HFMA CRCR EXAM 2024/2025
,What are collection agency fees based on? - VERIFIED ANSWERSA
percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the
gender rule or what other rule? - VERIFIED ANSWERSBirthday
In what type of payment methodology is a lump sum or bundled
payment negotiated between the payer and some or all providers? -
VERIFIED ANSWERSCase rates
What customer service improvements might improve the patient
accounts department? - VERIFIED ANSWERSHolding staff
accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage)
required to do? - VERIFIED ANSWERSInform 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? - VERIFIED ANSWERSBad debt
adjustment
What is the initial hospice benefit? - VERIFIED ANSWERSTwo 90-day
periods and an unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient
claim? - VERIFIED ANSWERSIf 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? - VERIFIED ANSWERSPost 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 - VERIFIED ANSWERSThey are not
being processed in a timely manner
What is an advantage of a preregistration program? - VERIFIED
ANSWERSIt reduces processing times at the time of service
What are the two statutory exclusions from hospice coverage? -
VERIFIED ANSWERSMedically unnecessary services and custodial
care
What core financial activities are resolved within patient access? -
VERIFIED ANSWERSScheduling, insurance verification, discharge
processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - VERIFIED
ANSWERSThe services do not involve an overnight stay
How is a mis-posted contractual allowance resolved? - VERIFIED
ANSWERSComparing 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? - VERIFIED ANSWERSObservation
Coverage rules for Medicare beneficiaries receiving skilled nursing care
require that the beneficiary has received what? - VERIFIED
ANSWERSMedically 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$? - VERIFIED ANSWERSWhen the patient is the insured
, What are non-emergency patients who come for service without prior
notification to the provider called? - VERIFIED
ANSWERSUnscheduled patients
If the insurance verification response reports that a subscriber has a
single policy, what is the status of the subscriber's spouse? - VERIFIED
ANSWERSNeither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the
Truth in Lending Act, establishes what? - VERIFIED
ANSWERSDisclosure rules for consumer credit sales and consumer
loans
What is a principal diagnosis? - VERIFIED ANSWERSPrimary reason
for the patient's admission
Collecting patient liability dollars after service leads to what? -
VERIFIED ANSWERSLower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day
used? - VERIFIED ANSWERS50% 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? - VERIFIED
ANSWERSInpatient care
What code indicates the disposition of the patient at the conclusion of
service? - VERIFIED ANSWERSPatient discharge status code
What are hospitals required to do for Medicare credit balance accounts?
- VERIFIED ANSWERSThey result in lost reimbursement and
additional cost to collect
,What are collection agency fees based on? - VERIFIED ANSWERSA
percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the
gender rule or what other rule? - VERIFIED ANSWERSBirthday
In what type of payment methodology is a lump sum or bundled
payment negotiated between the payer and some or all providers? -
VERIFIED ANSWERSCase rates
What customer service improvements might improve the patient
accounts department? - VERIFIED ANSWERSHolding staff
accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage)
required to do? - VERIFIED ANSWERSInform 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? - VERIFIED ANSWERSBad debt
adjustment
What is the initial hospice benefit? - VERIFIED ANSWERSTwo 90-day
periods and an unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient
claim? - VERIFIED ANSWERSIf 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? - VERIFIED ANSWERSPost 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 - VERIFIED ANSWERSThey are not
being processed in a timely manner
What is an advantage of a preregistration program? - VERIFIED
ANSWERSIt reduces processing times at the time of service
What are the two statutory exclusions from hospice coverage? -
VERIFIED ANSWERSMedically unnecessary services and custodial
care
What core financial activities are resolved within patient access? -
VERIFIED ANSWERSScheduling, insurance verification, discharge
processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - VERIFIED
ANSWERSThe services do not involve an overnight stay
How is a mis-posted contractual allowance resolved? - VERIFIED
ANSWERSComparing 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? - VERIFIED ANSWERSObservation
Coverage rules for Medicare beneficiaries receiving skilled nursing care
require that the beneficiary has received what? - VERIFIED
ANSWERSMedically 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$? - VERIFIED ANSWERSWhen the patient is the insured
, What are non-emergency patients who come for service without prior
notification to the provider called? - VERIFIED
ANSWERSUnscheduled patients
If the insurance verification response reports that a subscriber has a
single policy, what is the status of the subscriber's spouse? - VERIFIED
ANSWERSNeither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the
Truth in Lending Act, establishes what? - VERIFIED
ANSWERSDisclosure rules for consumer credit sales and consumer
loans
What is a principal diagnosis? - VERIFIED ANSWERSPrimary reason
for the patient's admission
Collecting patient liability dollars after service leads to what? -
VERIFIED ANSWERSLower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day
used? - VERIFIED ANSWERS50% 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? - VERIFIED
ANSWERSInpatient care
What code indicates the disposition of the patient at the conclusion of
service? - VERIFIED ANSWERSPatient discharge status code
What are hospitals required to do for Medicare credit balance accounts?
- VERIFIED ANSWERSThey result in lost reimbursement and
additional cost to collect
