HFMA CRCR EXAM QUESTIONS WITH
CORRECT ANSWERS
.A claim is denied for the following reasons EXCEPT: - ANSWER-The submitted claim does not have the
physician signature
.A common billing issue with hospital-based physician's is - ANSWER-They are not contracted with the patient's
health plan to provide services
.A decision on whether a patient should be admitted as an inpatient or become an outpatient observation
patient requires medical judgement based on all of the following EXCEPT: - ANSWER-The patient's home care
coverage
.A four-digit number code established by the National Uniform Billing Committee (NUBC) that
categorizes/classifies a line in the charge master is known as: - ANSWER-Revenue codes
.A patient has met the $200 individual deductible and $900 of the $1000 co-insurance responsibility. The co-
insurance rate is 20%. The estimated insurance plan responsibility is $1975.00. What amount of coinsurance is
due from the patient? - ANSWER-$100.00
.A portion of the accounts receivable inventory which has NOT qualified for billing includes: - ANSWER-
Accounts created during pre-registration but not activated
.A scheduled inpatient represents an opportunity for the provider to do which of the following? - ANSWER-
Complete registration and insurance approval before service
.Account Receivable (A/R) aging reports - ANSWER-Identify past due accounts likely to become bad debit
.Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite
discharge, the HFMA best practice is to: - ANSWER-Support that choice, providing that the discussion does not
,interfere with patient care or disrupt patient flow.
.All Hospitals are required to establish a written financial assistance policy that applies to: - ANSWER-All
emergency and medically necessary care
.All of following are steps in safeguarding collections EXCEPT: - ANSWER-Placing collections in a lock-box for
posting review the next business day
.All of the following are potential causes of credit balances EXCEPT: - ANSWER-A patient's choice to build up a
credit against future medical bills
.Ambulance services are billed directly to the health plan for: - ANSWER-Services provided before a patient is
admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take
him/her home or to another facility.
.An advantage of a pre-registration program in - ANSWER-The opportunity to reduce processing times at the
time of service
.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
.Any healthcare insurance plan that providers or insures comprehensive health maintenance and services for
an enrolled group of persons based on a monthly fee is known as a - ANSWER-HMO
.Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment
services for an enrolled group of persons on a monthly fee is known as: - ANSWER-HMO
.Any provider that has filed a timely cost report may appeal in an adverse final decision received from the
Medicare Administrative Contractor (MAC), the appeal may be filed with: - ANSWER-The Provider
Reimbursement Review Board.
, .Applying the contracted payment amount to the amount of total charges yields: - ANSWER-An estimated price
for the patient's responsibility
.Applying the contracted payment methodology to the total charges yields: - ANSWER-An estimate price
.Appropriate training for patient financial counseling staff must cover all of the following EXCEPT: - ANSWER-
Documenting the conversation in the medical records
.Before classifying and subsequently writing off an account to financial assistance or bad debit, the hospital
must establish policy define appropriate criteria, implement procedures for identifying accounts and: -
ANSWER-Monitor compliance
.Chapter 11 Bankruptcy permits a debtor to: - ANSWER-Work out a court-supervised plan with creditors
.Charges, as the most appropriate measurement of utilization, enables: - ANSWER-Generation of timely and
accurate billing
.Claims with the dates of service received later than one calendar year beyond the date of service will be: -
ANSWER-Denied by Medicare
.Collecting patient liability dollars after service leads to what? - ANSWER-Lower accounts receivable levels
.Concurrent review and discharge planning - ANSWER-Occurs during service
.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.
.Days in A/R calculated based on the value of: - ANSWER-The total account receivable on a specific date
CORRECT ANSWERS
.A claim is denied for the following reasons EXCEPT: - ANSWER-The submitted claim does not have the
physician signature
.A common billing issue with hospital-based physician's is - ANSWER-They are not contracted with the patient's
health plan to provide services
.A decision on whether a patient should be admitted as an inpatient or become an outpatient observation
patient requires medical judgement based on all of the following EXCEPT: - ANSWER-The patient's home care
coverage
.A four-digit number code established by the National Uniform Billing Committee (NUBC) that
categorizes/classifies a line in the charge master is known as: - ANSWER-Revenue codes
.A patient has met the $200 individual deductible and $900 of the $1000 co-insurance responsibility. The co-
insurance rate is 20%. The estimated insurance plan responsibility is $1975.00. What amount of coinsurance is
due from the patient? - ANSWER-$100.00
.A portion of the accounts receivable inventory which has NOT qualified for billing includes: - ANSWER-
Accounts created during pre-registration but not activated
.A scheduled inpatient represents an opportunity for the provider to do which of the following? - ANSWER-
Complete registration and insurance approval before service
.Account Receivable (A/R) aging reports - ANSWER-Identify past due accounts likely to become bad debit
.Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite
discharge, the HFMA best practice is to: - ANSWER-Support that choice, providing that the discussion does not
,interfere with patient care or disrupt patient flow.
.All Hospitals are required to establish a written financial assistance policy that applies to: - ANSWER-All
emergency and medically necessary care
.All of following are steps in safeguarding collections EXCEPT: - ANSWER-Placing collections in a lock-box for
posting review the next business day
.All of the following are potential causes of credit balances EXCEPT: - ANSWER-A patient's choice to build up a
credit against future medical bills
.Ambulance services are billed directly to the health plan for: - ANSWER-Services provided before a patient is
admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take
him/her home or to another facility.
.An advantage of a pre-registration program in - ANSWER-The opportunity to reduce processing times at the
time of service
.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
.Any healthcare insurance plan that providers or insures comprehensive health maintenance and services for
an enrolled group of persons based on a monthly fee is known as a - ANSWER-HMO
.Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment
services for an enrolled group of persons on a monthly fee is known as: - ANSWER-HMO
.Any provider that has filed a timely cost report may appeal in an adverse final decision received from the
Medicare Administrative Contractor (MAC), the appeal may be filed with: - ANSWER-The Provider
Reimbursement Review Board.
, .Applying the contracted payment amount to the amount of total charges yields: - ANSWER-An estimated price
for the patient's responsibility
.Applying the contracted payment methodology to the total charges yields: - ANSWER-An estimate price
.Appropriate training for patient financial counseling staff must cover all of the following EXCEPT: - ANSWER-
Documenting the conversation in the medical records
.Before classifying and subsequently writing off an account to financial assistance or bad debit, the hospital
must establish policy define appropriate criteria, implement procedures for identifying accounts and: -
ANSWER-Monitor compliance
.Chapter 11 Bankruptcy permits a debtor to: - ANSWER-Work out a court-supervised plan with creditors
.Charges, as the most appropriate measurement of utilization, enables: - ANSWER-Generation of timely and
accurate billing
.Claims with the dates of service received later than one calendar year beyond the date of service will be: -
ANSWER-Denied by Medicare
.Collecting patient liability dollars after service leads to what? - ANSWER-Lower accounts receivable levels
.Concurrent review and discharge planning - ANSWER-Occurs during service
.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.
.Days in A/R calculated based on the value of: - ANSWER-The total account receivable on a specific date
