HFMA CRCR EXAM LATEST 2024-2025
EXAM 170+ QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS)
IF outpatient diagnostic services are provided within three days of the
admission of a Medicare beneficiary to an IPPS (Inpatient Prospective
Payment System) hospital, what must happen to these charges -
ANSWER- They must be billed separately to the part B Carrier
what is a recurring or series registration? - ANSWER- One registration
record is created for multiple days of service
What are nonemergency patients who come for service without prior
notification to the provider called? - ANSWER- Unscheduled patients
Which of the following statement apply to the observation patient type?
- ANSWER- It is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the
clock patient - ANSWER- Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? -
ANSWER- Complete the scheduling process correctly based on service
requeste
The Time needed to prepare the patient before service is the difference
between the patients arrival time and which of the following? -
ANSWER- Procedure time
,What are collection agency fees based on?
A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule
or what other rule?
Birthday
In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers?
Case rates
What customer service improvements might improve the patient accounts
department?
Holding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do?
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?
Bad debt adjustment
What is the initial hospice benefit?
Two 90-day periods and an unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim?
If the patient requires ambulance transportation to a skilled nursing facili
Medicare guidelines require that when a test is ordered for a LCD or
NCD exists, the information provided on the order must include: -
ANSWER- Documentation of the medical necessity for the test
What is the advantage of a pre-registration program - ANSWER- It
reduces processing times at the time of service
What date are required to establish a new MPI(Master patient Index)
entry - ANSWER- The responsible party's full legal name, date of birth,
and social security number
, Which of the following statements is true about third-party payments? -
ANSWER- The payments are received by the provider from the payer
responsible for reimbursing the provider for the patient's covered
services.
Which provision protects the patient from medical expenses that exceed
the pre-set level - ANSWER- stop loss
what documentation must a primary care physician send to HMO patient
to authorize a visit to a specialist for additional testing or care? -
ANSWER- Referral
Under EMTALA (Emergency Medical Treatment and Labor Act)
regulations, the provider may not ask about a patient's insurance
information if it would delay what? - ANSWER- Medical screening and
stabilizing treatment
Which of the following is a step in the discharge process? - ANSWER-
Have a case management service complete the discharge plan
The hospital has a APC based contract for the payment of outpatient
services. Total anticipated charges for the visit are $2,380. The approved
APC payment rate is $780. Where will the patients benefit package be
applied? - ANSWER- To the approved APC payment rate
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
When is a patient considered to be medically indigent? - ANSWER- The
patient's outstanding medical bills exceed a defined dollar amount or
percentage of assets.
EXAM 170+ QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS)
IF outpatient diagnostic services are provided within three days of the
admission of a Medicare beneficiary to an IPPS (Inpatient Prospective
Payment System) hospital, what must happen to these charges -
ANSWER- They must be billed separately to the part B Carrier
what is a recurring or series registration? - ANSWER- One registration
record is created for multiple days of service
What are nonemergency patients who come for service without prior
notification to the provider called? - ANSWER- Unscheduled patients
Which of the following statement apply to the observation patient type?
- ANSWER- It is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the
clock patient - ANSWER- Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? -
ANSWER- Complete the scheduling process correctly based on service
requeste
The Time needed to prepare the patient before service is the difference
between the patients arrival time and which of the following? -
ANSWER- Procedure time
,What are collection agency fees based on?
A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule
or what other rule?
Birthday
In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers?
Case rates
What customer service improvements might improve the patient accounts
department?
Holding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do?
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?
Bad debt adjustment
What is the initial hospice benefit?
Two 90-day periods and an unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim?
If the patient requires ambulance transportation to a skilled nursing facili
Medicare guidelines require that when a test is ordered for a LCD or
NCD exists, the information provided on the order must include: -
ANSWER- Documentation of the medical necessity for the test
What is the advantage of a pre-registration program - ANSWER- It
reduces processing times at the time of service
What date are required to establish a new MPI(Master patient Index)
entry - ANSWER- The responsible party's full legal name, date of birth,
and social security number
, Which of the following statements is true about third-party payments? -
ANSWER- The payments are received by the provider from the payer
responsible for reimbursing the provider for the patient's covered
services.
Which provision protects the patient from medical expenses that exceed
the pre-set level - ANSWER- stop loss
what documentation must a primary care physician send to HMO patient
to authorize a visit to a specialist for additional testing or care? -
ANSWER- Referral
Under EMTALA (Emergency Medical Treatment and Labor Act)
regulations, the provider may not ask about a patient's insurance
information if it would delay what? - ANSWER- Medical screening and
stabilizing treatment
Which of the following is a step in the discharge process? - ANSWER-
Have a case management service complete the discharge plan
The hospital has a APC based contract for the payment of outpatient
services. Total anticipated charges for the visit are $2,380. The approved
APC payment rate is $780. Where will the patients benefit package be
applied? - ANSWER- To the approved APC payment rate
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
When is a patient considered to be medically indigent? - ANSWER- The
patient's outstanding medical bills exceed a defined dollar amount or
percentage of assets.
