HFMA CRCR EXAM (ACTUAL 2025/2026)
QUESTIONS AND CORRECT VERIFIED
ANSWERS (GRADED A+)
Through what document does a hospital establish compliance
standards? -<<<Answers>>>>code of conduct
What is the purpose OIG work plant? -
<<<Answers>>>>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? -
<<<Answers>>>>Non-diagnostic service provided on
Tuesday through Friday
What does a modifier allow a provider to do? -
<<<Answers>>>>Report a specific circumstance that affected
a procedure or service without changing the code or its
definition
Ambulance services are billed directly to the health plan for: -
<<<Answers>>>>Services provided before a patient is
admitted and for ambulance rides arranged to pick up the
patient from the hospital after discharge to take him/her home
or to another facility.
,Any provider that has filed a timely cost report may appeal in
an adverse final decision received from the Medicare
Administrative Contractor (MAC), the appeal may be filed
with: -<<<Answers>>>>The Provider Reimbursement
Review Board.
For scheduled payments, important revenue cycle activities in
the time-of-service stage DO Not include: -
<<<Answers>>>>Obtaining or updating patient and guarantor
information
Hospital can only convert an inpatient case to observation if: -
<<<Answers>>>>The hospital utilization review committee
determines before the patient is discharged and prior to billing
that an observation setting would be more appropriate.
Hospital need which of the following information sets to
assess a patient's financial status? -
<<<Answers>>>>Demographic, Income, Assets and
Expenses.
HIPAA privacy rules require covered entities to take all, of
the following actions EXCEPT: -<<<Answers>>>>Use only
designated software platforms to secure patient date.
, When Recovery Audit Contractors (RAC) identify improper
payments as overpayment. the claims processing contractor
must: -<<<Answers>>>>Send a demand letter to the provider
to recover the over payment amount.
Which HIPPA transaction set provides electronic processing
of 8insurance verification requests and responses? -
<<<Answers>>>>The 270-271 set
Across all care settings, if a patient consents to a financial
discussion during a medical encounter to expedite discharge,
the HFMA best practice is to: -<<<Answers>>>>Support that
choice, providing that the discussion does not interfere with
patient care or disrupt patient flow.
A scheduled inpatient represents an opportunity for the
provider to do which of the following? -
<<<Answers>>>>Complete registration and insurance
approval before service
The Medicare Bundled Payments for Care Initiative (BCP) is
designed to: -<<<Answers>>>>Align incentives between
hospitals, physicians, and non-physician providers in-order to
better coordinate patient care.
QUESTIONS AND CORRECT VERIFIED
ANSWERS (GRADED A+)
Through what document does a hospital establish compliance
standards? -<<<Answers>>>>code of conduct
What is the purpose OIG work plant? -
<<<Answers>>>>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? -
<<<Answers>>>>Non-diagnostic service provided on
Tuesday through Friday
What does a modifier allow a provider to do? -
<<<Answers>>>>Report a specific circumstance that affected
a procedure or service without changing the code or its
definition
Ambulance services are billed directly to the health plan for: -
<<<Answers>>>>Services provided before a patient is
admitted and for ambulance rides arranged to pick up the
patient from the hospital after discharge to take him/her home
or to another facility.
,Any provider that has filed a timely cost report may appeal in
an adverse final decision received from the Medicare
Administrative Contractor (MAC), the appeal may be filed
with: -<<<Answers>>>>The Provider Reimbursement
Review Board.
For scheduled payments, important revenue cycle activities in
the time-of-service stage DO Not include: -
<<<Answers>>>>Obtaining or updating patient and guarantor
information
Hospital can only convert an inpatient case to observation if: -
<<<Answers>>>>The hospital utilization review committee
determines before the patient is discharged and prior to billing
that an observation setting would be more appropriate.
Hospital need which of the following information sets to
assess a patient's financial status? -
<<<Answers>>>>Demographic, Income, Assets and
Expenses.
HIPAA privacy rules require covered entities to take all, of
the following actions EXCEPT: -<<<Answers>>>>Use only
designated software platforms to secure patient date.
, When Recovery Audit Contractors (RAC) identify improper
payments as overpayment. the claims processing contractor
must: -<<<Answers>>>>Send a demand letter to the provider
to recover the over payment amount.
Which HIPPA transaction set provides electronic processing
of 8insurance verification requests and responses? -
<<<Answers>>>>The 270-271 set
Across all care settings, if a patient consents to a financial
discussion during a medical encounter to expedite discharge,
the HFMA best practice is to: -<<<Answers>>>>Support that
choice, providing that the discussion does not interfere with
patient care or disrupt patient flow.
A scheduled inpatient represents an opportunity for the
provider to do which of the following? -
<<<Answers>>>>Complete registration and insurance
approval before service
The Medicare Bundled Payments for Care Initiative (BCP) is
designed to: -<<<Answers>>>>Align incentives between
hospitals, physicians, and non-physician providers in-order to
better coordinate patient care.
