HFMA CRCR Exam | Questions and Verified
Answers| 2023/ 2024 New Update |100%
Correct
QUESTION
In what type of payment methodology is a lump sum of bundled payment negotiated between
the payer and some or all providers?
Answer:
DRG/Case rate
QUESTION
What Restriction does a managed care plan place on locations that must be used if the plan is to
pay for the service provided?
Answer:
Site of service limitation
QUESTION
Which of the following statements applies to private rooms?
Answer:
If the medical necessity for a private room is documented in the chart. The patients insurance
will be billed for the differential
QUESTION
Which of the following is true about screening a beneficiary of possible MSP(Medicare
secondary payer) situations?
Answer:
It is necessary to ask the patient each of the MSP questions
,QUESTION
Which of the following is not true of Medicare Advantage Plans?
Answer:
A patient must have both Medicare Part A and B benefits to be eligible for a Medicare
Advantage plan
QUESTION
Which of the following is a valid reason for a payer to deny a claim?
Answer:
Failure to complete authorization
QUESTION
Which of the following statements is NOT a possible consequence of selecting the wrong
patient in the MPI(master patient index)
Answer:
Claim is paid in full
QUESTION
Which of the following statements is true of a Medicare Advantage Plan?
Answer:
This plan supplements Part A and Part B benefits
QUESTION
Which is the following is not a characteristic of Medicaid HMO plan?
,Answer:
Medicaid-eligible patients are never required to join a Medicaid HMO plan
QUESTION
Which of the following is violation of the EMTALA ?
Answer:
Registration staff members routinely contact managed care plans for prior authorizations before
the patients is seen by the on duty physician
QUESTION
Which of the following statements is true of the important message from Medicare notification
requirements?
Answer:
Notification can be issued no earlier than 7 days before admission and no more than 2 days
before discharge.
QUESTION
What is the self pay balance after insurance
Answer:
The portion of the adjudicated claim that is due from the patient
QUESTION
Which of the following options is an alternative to valid long term payment plans
Answer:
Bank loans
QUESTION
, The patient has the following benefit plan $400 per family member deductible, to a maximum of
$1200 per year and $2000 per family member co insurance, to a family maximum of $6000 per
year excluding the deductible . Five family members are enrolled in this benefit plan. What is the
maximum out of pocket expense that that family could incur during the calendar year?
Answer:
$6000
QUESTION
What type of plan restricts benefits for non-emergency care to approve providers only?
Answer:
A POS (point of service )plan
QUESTION
What does scheduling allow provider staff to do?
Answer:
Review the appropriateness of the service requested
QUESTION
When an adult patient is covered by both his own and his spouse health insurance plan, which of
the statements is true?
Answer:
The patients insurance plan is primary
QUESTION
Mrs. Jones , a Medicare beneficiary was admitted to the hospital on June 20,2010. As of the
admission date, she had only used 8 inpatient days in the current benefit period. If she is not
discharge on what date will Mr jones exhaust her full coverage days.
Answers| 2023/ 2024 New Update |100%
Correct
QUESTION
In what type of payment methodology is a lump sum of bundled payment negotiated between
the payer and some or all providers?
Answer:
DRG/Case rate
QUESTION
What Restriction does a managed care plan place on locations that must be used if the plan is to
pay for the service provided?
Answer:
Site of service limitation
QUESTION
Which of the following statements applies to private rooms?
Answer:
If the medical necessity for a private room is documented in the chart. The patients insurance
will be billed for the differential
QUESTION
Which of the following is true about screening a beneficiary of possible MSP(Medicare
secondary payer) situations?
Answer:
It is necessary to ask the patient each of the MSP questions
,QUESTION
Which of the following is not true of Medicare Advantage Plans?
Answer:
A patient must have both Medicare Part A and B benefits to be eligible for a Medicare
Advantage plan
QUESTION
Which of the following is a valid reason for a payer to deny a claim?
Answer:
Failure to complete authorization
QUESTION
Which of the following statements is NOT a possible consequence of selecting the wrong
patient in the MPI(master patient index)
Answer:
Claim is paid in full
QUESTION
Which of the following statements is true of a Medicare Advantage Plan?
Answer:
This plan supplements Part A and Part B benefits
QUESTION
Which is the following is not a characteristic of Medicaid HMO plan?
,Answer:
Medicaid-eligible patients are never required to join a Medicaid HMO plan
QUESTION
Which of the following is violation of the EMTALA ?
Answer:
Registration staff members routinely contact managed care plans for prior authorizations before
the patients is seen by the on duty physician
QUESTION
Which of the following statements is true of the important message from Medicare notification
requirements?
Answer:
Notification can be issued no earlier than 7 days before admission and no more than 2 days
before discharge.
QUESTION
What is the self pay balance after insurance
Answer:
The portion of the adjudicated claim that is due from the patient
QUESTION
Which of the following options is an alternative to valid long term payment plans
Answer:
Bank loans
QUESTION
, The patient has the following benefit plan $400 per family member deductible, to a maximum of
$1200 per year and $2000 per family member co insurance, to a family maximum of $6000 per
year excluding the deductible . Five family members are enrolled in this benefit plan. What is the
maximum out of pocket expense that that family could incur during the calendar year?
Answer:
$6000
QUESTION
What type of plan restricts benefits for non-emergency care to approve providers only?
Answer:
A POS (point of service )plan
QUESTION
What does scheduling allow provider staff to do?
Answer:
Review the appropriateness of the service requested
QUESTION
When an adult patient is covered by both his own and his spouse health insurance plan, which of
the statements is true?
Answer:
The patients insurance plan is primary
QUESTION
Mrs. Jones , a Medicare beneficiary was admitted to the hospital on June 20,2010. As of the
admission date, she had only used 8 inpatient days in the current benefit period. If she is not
discharge on what date will Mr jones exhaust her full coverage days.
