HFMA CRCR Question and Answer | Latest
Update Complete Exam Prep with Accurate
Solutions | Grade A+
• Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? -✓✓Birthday
• In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? -✓✓Case rates
• What customer service improvements might improve the patient accounts
department? -✓✓Holding staff accountable for customer service during performance
reviews
• What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
✓✓Inform 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? -✓✓Bad debt adjustment
• What is the initial hospice benefit? -✓✓Two 90-day periods and an unlimited number
of subsequent periods
• When does a hospital add ambulance charges to the Medicare inpatient claim? -✓✓If
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? -
✓✓Post 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 -✓✓They are not being processed in a timely manner
• What is an advantage of a preregistration program? -✓✓It reduces processing times at
the time of service
• What are the two statutory exclusions from hospice coverage? -✓✓Medically
unnecessary services and custodial care
• What core financial activities are resolved within patient access? -✓✓Scheduling,
insurance verification, discharge processing, and payment of point-of-service receipts
,• What statement applies to the scheduled outpatient? -✓✓The services do not involve
an overnight stay
• How is a mis-posted contractual allowance resolved? -✓✓Comparing 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? -
✓✓Observation
• Coverage rules for Medicare beneficiaries receiving skilled nursing care require that
the beneficiary has received what? -✓✓Medically 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$? -
✓✓When the patient is the insured
• What are non-emergency patients who come for service without prior notification to the
provider called? -✓✓Unscheduled patients
• If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse? -✓✓Neither enrolled not entitled to
benefits
• Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
Lending Act, establishes what? -✓✓Disclosure rules for consumer credit sales and
consumer loans
• What is a principal diagnosis? -✓✓Primary reason for the patient's admission
• Collecting patient liability dollars after service leads to what? -✓✓Lower accounts
receivable levels
• What is the daily out-of-pocket amount for each lifetime reserve day used? -✓✓50% 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? -✓✓Inpatient care
• What code indicates the disposition of the patient at the conclusion of service? -
✓✓Patient discharge status code
• What are hospitals required to do for Medicare credit balance accounts? -✓✓They
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? -✓✓Patient
• Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: -✓✓A valid CPT or HCPCS code
• With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? -✓✓Access their information and perform
functions on-line
• What date is required on all CMS 1500 claim forms? -✓✓onset date of current illness
• What does scheduling allow provider staff to do -✓✓Review appropriateness of the
service request
• What code is used to report the provider's most common semiprivate room rate? -
✓✓Condition code
• Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: -✓✓2012
• What is a primary responsibility of the Recover Audit Contractor? -✓✓To correctly
identify proper payments for Medicare Part A & B claims
• How must providers handle credit balances? -✓✓Comply with state statutes
concerning reporting credit balance
• Insurance verification results in what? -✓✓The accurate identification of the patient's
eligibility and benefits
• What form is used to bill Medicare for rural health clinics? -✓✓CMS 1500
• What activities are completed when a scheduled pre-registered patient arrives for
service? -✓✓Registering 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? -✓✓HCPCS (Healthcare Common Procedure Coding
system)
• What results from a denied claim? -✓✓The provider incurs rework and appeal costs
• Why does the financial counselor need pricing for services? -✓✓To calculate the
patient's financial responsibility
, • What type of provider bills third-party payers using CMS 1500 form -✓✓Hospital-based
mammography centers
• How are disputes with nongovernmental payers resolved? -✓✓Appeal conditions
specified in the individual payer's contract
• The important message from Medicare provides beneficiaries with information
concerning what? -✓✓Right 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? -✓✓To 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? -✓✓Submit interim bills to the Medicare
program.
