HFMA CRCR with questions
and well verified answers
actual exam!!! 2026
Through what document does a hospital establish compliance standards? - ANSWER -
code of conduct
What is the purpose OIG work plant? - ANSWER -Identify Acceptable compliance
programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG
window rule? - ANSWER -Non-diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do? - ANSWER -Report a specific circumstance
that affected a procedure or service without changing the code or its definition
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 - ANSWER -They must be billed separately to the part B Carrier
what is a recurring or series registration? - 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? - ANSWER -Unscheduled patients
Which of the following statement apply to the observation patient type? - ANSWER -It is
used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient -
ANSWER -Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? - 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? - 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: - ANSWER -Documentation of the
medical necessity for the test
What is the advantage of a pre-registration program - ANSWER -It reduces processing
times at the time of service
What date are required to establish a new MPI(Master patient Index) entry - 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? - 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 -
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? - 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? - ANSWER -
Medical screening and stabilizing treatment
Which of the following is a step in the discharge process? - 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? - 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? - ANSWER -$100.00
When is a patient considered to be medically indigent? - 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? - 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? -
ANSWER -Warn the patient that unpaid accounts are placed with collection agencies for
further processing
What core financial activities are resolved within patient access? - ANSWER -scheduling ,
pre-registration, insurance verification and managed care processing
What is an unscheduled direct admission? - 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? - ANSWER -As a substitute for an
inpatient admission
and well verified answers
actual exam!!! 2026
Through what document does a hospital establish compliance standards? - ANSWER -
code of conduct
What is the purpose OIG work plant? - ANSWER -Identify Acceptable compliance
programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG
window rule? - ANSWER -Non-diagnostic service provided on Tuesday through Friday
What does a modifier allow a provider to do? - ANSWER -Report a specific circumstance
that affected a procedure or service without changing the code or its definition
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 - ANSWER -They must be billed separately to the part B Carrier
what is a recurring or series registration? - 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? - ANSWER -Unscheduled patients
Which of the following statement apply to the observation patient type? - ANSWER -It is
used to evaluate the need for an inpatient admission
which services are hospice programs required to provide around the clock patient -
ANSWER -Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? - 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? - 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: - ANSWER -Documentation of the
medical necessity for the test
What is the advantage of a pre-registration program - ANSWER -It reduces processing
times at the time of service
What date are required to establish a new MPI(Master patient Index) entry - 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? - 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 -
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? - 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? - ANSWER -
Medical screening and stabilizing treatment
Which of the following is a step in the discharge process? - 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? - 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? - ANSWER -$100.00
When is a patient considered to be medically indigent? - 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? - 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? -
ANSWER -Warn the patient that unpaid accounts are placed with collection agencies for
further processing
What core financial activities are resolved within patient access? - ANSWER -scheduling ,
pre-registration, insurance verification and managed care processing
What is an unscheduled direct admission? - 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? - ANSWER -As a substitute for an
inpatient admission
