HFMA CRCR Final and Practice Exam Test Bank –
2025/2026 Edition
GRADED A+ | LATEST UPDATE | GUARANTEED PASS!!!
Section 1: CRCR Final Exam – 2025/2026
Question 1: If outpatient diagnostic services are provided within three days of the
admission of a Medicare beneficiary to an Inpatient Prospective Payment System (IPPS)
hospital, what must happen to these charges?
A. They must be included in the inpatient claim.
B. They must be billed separately to the Part B Carrier.
C. They are covered under the outpatient facility fee.
D. They are exempt from billing.
Correct Answer: B. They must be billed separately to the Part B Carrier.
Rationale: Medicare’s 72-hour rule requires that outpatient diagnostic services provided
within three days of an inpatient admission to an IPPS hospital be billed separately to
the Part B Carrier, as they are not included in the inpatient DRG payment.
Question 2: What is a recurring or series registration?
A. A single registration for a one-time service.
B. One registration record created for multiple days of service.
C. A registration updated daily for each patient visit.
D. A registration used only for emergency department visits.
Correct Answer: B. One registration record created for multiple days of service.
Rationale: A recurring or series registration is used for patients receiving ongoing
treatments (e.g., chemotherapy), where one registration covers multiple service dates,
streamlining administrative processes.
Question 3: Which of the following is a benefit of pre-registering a patient for services?
A. It increases the likelihood of claim denials.
B. It expedites the patient arrival process, reducing wait times and delays.
C. It eliminates the need for insurance verification.
D. It ensures all services are pre-authorized.
Correct Answer: B. It expedites the patient arrival process, reducing wait times and
delays.
,Rationale: Pre-registration collects patient demographic and insurance information in
advance, allowing for a smoother check-in process and reduced wait times.
Question 4: Under the Medicare 72-hour rule, if outpatient diagnostic services are
performed within three calendar days before a Medicare inpatient admission, how
should the hospital bill for those services?
A. Include them on the inpatient claim as part of the DRG.
B. Bill them separately to the patient as self-pay.
C. Bill them to the Part B carrier as outpatient services.
D. Write them off as a courtesy allowance.
Correct Answer: C. Bill them to the Part B carrier as outpatient services.
Rationale: The 72-hour rule requires that outpatient diagnostic services provided within
three days of an inpatient admission be billed separately to Medicare Part B, not
included in the inpatient DRG payment. Domain: Reimbursement.
Question 5: What is the primary purpose of a "series registration" in an outpatient
oncology clinic?
A. To create a new registration for each chemotherapy visit.
B. To create a single registration record that covers multiple scheduled visits over a
period of time.
C. To eliminate the need for insurance verification.
D. To automatically discharge the patient after each visit.
Correct Answer: B. To create a single registration record that covers multiple scheduled
visits over a period of time.
Rationale: Series registrations streamline administrative work for patients receiving
recurring treatments (e.g., chemotherapy, dialysis) by using one record for multiple
service dates. Domain: Patient Access.
Question 6: Which of the following is a key benefit of pre-registering a patient before a
scheduled procedure?
A. Guarantees that the procedure will be covered in full.
B. Eliminates the need for a signed consent form.
C. Allows time to verify insurance, obtain authorizations, and identify patient financial
responsibility.
D. Automatically waives all deductibles.
Correct Answer: C. Allows time to verify insurance, obtain authorizations, and identify
patient financial responsibility.
Rationale: Pre-registration gives staff time to complete financial clearance tasks before
the patient arrives, reducing denials and improving patient experience. Domain: Patient
Access.
,Question 7: The HCAHPS survey measures patient perspectives on hospital care. Which
of the following domains is included in HCAHPS?
A. Physician board certification status.
B. Communication with nurses and doctors.
C. Hospital profitability.
D. Staff parking availability.
Correct Answer: B. Communication with nurses and doctors.
Rationale: HCAHPS (Hospital Consumer Assessment of Healthcare Providers and
Systems) includes domains such as communication, responsiveness, cleanliness, and
discharge information. Domain: Patient Experience / Compliance.
Question 8: A patient presents for an elective surgery. The registrar discovers that the
required prior authorization was never obtained. What should happen next?
A. Proceed with the surgery as scheduled.
B. Cancel the surgery and refuse to reschedule.
C. Notify the physician and the patient, and attempt to obtain a retroactive
authorization or reschedule once authorization is secured.
D. Bill the patient for the full cost of the surgery.
Correct Answer: C. Notify the physician and the patient, and attempt to obtain a
retroactive authorization or reschedule once authorization is secured.
Rationale: Performing surgery without prior authorization risks denial; best practice is
to delay until authorization is obtained unless it is an emergency. Domain: Patient
Access.
Question 9: What is the "Notice of Admission" (NOA) for Medicare Advantage plans?
A. A form signed by the patient waiving their right to appeal.
B. A notification that the hospital must submit to the Medicare Advantage plan within a
specified timeframe (often 24-48 hours) to receive full payment.
C. A patient satisfaction survey.
D. A discharge planning document.
Correct Answer: B. A notification that the hospital must submit to the Medicare
Advantage plan within a specified timeframe (often 24-48 hours) to receive full
payment.
Rationale: Many Medicare Advantage plans require a NOA to be submitted within 24-
48 hours of admission; failure to do so can result in payment penalties or
denials. Domain: Billing.
Question 10: Which of the following is an example of a "late charge" in hospital billing?
A. A copayment collected at registration.
B. A charge for an emergency department service entered into the system three days
after the patient was discharged.
, C. A contractual adjustment posted at the time of payment.
D. A patient payment made after discharge.
Correct Answer: B. A charge for an emergency department service entered into the
system three days after the patient was discharged.
Rationale: Late charges are those added after the initial claim has been generated or
submitted, often causing delays and increased denials. Domain: Charge Capture.
Question 11: What is the primary function of a "claims clearinghouse"?
A. To adjudicate claims and send payments to providers.
B. To receive claims from providers, perform format and data edits, and forward them to
the correct payers.
C. To assign ICD-10 codes to patient records.
D. To collect patient copayments at the time of service.
Correct Answer: B. To receive claims from providers, perform format and data edits,
and forward them to the correct payers.
Rationale: Clearinghouses act as intermediaries that standardize and route electronic
claims, reducing rejections due to formatting errors. Domain: Billing.
Question 12: A patient has Medicare Part A and Part B. They are admitted as an
inpatient for a hip fracture repair. Which part of Medicare covers the inpatient hospital
stay?
A. Part A
B. Part B
C. Part C
D. Part D
Correct Answer: A. Part A
Rationale: Medicare Part A covers inpatient hospital stays, skilled nursing facility care,
hospice, and some home health services. Domain: Reimbursement.
Question 13: Under the False Claims Act, a provider who knowingly submits a
fraudulent claim can face:
A. A warning letter only.
B. Treble damages (three times the government’s loss) plus penalties per claim.
C. A reduction in future payments by 10%.
D. