis? - ANSWERS-Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - ANSWERS-Lower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? -
ANSWERS-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 services? - ANSWERS-Inpatient care
What code indicates the disposition of the patient at the conclusion of service? -
ANSWERS-Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - ANSWERS-
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? - ANSWERS-Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - ANSWERS-A valid CPT or HCPCS
code
, With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - ANSWERS-Access their information and
perform functions on-line
What date is required on all CMS 1500 claim forms? - ANSWERS-onset date of current
illness
What does scheduling allow provider staff to do - ANSWERS-Review appropriateness
of the service request
What code is used to report the provider's most common semiprivate room rate? -
ANSWERS-Condition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: - ANSWERS-2012
What is a primary responsibility of the Recover Audit Contractor? - ANSWERS-To
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - ANSWERS-Comply with state statutes
concerning reporting credit balance
Insurance verification results in what? - ANSWERS-The accurate identification of the
patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - ANSWERS-CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for
service? - ANSWERS-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? - ANSWERS-HCPCS (Healthcare Common
Procedure Coding system)
What results from a denied claim? - ANSWERS-The provider incurs rework and appeal
costs
Why does the financial counselor need pricing for services? - ANSWERS-To calculate
the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - ANSWERS-
Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? - ANSWERS-Appeal
conditions specified in the individual payer's contract
AND CORRECT ANSWERS(VERIFIED ANSWERS)
Sue Smith came into the hospital. Her insurance provider sent an EFT directly into the
hospital's account at the bank. John, the hospital representative, receives an electronic
Level 2 ERA. What should he do next? - ANSWERS-**A. Manually match the ERA to
the patient account.
B. Nothing unless there is an error.
What is EFT? - ANSWERS-**A. The electronic transfer of funds from payer to payee
through the banking system.
B. The establishment of internal audits by personnel outside the involved department.
C. A standardized healthcare claim payment/advice known as the 835 format.
D. A process that requires the separation of duties when processing patient payments.
Which statement is false regarding credit balances? - ANSWERS-A. A small credit
policy should be matched by a similar policy for small debit balances.
B. Tracking reports should be developed to identify internal charge credits versus
external charge credits.
C. Hospital generated statements should be sent to patients regarding small credit
balances.
**D. There are no CMS hospital compliance requirements regarding credit balances.
Which option is NOT a type of denial? - ANSWERS-A. Technical
B. Clinical
C. Underpayment
**D. Contractual Adjustment
Which option is NOT a lien type? - ANSWERS-A. Judicial
**B. Subrogation
C. Statutory
D. Agreement (Consensus)
Based on what you have just read, which activity is not considered when initiating self-
pay follow-up and account resolution activities? - ANSWERS-A. Poverty Guidelines
B. Financial Profile
C. Presumptive Financial Assistance Determination
**D. Patient Open Balance Billing
What are collection agency fees based on? - ANSWERS-A percentage of dollars
collected
,Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? - ANSWERS-Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - ANSWERS-Case rates
What customer service improvements might improve the patient accounts department?
- ANSWERS-Holding staff accountable for customer service during performance
reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
ANSWERS-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? - ANSWERS-Bad debt adjustment
What is the initial hospice benefit? - ANSWERS-Two 90-day periods and an unlimited
number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -
ANSWERS-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? -
ANSWERS-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 - ANSWERS-They are not being processed in a timely manner
What is an advantage of a preregistration program? - ANSWERS-It reduces processing
times at the time of service
What are the two statutory exclusions from hospice coverage? - ANSWERS-Medically
unnecessary services and custodial care
What core financial activities are resolved within patient access? - ANSWERS-
Scheduling, insurance verification, discharge processing, and payment of point-of-
service receipts
What statement applies to the scheduled outpatient? - ANSWERS-The services do not
involve an overnight stay
How is a mis-posted contractual allowance resolved? - ANSWERS-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? -
ANSWERS-Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - ANSWERS-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$? -
ANSWERS-When the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - ANSWERS-Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what
is the status of the subscriber's spouse? - ANSWERS-Neither enrolled not entitled to
benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - ANSWERS-Disclosure rules for consumer credit sales and
consumer loans
What is a principal diagnosis? - ANSWERS-Primary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - ANSWERS-Lower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? -
ANSWERS-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 services? - ANSWERS-Inpatient care
What code indicates the disposition of the patient at the conclusion of service? -
ANSWERS-Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - ANSWERS-
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? - ANSWERS-Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - ANSWERS-A valid CPT or HCPCS
code
, With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - ANSWERS-Access their information and
perform functions on-line
What date is required on all CMS 1500 claim forms? - ANSWERS-onset date of current
illness
What does scheduling allow provider staff to do - ANSWERS-Review appropriateness
of the service request
What code is used to report the provider's most common semiprivate room rate? -
ANSWERS-Condition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: - ANSWERS-2012
What is a primary responsibility of the Recover Audit Contractor? - ANSWERS-To
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - ANSWERS-Comply with state statutes
concerning reporting credit balance
Insurance verification results in what? - ANSWERS-The accurate identification of the
patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - ANSWERS-CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for
service? - ANSWERS-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? - ANSWERS-HCPCS (Healthcare Common
Procedure Coding system)
What results from a denied claim? - ANSWERS-The provider incurs rework and appeal
costs
Why does the financial counselor need pricing for services? - ANSWERS-To calculate
the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - ANSWERS-
Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? - ANSWERS-Appeal
conditions specified in the individual payer's contract
