HFMA CRCR Question and Answer (2026) |
Newest Update Verified Answers with
Detailed Rationales | A+ Verified
• What is the purpose OIG work plant? -✓✓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? -✓✓Non-diagnostic service provided on Tuesday through
Friday
• What does a modifier allow a provider to do? -✓✓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 -✓✓They must be billed separately to
the part B Carrier
• what is a recurring or series registration? -✓✓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? -✓✓Unscheduled patients
• Which of the following statement apply to the observation patient type? -✓✓It is
used to evaluate the need for an inpatient admission
,• which services are hospice programs required to provide around the clock patient
-✓✓Physician, Nursing, Pharmacy
• Scheduler instructions are used to prompt the scheduler to do what? -
✓✓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? -✓✓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: -✓✓Documentation of the
medical necessity for the test
• What is the advantage of a pre-registration program -✓✓It reduces processing
times at the time of service
• What date are required to establish a new MPI(Master patient Index) entry -
✓✓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? -✓✓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 -✓✓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? -✓✓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? -✓✓Medical screening and stabilizing treatment
• Which of the following is a step in the discharge process? -✓✓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? -✓✓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? -✓✓$100.00
• When is a patient considered to be medically indigent? -✓✓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? -
✓✓Sources of readily available funds , vehicles, campers, boats and saving
accounts
Newest Update Verified Answers with
Detailed Rationales | A+ Verified
• What is the purpose OIG work plant? -✓✓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? -✓✓Non-diagnostic service provided on Tuesday through
Friday
• What does a modifier allow a provider to do? -✓✓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 -✓✓They must be billed separately to
the part B Carrier
• what is a recurring or series registration? -✓✓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? -✓✓Unscheduled patients
• Which of the following statement apply to the observation patient type? -✓✓It is
used to evaluate the need for an inpatient admission
,• which services are hospice programs required to provide around the clock patient
-✓✓Physician, Nursing, Pharmacy
• Scheduler instructions are used to prompt the scheduler to do what? -
✓✓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? -✓✓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: -✓✓Documentation of the
medical necessity for the test
• What is the advantage of a pre-registration program -✓✓It reduces processing
times at the time of service
• What date are required to establish a new MPI(Master patient Index) entry -
✓✓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? -✓✓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 -✓✓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? -✓✓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? -✓✓Medical screening and stabilizing treatment
• Which of the following is a step in the discharge process? -✓✓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? -✓✓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? -✓✓$100.00
• When is a patient considered to be medically indigent? -✓✓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? -
✓✓Sources of readily available funds , vehicles, campers, boats and saving
accounts
