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