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HFMA CRCR EXAM QUESTIONS AND ANSWERS
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HFMA CRCR EXAM QUESTIONS AND ANSWERS
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HFMA CRCR EXAM QUESTIONS AND ANSWERSWhat are collection agency fees based on? - Answers -A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? - Answers -Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - Answers -Case rates
What customer service improvements might improve the patient accounts department?
- Answers -Holding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
Answers -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? - Answers -Bad debt adjustment
What is the initial hospice benefit? - Answers -Two 90-day periods and an unlimited
number of subsequent periods
What type of patient status is used to evaluate the patient's need for inpatient care? -
Answers -Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - Answers -Medically necessary inpatient hospital
services for at least 3 consecutive days before the skilled nursing care admission
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - Answers
-When the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - Answers -Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what
is the status of the subscriber's spouse? - Answers -Neither enrolled not entitled to
benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - Answers -Disclosure rules for consumer credit sales and
consumer loans
What is a principal diagnosis? - Answers -Primary reason for the patient's admission
,Collecting patient liability dollars after service leads to what? - Answers -Lower accounts
receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - Answers -
50% of the current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not
billable as an RHC services? - Answers -Inpatient care
What code indicates the disposition of the patient at the conclusion of service? -
Answers -Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - Answers -
They result in lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient and the
third party payer, who is responsible for payment? - Answers -Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - Answers -A valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - Answers -Access their information and
perform functions on-line
What date is required on all CMS 1500 claim forms? - Answers -onset date of current
illness
What does scheduling allow provider staff to do - Answers -Review appropriateness of
the service request
What code is used to report the provider's most common semiprivate room rate? -
Answers -Condition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: - Answers -2012
What is a primary responsibility of the Recover Audit Contractor? - Answers -To
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - Answers -Comply with state statutes
concerning reporting credit balance
Insurance verification results in what? - Answers -The accurate identification of the
patient's eligibility and benefits
,What form is used to bill Medicare for rural health clinics? - Answers -CMS 1500
What activities are completed when a scheduled pre-registered patient arrives for
service? - Answers -Registering the patient and directing the patient to the service area
In addition to being supported by information found in the patient's chart, a CMS 1500
claim must be coded using what? - Answers -HCPCS (Healthcare Common Procedure
Coding system)
What results from a denied claim? - Answers -The provider incurs rework and appeal
costs
Why does the financial counselor need pricing for services? - Answers -To calculate the
patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - Answers -Hospital-
based mammography centers
How are disputes with nongovernmental payers resolved? - Answers -Appeal conditions
specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - Answers -Right to appeal a discharge decision if the patient
disagrees with the services
Why do managed care plans have agreements with hospitals, physicians, and other
healthcare providers to offer a range of services to plan members? - Answers -To
improve access to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30
days, what is the SNF permitted to do? - Answers -Submit interim bills to the Medicare
program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - Answers -120 days passes, but the claim then be
withdrawn from the liability carrier
What data are required to establish a new MPI entry? - Answers -The patient's full legal
name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as primary? -
Answers -Determine the correct payer and notify the incorrect payer of the processing
error
What do EMTALA regulations require on-call physicians to do? - Answers -Personally
appear in the emergency department and attend to the patient within a reasonable time
, At the end of each shift, what must happen to cash, checks, and credit card transaction
documents? - Answers -They must be balanced
What will cause a CMS 1500 claim to be rejected? - Answers -The provider is billing
with a future date of service
Under Medicare regulations, which of the following is not included on a valid physician's
order for services? - Answers -The cost of the test
how are HCPCS codes and the appropriate modifiers used? - Answers -To report the
level 1, 2, or 3 code that correctly describes the service provided
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG
window rule? - Answers -Diagnostic and clinically-related non-diagnostic charges
provided on the Tuesday, Wednesday, Thursday, and Friday before admission
What is a benefit of pre-registering patient's for service? - Answers -Patient arrival
processing is expedited, reducing wait times and delays
What is a characteristic of a managed contracting methodology? - Answers -
Prospectively set rates for inpatient and outpatient services
What do the MSP disability rules require? - Answers -That the patient's spouse's
employer must have less than 20 employees in the group health plan
How does utilization review staff use correct insurance information? - Answers -To
obtain approval for inpatient days and coordinate services
When is it not appropriate to use observation status? - Answers -As a substitute for an
inpatient admission
When does a hospital add ambulance charges to the Medicare inpatient claim? -
Answers -If the patient requires ambulance transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account is billed? -
Answers -Post a late-charge adjustment to the account
an increase in the dollars aged greater than 90 days from date of service indicate what
about accounts - Answers -They are not being processed in a timely manner
What is an advantage of a preregistration program? - Answers -It reduces processing
times at the time of service
What are the two statutory exclusions from hospice coverage? - Answers -Medically
unnecessary services and custodial care
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