• 90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? -✓✓120 days passes, but the claim then be withdrawn from
the liability carrier
• What data are required to establish a new MPI entry? -✓✓The 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? -
✓✓Determine the correct payer and notify the incorrect payer of the processing error
• What do EMTALA regulations require on-call physicians to do? -✓✓Personally 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? -✓✓They must be balanced
• What will cause a CMS 1500 claim to be rejected? -✓✓The 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? -✓✓The cost of the test
• how are HCPCS codes and the appropriate modifiers used? -✓✓To report the level 1,
2, or 3 code that correctly describes the service provided
Update Complete Exam Prep with Accurate
Solutions | Grade A+
• Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? -✓✓Birthday
• In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? -✓✓Case rates
• What customer service improvements might improve the patient accounts
department? -✓✓Holding staff accountable for customer service during performance
reviews
• What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
✓✓Inform 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? -✓✓Bad debt adjustment
• What is the initial hospice benefit? -✓✓Two 90-day periods and an unlimited number
of subsequent periods
• When does a hospital add ambulance charges to the Medicare inpatient claim? -✓✓If
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? -
✓✓Post 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 -✓✓They are not being processed in a timely manner
• What is an advantage of a preregistration program? -✓✓It reduces processing times at
the time of service
• What are the two statutory exclusions from hospice coverage? -✓✓Medically
unnecessary services and custodial care
• What core financial activities are resolved within patient access? -✓✓Scheduling,
insurance verification, discharge processing, and payment of point-of-service receipts
,• What statement applies to the scheduled outpatient? -✓✓The services do not involve
an overnight stay
• How is a mis-posted contractual allowance resolved? -✓✓Comparing 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? -
✓✓Observation
• Coverage rules for Medicare beneficiaries receiving skilled nursing care require that
the beneficiary has received what? -✓✓Medically 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$? -
✓✓When the patient is the insured
• What are non-emergency patients who come for service without prior notification to the
provider called? -✓✓Unscheduled patients
• If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse? -✓✓Neither enrolled not entitled to
benefits
• Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
Lending Act, establishes what? -✓✓Disclosure rules for consumer credit sales and
consumer loans
• What is a principal diagnosis? -✓✓Primary reason for the patient's admission
• Collecting patient liability dollars after service leads to what? -✓✓Lower accounts
receivable levels
• What is the daily out-of-pocket amount for each lifetime reserve day used? -✓✓50% 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? -✓✓Inpatient care
• What code indicates the disposition of the patient at the conclusion of service? -
✓✓Patient discharge status code
• What are hospitals required to do for Medicare credit balance accounts? -✓✓They
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? -✓✓Patient
• Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: -✓✓A valid CPT or HCPCS code
• With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? -✓✓Access their information and perform
functions on-line
• What date is required on all CMS 1500 claim forms? -✓✓onset date of current illness
• What does scheduling allow provider staff to do -✓✓Review appropriateness of the
service request
• What code is used to report the provider's most common semiprivate room rate? -
✓✓Condition code
• Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: -✓✓2012
• What is a primary responsibility of the Recover Audit Contractor? -✓✓To correctly
identify proper payments for Medicare Part A & B claims
• How must providers handle credit balances? -✓✓Comply with state statutes
concerning reporting credit balance
• Insurance verification results in what? -✓✓The accurate identification of the patient's
eligibility and benefits
• What form is used to bill Medicare for rural health clinics? -✓✓CMS 1500
• What activities are completed when a scheduled pre-registered patient arrives for
service? -✓✓Registering 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? -✓✓HCPCS (Healthcare Common Procedure Coding
system)
• What results from a denied claim? -✓✓The provider incurs rework and appeal costs
• Why does the financial counselor need pricing for services? -✓✓To calculate the
patient's financial responsibility
, • What type of provider bills third-party payers using CMS 1500 form -✓✓Hospital-based
mammography centers
• How are disputes with nongovernmental payers resolved? -✓✓Appeal conditions
specified in the individual payer's contract
• The important message from Medicare provides beneficiaries with information
concerning what? -✓✓Right 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? -✓✓To 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? -✓✓Submit interim bills to the Medicare
program.
• 90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? -✓✓120 days passes, but the claim then be withdrawn from
the liability carrier
• What data are required to establish a new MPI entry? -✓✓The 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? -
✓✓Determine the correct payer and notify the incorrect payer of the processing error
• What do EMTALA regulations require on-call physicians to do? -✓✓Personally 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? -✓✓They must be balanced
• What will cause a CMS 1500 claim to be rejected? -✓✓The 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? -✓✓The cost of the test
• how are HCPCS codes and the appropriate modifiers used? -✓✓To report the level 1,
2, or 3 code that correctly describes the service provided
