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HFMA CRCR EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS
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HFMA CRCR EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS
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HFMA CRCR EXAM 2024/2025 WITH100% ACCURATE SOLUTIONS
Through what document does a hospital establish compliance standards? - Precise Answer ✔✔code of
conduct
What is the purpose OIG work plant? - Precise Answer ✔✔Identify Acceptable compliance programs in
various provider setting
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? -
Precise Answer ✔✔Non-diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do? - Precise Answer ✔✔Report a specific circumstance that
affected a procedure or service without changing the code or its definition
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 - Precise Answer ✔✔They must be billed separately to the part B Carrier
what is a recurring or series registration? - Precise 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?
- Precise Answer ✔✔Unscheduled patients
Which of the following statement apply to the observation patient type? - Precise Answer ✔✔It is used
to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient - Precise Answer
✔✔Physician, Nursing, Pharmacy
,Scheduler instructions are used to prompt the scheduler to do what? - Precise 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? - Precise Answer ✔✔Procedure time
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: - Precise Answer ✔✔Documentation of the medical necessity for
the test
What is the advantage of a pre-registration program - Precise Answer ✔✔It reduces processing times at
the time of service
What date are required to establish a new MPI(Master patient Index) entry - Precise 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? - Precise 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 - Precise
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? - Precise 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? - Precise Answer ✔✔Medical screening
and stabilizing treatment
Which of the following is a step in the discharge process? - Precise 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? - Precise 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? - Precise Answer ✔✔$100.00
When is a patient considered to be medically indigent? - Precise Answer ✔✔The patient's outstanding
medical bills exceed a defined dollar amount or percentage of assets.
What patient assets are considered in the financial assistance application? - Precise Answer ✔✔Sources
of readily available funds , vehicles, campers, boats and saving accounts
If the patient cannot agree to payment arrangements, What is the next option? - Precise Answer
✔✔Warn the patient that unpaid accounts are placed with collection agencies for further processing
What core financial activities are resolved within patient access? - Precise Answer ✔✔scheduling , pre-
registration, insurance verification and managed care processing
What is an unscheduled direct admission? - Precise Answer ✔✔A patient who arrives at the hospital via
ambulance for treatment in the emergency department
When is it not appropriate to use observation status? - Precise Answer ✔✔As a substitute for an
inpatient admission
Patients who require periodic skilled nursing or therapeutic care receive services from what type of
program? - Precise Answer ✔✔Home health agency
Every patient who is new to the healthcare provider must be offered what? - Precise Answer ✔✔A
printed copy of the provider privacy notice
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