HFMA CRCR Exam with Verified Answers Graded A+
1. code of conduct
2. Identify Accept-
able compliance
programs in vari-
ous provider set-
ting
3. Non-diagnostic
service provided
on Tuesday
through Friday
4. Report a specif-
ic circumstance
that affected a
procedure or
service without...
1. code of conduct Through what document does a hospital establish com-
pliance standards?
2. Identify Accept- What is the purpose OIG work plant?
able compliance
programs in vari-
ous provider set-
ting
3. Non-diagnostic If a Medicare patient is admitted on Friday, what services
service provided fall within the three-day DRG window rule?
on Tuesday
through Friday
4. Report a specif- What does a modifier allow a provider to do?
ic circumstance
that affected a
procedure or
service without
changing the
code or its defin-
ition
5. They must be IF outpatient diagnostic services are provided within three
billed separately days of the admission of a Medicare beneficiary to an
to the part B Car- IPPS (Inpatient Prospective Payment System) hospital,
rier what must happen to these charges
6. One registration what is a recurring or series registration?
record is created
for multiple days
of service
7. Unscheduled pa- What are nonemergency patients who come for service
tients without prior notification to the provider called?
8. It is used to eval- Which of the following statement apply to the observation
uate the need for patient type?
an inpatient ad-
mission
, HFMA CRCR Exam with Verified Answers Graded A+
9. Physician, Nurs- which services are hospice programs required to provide
ing, Pharmacy around the clock patient
10. Complete the Scheduler instructions are used to prompt the scheduler
scheduling to do what?
process
correctly based
on service
requeste
11. Procedure time The Time needed to prepare the patient before service is
the difference between the patients arrival time and which
of the following?
12. Documentation Medicare guidelines require that when a test is ordered
of the medical for a LCD or NCD exists, the information provided on the
necessity for the order must include:
test
13. It reduces pro- What is the advantage of a pre-registration program
cessing times at
the time of ser-
vice
14. The responsible What date are required to establish a new MPI(Master
party's full le- patient Index) entry
gal name, date of
birth, and social
security number
15. The payments Which of the following statements is true about third-party
are received by payments?
the provider from
the payer re-
sponsible for re-
imbursing the
provider for the
patient's covered
services.
, HFMA CRCR Exam with Verified Answers Graded A+
16. stop loss Which provision protects the patient from medical ex-
penses that exceed the pre-set level
17. Referral what documentation must a primary care physician send
to HMO patient to authorize a visit to a specialist for
additional testing or care?
18. Medical screen- Under EMTALA (Emergency Medical Treatment and La-
ing and stabiliz- bor Act) regulations, the provider may not ask about a
ing treatment patient's insurance information if it would delay what?
19. Have a case man- Which of the following is a step in the discharge process?
agement service
complete the dis-
charge plan
20. To the approved The hospital has a APC based contract for the payment
APC payment of outpatient services. Total anticipated charges for the
rate visit are $2,380. The approved APC payment rate is $780.
Where will the patients benefit package be applied?
21. $100.00 A patient has met the $200 individual deductible and $900
of the $1000 co-insurance responsibility. The co-insur-
ance rate is 20%. The estimated insurance plan respon-
sibility is $1975.00. What amount of coinsurance is due
from the patient?
22. The patient's out- When is a patient considered to be medically indigent?
standing med-
ical bills exceed
a defined dollar
amount or per-
centage of as-
sets.
23. Sources of read- What patient assets are considered in the financial assis-
ily available tance application?
funds , vehicles,
campers, boats
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