HFMA CRCR EXAM WITH VERIFIED QUESTIONS AND
ANSWERS LATEST UPDATED
When is it not appropriate to use observation status? - As a substitute for an inpatient
admission
Patients who require periodic skilled nursing or therapeutic care receive services from
what type of program? - Home health agency
Every patient who is new to the healthcare provider must be offered what? - A printed
copy of the provider privacy notice
What core financial activities are resolved within patient access? - scheduling ,
preregistration, insurance verification and managed care processing
What is an unscheduled direct admission? - A patient who arrives at the hospital via
ambulance for treatment in the emergency department
Which of the following statements apples to self insured insurance plans? - The
employer provides a traditional HMO health plan
In addition to the member's identification number, what information is recorded in a 270
transaction - Name
What process does a patient's health plan use to retroactively collect payments from
liability automobile or worker's compensation plan? - Subrogation
In what type of payment methodology is a lump sum of bundled payment negotiated
between the payer and some or all providers? - DRG/Case rate
What Restriction does a managed care plan place on locations that must be used if the
plan is to pay for the service provided? - Site of service limitation
, Which of the following statements applies to private rooms? - If the medical necessity
for a private room is documented in the chart. The patients insurance will be billed for
the differential
Which of the following is true about screening a beneficiary of possible MSP(Medicare
secondary payer) situations? - It is necessary to ask the patient each of the MSP
questions
Which of the following is not true of Medicare Advantage Plans? - A patient must have
both Medicare Part A and B benefits to be eligible for a Medicare Advantage plan Which
of the following is a valid reason for a payer to deny a claim? - Failure to complete
authorization
Which of the following statements is NOT a possible consequence of selecting the
wrong patient in the MPI(master patient index) - Claim is paid in full
Which of the following statements is true of a Medicare Advantage Plan? - This plan
supplements Part A and Part B benefits
Which is the following is not a characteristic of Medicaid HMO plan? - Medicaid-eligible
patients are never required to join a Medicaid HMO plan
Which of the following is violation of the EMTALA ? - Registration staff members
routinely contact managed care plans for prior authorizations before the patients is seen
by the on duty physician
Which of the following statements is true of the important message from Medicare
notification requirements? - Notification can be issued no earlier than 7 days before
admission and no more than 2 days before discharge.
What is the self pay balance after insurance - The portion of the adjudicated claim that
is due from the patient
Which of the following options is an alternative to valid long term payment plans - Bank
loans
The patient has the following benefit plan $400 per family member deductible, to a
maximum of $1200 per year and $2000 per family member co insurance, to a family
maximum of $6000 per year excluding the deductible . Five family members are
enrolled in this benefit plan. What is the maximum out of pocket expense that that family
could incur during the calendar year? - $6000
ANSWERS LATEST UPDATED
When is it not appropriate to use observation status? - As a substitute for an inpatient
admission
Patients who require periodic skilled nursing or therapeutic care receive services from
what type of program? - Home health agency
Every patient who is new to the healthcare provider must be offered what? - A printed
copy of the provider privacy notice
What core financial activities are resolved within patient access? - scheduling ,
preregistration, insurance verification and managed care processing
What is an unscheduled direct admission? - A patient who arrives at the hospital via
ambulance for treatment in the emergency department
Which of the following statements apples to self insured insurance plans? - The
employer provides a traditional HMO health plan
In addition to the member's identification number, what information is recorded in a 270
transaction - Name
What process does a patient's health plan use to retroactively collect payments from
liability automobile or worker's compensation plan? - Subrogation
In what type of payment methodology is a lump sum of bundled payment negotiated
between the payer and some or all providers? - DRG/Case rate
What Restriction does a managed care plan place on locations that must be used if the
plan is to pay for the service provided? - Site of service limitation
, Which of the following statements applies to private rooms? - If the medical necessity
for a private room is documented in the chart. The patients insurance will be billed for
the differential
Which of the following is true about screening a beneficiary of possible MSP(Medicare
secondary payer) situations? - It is necessary to ask the patient each of the MSP
questions
Which of the following is not true of Medicare Advantage Plans? - A patient must have
both Medicare Part A and B benefits to be eligible for a Medicare Advantage plan Which
of the following is a valid reason for a payer to deny a claim? - Failure to complete
authorization
Which of the following statements is NOT a possible consequence of selecting the
wrong patient in the MPI(master patient index) - Claim is paid in full
Which of the following statements is true of a Medicare Advantage Plan? - This plan
supplements Part A and Part B benefits
Which is the following is not a characteristic of Medicaid HMO plan? - Medicaid-eligible
patients are never required to join a Medicaid HMO plan
Which of the following is violation of the EMTALA ? - Registration staff members
routinely contact managed care plans for prior authorizations before the patients is seen
by the on duty physician
Which of the following statements is true of the important message from Medicare
notification requirements? - Notification can be issued no earlier than 7 days before
admission and no more than 2 days before discharge.
What is the self pay balance after insurance - The portion of the adjudicated claim that
is due from the patient
Which of the following options is an alternative to valid long term payment plans - Bank
loans
The patient has the following benefit plan $400 per family member deductible, to a
maximum of $1200 per year and $2000 per family member co insurance, to a family
maximum of $6000 per year excluding the deductible . Five family members are
enrolled in this benefit plan. What is the maximum out of pocket expense that that family
could incur during the calendar year? - $6000
