HFMA CRCR Exam 2026 | Latest Update 2026 |
100% Correct Answers | Actual Exam Prep
Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? - correct answerBirthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - correct answerCase rates
What customer service improvements might improve the patient accounts department?
- correct answerHolding staff accountable for customer service during performance
reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - correct
answerInform 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? - correct answerBad debt adjustment
What is the initial hospice benefit? - correct answerTwo 90-day periods and an unlimited
number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - correct
answerIf 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? -
correct answerPost 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 - correct answerThey are not being processed in a timely manner
What is an advantage of a preregistration program? - correct answerIt reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? - correct
answerMedically unnecessary services and custodial care
What core financial activities are resolved within patient access? - correct
answerScheduling, insurance verification, discharge processing, and payment of point-
of-service receipts
What statement applies to the scheduled outpatient? - correct answerThe services do
not involve an overnight stay
,How is a mis-posted contractual allowance resolved? - correct answerComparing the
contract reimbursement rates with the contract on the admittance advice to identify the
correct amount
What type of patient status is used to evaluate the patient's need for inpatient care? -
correct answerObservation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - correct answerMedically 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$? - correct
answerWhen the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - correct answerUnscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what
is the status of the subscriber's spouse? - correct answerNeither enrolled not entitled to
benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - correct answerDisclosure rules for consumer credit sales and
consumer loans
What is a principal diagnosis? - correct answerPrimary reason for the patient's
admission
Collecting patient liability dollars after service leads to what? - correct answerLower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - correct
answer50% 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? - correct answerInpatient care
What code indicates the disposition of the patient at the conclusion of service? - correct
answerPatient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - correct
answerThey 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? - correct answerPatient
,Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - correct answerA valid CPT or HCPCS
code
With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - correct answerAccess their information and
perform functions on-line
What date is required on all CMS 1500 claim forms? - correct answeronset date of
current illness
What does scheduling allow provider staff to do - correct answerReview
appropriateness of the service request
What code is used to report the provider's most common semiprivate room rate? -
correct answerCondition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: - correct answer2012
What is a primary responsibility of the Recover Audit Contractor? - correct answerTo
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - correct answerComply with state statutes
concerning reporting credit balance
Insurance verification results in what? - correct answerThe accurate identification of the
patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - correct answerCMS 1500
What activities are completed when a scheduled pre-registered patient arrives for
service? - correct answerRegistering 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? - correct answerHCPCS (Healthcare Common
Procedure Coding system)
What results from a denied claim? - correct answerThe provider incurs rework and
appeal costs
Why does the financial counselor need pricing for services? - correct answerTo
calculate the patient's financial responsibility
, What type of provider bills third-party payers using CMS 1500 form - correct
answerHospital-based mammography centers
How are disputes with nongovernmental payers resolved? - correct answerAppeal
conditions specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - correct answerRight 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? - correct answerTo
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? - correct answerSubmit interim bills to the
Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - correct answer120 days passes, but the claim then be
withdrawn from the liability carrier
What data are required to establish a new MPI entry? - correct answerThe 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? -
correct answerDetermine the correct payer and notify the incorrect payer of the
processing error
What do EMTALA regulations require on-call physicians to do? - correct
answerPersonally 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? - correct answerThey must be balanced
What will cause a CMS 1500 claim to be rejected? - correct answerThe 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? - correct answerThe cost of the test
how are HCPCS codes and the appropriate modifiers used? - correct answerTo report
the level 1, 2, or 3 code that correctly describes the service provided
100% Correct Answers | Actual Exam Prep
Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? - correct answerBirthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - correct answerCase rates
What customer service improvements might improve the patient accounts department?
- correct answerHolding staff accountable for customer service during performance
reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - correct
answerInform 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? - correct answerBad debt adjustment
What is the initial hospice benefit? - correct answerTwo 90-day periods and an unlimited
number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - correct
answerIf 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? -
correct answerPost 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 - correct answerThey are not being processed in a timely manner
What is an advantage of a preregistration program? - correct answerIt reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? - correct
answerMedically unnecessary services and custodial care
What core financial activities are resolved within patient access? - correct
answerScheduling, insurance verification, discharge processing, and payment of point-
of-service receipts
What statement applies to the scheduled outpatient? - correct answerThe services do
not involve an overnight stay
,How is a mis-posted contractual allowance resolved? - correct answerComparing the
contract reimbursement rates with the contract on the admittance advice to identify the
correct amount
What type of patient status is used to evaluate the patient's need for inpatient care? -
correct answerObservation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - correct answerMedically 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$? - correct
answerWhen the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - correct answerUnscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what
is the status of the subscriber's spouse? - correct answerNeither enrolled not entitled to
benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - correct answerDisclosure rules for consumer credit sales and
consumer loans
What is a principal diagnosis? - correct answerPrimary reason for the patient's
admission
Collecting patient liability dollars after service leads to what? - correct answerLower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - correct
answer50% 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? - correct answerInpatient care
What code indicates the disposition of the patient at the conclusion of service? - correct
answerPatient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - correct
answerThey 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? - correct answerPatient
,Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - correct answerA valid CPT or HCPCS
code
With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - correct answerAccess their information and
perform functions on-line
What date is required on all CMS 1500 claim forms? - correct answeronset date of
current illness
What does scheduling allow provider staff to do - correct answerReview
appropriateness of the service request
What code is used to report the provider's most common semiprivate room rate? -
correct answerCondition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: - correct answer2012
What is a primary responsibility of the Recover Audit Contractor? - correct answerTo
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - correct answerComply with state statutes
concerning reporting credit balance
Insurance verification results in what? - correct answerThe accurate identification of the
patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - correct answerCMS 1500
What activities are completed when a scheduled pre-registered patient arrives for
service? - correct answerRegistering 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? - correct answerHCPCS (Healthcare Common
Procedure Coding system)
What results from a denied claim? - correct answerThe provider incurs rework and
appeal costs
Why does the financial counselor need pricing for services? - correct answerTo
calculate the patient's financial responsibility
, What type of provider bills third-party payers using CMS 1500 form - correct
answerHospital-based mammography centers
How are disputes with nongovernmental payers resolved? - correct answerAppeal
conditions specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - correct answerRight 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? - correct answerTo
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? - correct answerSubmit interim bills to the
Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - correct answer120 days passes, but the claim then be
withdrawn from the liability carrier
What data are required to establish a new MPI entry? - correct answerThe 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? -
correct answerDetermine the correct payer and notify the incorrect payer of the
processing error
What do EMTALA regulations require on-call physicians to do? - correct
answerPersonally 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? - correct answerThey must be balanced
What will cause a CMS 1500 claim to be rejected? - correct answerThe 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? - correct answerThe cost of the test
how are HCPCS codes and the appropriate modifiers used? - correct answerTo report
the level 1, 2, or 3 code that correctly describes the service provided
