HFMA CRCR Exam Prep 2026 (155 Most Tested
Questions) | Latest Update 2026 | 100% Correct Answers
| Actual Exam Prep
1. When a billing and coding specialist is completing the CMS-1500 claim form,
which of the following information is required to process a medical claim?
CCI, LCD
NDC, EOB
CPT, ICD
EOB, CPT
2. Describe the role of a subscriber in a health insurance plan and how it differs
from other roles such as a dependent.
The subscriber is the healthcare provider managing the insurance
claims.
The subscriber is anyone who receives medical care under the
insurance plan.
The subscriber is the insurance company that issues the policy.
The subscriber is the individual who owns the insurance policy, while
dependents are individuals covered under that policy.
3. What does MSP stand for in the context of healthcare billing?
Medicare Savings Program
Medical Service Provider
Medicare Standard Plan
Medicare Secondary Payer
,4. Describe how a third-party administrator (TPA) contributes to the efficiency
of healthcare billing processes.
A TPA provides direct patient care and manages healthcare facilities.
A TPA only handles patient eligibility verification.
A TPA is responsible for coding medical procedures and treatments.
A TPA streamlines claims processing and ensures compliance with
regulations, which enhances billing efficiency.
5. If a healthcare provider fails to conduct insurance verification before a
patient's appointment, what potential issue might arise?
Increased collection agency fees
Delayed Medicare reimbursements
Billing disputes due to lack of coverage confirmation
Incorrect coding of services
6. What is the daily out-of-pocket cost for each lifetime reserve day utilized
under Medicare?
$250
$778
$1000
$500
7. What is the term used to describe the code that reflects a patient's status
after receiving healthcare services?
Procedure code
Billing code
, Disposition code
Diagnosis code
8. What is the definition of self-insured in the context of healthcare?
An employer provides healthcare benefits through a government
program.
An employer only pays for employee healthcare costs after they
exceed a certain limit.
An employer assumes the financial risk for providing healthcare
benefits to its employees.
An employer purchases insurance from a third party to cover
healthcare costs.
9. Interpret the significance of an increase in dollars aged greater than 90 days
in a healthcare billing context.
It may indicate issues with collections or patient payment
compliance.
It shows that billing practices are highly efficient.
It means that the healthcare provider is gaining more patients.
It suggests that all accounts are being paid on time.
10. What is one primary benefit of scheduling in healthcare settings?
Manage patient appointments efficiently
Reduce staff communication
Increase patient wait times
Limit patient access to services
, 11. If a healthcare provider submits a CMS 1500 claim form without the date of
service, what potential consequences could arise?
The provider will receive a bonus for the submission.
The claim may be denied or delayed in processing.
The claim will be automatically approved.
The patient will be billed directly without insurance involvement.
12. Describe the circumstances that allow a hospital to bill for ambulance
services under Medicare.
A hospital can bill for ambulance services when the patient is in
critical condition.
A hospital can bill for ambulance services if the patient has a
secondary insurance.
A hospital can bill for ambulance services under Medicare when
the service is deemed necessary for the patient's admission to the
hospital.
A hospital can bill for ambulance services if the patient is transported
from a nursing home.
13. Describe the significance of a disposition code in healthcare billing.
A disposition code indicates the patient's status at the end of
service, which is essential for accurate billing and record-keeping.
A disposition code is used to classify the type of medical procedure
performed.
A disposition code is primarily for insurance verification purposes.
A disposition code is related to the patient's eligibility for Medicare.
Questions) | Latest Update 2026 | 100% Correct Answers
| Actual Exam Prep
1. When a billing and coding specialist is completing the CMS-1500 claim form,
which of the following information is required to process a medical claim?
CCI, LCD
NDC, EOB
CPT, ICD
EOB, CPT
2. Describe the role of a subscriber in a health insurance plan and how it differs
from other roles such as a dependent.
The subscriber is the healthcare provider managing the insurance
claims.
The subscriber is anyone who receives medical care under the
insurance plan.
The subscriber is the insurance company that issues the policy.
The subscriber is the individual who owns the insurance policy, while
dependents are individuals covered under that policy.
3. What does MSP stand for in the context of healthcare billing?
Medicare Savings Program
Medical Service Provider
Medicare Standard Plan
Medicare Secondary Payer
,4. Describe how a third-party administrator (TPA) contributes to the efficiency
of healthcare billing processes.
A TPA provides direct patient care and manages healthcare facilities.
A TPA only handles patient eligibility verification.
A TPA is responsible for coding medical procedures and treatments.
A TPA streamlines claims processing and ensures compliance with
regulations, which enhances billing efficiency.
5. If a healthcare provider fails to conduct insurance verification before a
patient's appointment, what potential issue might arise?
Increased collection agency fees
Delayed Medicare reimbursements
Billing disputes due to lack of coverage confirmation
Incorrect coding of services
6. What is the daily out-of-pocket cost for each lifetime reserve day utilized
under Medicare?
$250
$778
$1000
$500
7. What is the term used to describe the code that reflects a patient's status
after receiving healthcare services?
Procedure code
Billing code
, Disposition code
Diagnosis code
8. What is the definition of self-insured in the context of healthcare?
An employer provides healthcare benefits through a government
program.
An employer only pays for employee healthcare costs after they
exceed a certain limit.
An employer assumes the financial risk for providing healthcare
benefits to its employees.
An employer purchases insurance from a third party to cover
healthcare costs.
9. Interpret the significance of an increase in dollars aged greater than 90 days
in a healthcare billing context.
It may indicate issues with collections or patient payment
compliance.
It shows that billing practices are highly efficient.
It means that the healthcare provider is gaining more patients.
It suggests that all accounts are being paid on time.
10. What is one primary benefit of scheduling in healthcare settings?
Manage patient appointments efficiently
Reduce staff communication
Increase patient wait times
Limit patient access to services
, 11. If a healthcare provider submits a CMS 1500 claim form without the date of
service, what potential consequences could arise?
The provider will receive a bonus for the submission.
The claim may be denied or delayed in processing.
The claim will be automatically approved.
The patient will be billed directly without insurance involvement.
12. Describe the circumstances that allow a hospital to bill for ambulance
services under Medicare.
A hospital can bill for ambulance services when the patient is in
critical condition.
A hospital can bill for ambulance services if the patient has a
secondary insurance.
A hospital can bill for ambulance services under Medicare when
the service is deemed necessary for the patient's admission to the
hospital.
A hospital can bill for ambulance services if the patient is transported
from a nursing home.
13. Describe the significance of a disposition code in healthcare billing.
A disposition code indicates the patient's status at the end of
service, which is essential for accurate billing and record-keeping.
A disposition code is used to classify the type of medical procedure
performed.
A disposition code is primarily for insurance verification purposes.
A disposition code is related to the patient's eligibility for Medicare.
