HFMA CRCR EXAM, CERTIFICATION EXAM,
PRACTICE EXAM AND A STUDY GUIDE LATEST 2024
ACTUAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS
• The disadvantages of outsourcing include all of the
following EXCEPT:
• The impact of customer service or patient relations
• The impact of loss of direct control of accounts receivable
services
• Increased costs due to vendor ineffectiveness
• Reduced internal staffing costs and a reliance on
outsourced staff: D
• The Medicare fee-for service appeal process for both
beneficiaries andproviders
includes all of the following levels EXCEPT:
• Medical necessity review by an independent physician's
panel
• Judicial review by a federal district court
• Redetermination by the company that
handles claims forMedicare
,• Review by the Medicare Appeals Council (Appeals
Council): B
• Business ethics, or organizational ethics represent:
• The principles and standards by which organizations
operate
• Regulations that must be followed by law
• Definitions of appropriate customer service
• The code of acceptable conduct: A
• A portion of the accounts receivable inventory which has
NOT qualified forbilling
includes:
• Charitable pledges
• Accounts created during pre-registration but not activated
• Accounts coded but held within the suspense period
• Accounts assigned to a pre-collection agency: A
• Local Coverage Determinations (LCD) and National
Coverage Determina-tions (NCD) are
,Medicare established guideline(s) used to determine:
• Medicare and Medicaid provider eligibility
• Medicare outpatient reimbursement rates
• Which diagnoses, signs, or symptoms are reimbursable
• What Medicare reimburses and what
should be referred toMedicaid: C
• Days in A/R is calculated based on the value of:
• The total accounts receivable on a specific date
• Total anticipated revenue minus expenses
• The time it takes to collect anticipated revenue
• Total cash received to date: C
• Patients are contacting hospitals to proactively inquire
about costs and feesprior to
agreeing to service. The problem for hospitals in providing
such informationis:
, • That hospitals don't want to establish a price
without knowing ifthe patient has insurance and
how much reimbursement can be expected
• The fact that charge master lists the total
charge, not net chargesthat reflect charges after a
payer's contractual adjustment
• That hospitals don't want to be put in the
position of "guaranteeing" price without having
room for additional chargesthat may arise in
the course of treatment
• Their reluctance to share proprietary information: B
• Across all care settings, if a patient consents to a
financial discussionduring a medical
encounter to expedite discharge, the HFMA best practice is
to:
• Make sure that the attending staff can
answer questions andassist in obtaining
required patient financial data
• Have a patient financial responsibilities kit
ready for the patient,containing all of the required
registration forms and instructions
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