HFMA CRCR (ACTUAL)
EXAM | 170 QUESTIONS
AND VERIFIED SOLUTIONS
2024/2025
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 - CORRECT ANSWER- ...
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 - CORRECT ANSWER- They must be billed separately to the part B Carrier
what is a recurring or series registration? - CORRECT 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?
- CORRECT ANSWER- Unscheduled patients
Which of the following statement apply to the observation patient type?
- CORRECT ANSWER- It is used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient - CORRECT ANSWER-
Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? - CORRECT 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? - CORRECT 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: - CORRECT ANSWER- Documentation of the medical necessity for
the test
What is the advantage of a pre-registration program - CORRECT ANSWER- It reduces processing times at
the time of service
What date are required to establish a new MPI(Master patient Index) entry - CORRECT 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? - CORRECT 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 - CORRECT
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? - CORRECT 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? - CORRECT ANSWER- Medical screening
and stabilizing treatment
Which of the following is a step in the discharge process? - CORRECT 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? - CORRECT 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? - CORRECT ANSWER- $100.00
When is a patient considered to be medically indigent? - CORRECT 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? - CORRECT 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? - CORRECT ANSWER-
Warn the patient that unpaid accounts are placed with collection agencies for further processing
What core financial activities are resolved within patient access? - CORRECT ANSWER- scheduling , pre-
registration, insurance verification and managed care processing
What is an unscheduled direct admission? - CORRECT 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? - CORRECT ANSWER- As a substitute for an
inpatient admission
Patients who require periodic skilled nursing or therapeutic care receive services from what type of
program? - CORRECT ANSWER- Home health agency
Every patient who is new to the healthcare provider must be offered what? - CORRECT ANSWER- A
printed copy of the provider privacy notice
Which of the following statements apples to self insured insurance plans? - CORRECT ANSWER- The
employer provides a traditional HMO health plan
In addition to the member's identification number, what information is recorded in a 270 transaction -
CORRECT ANSWER- Name
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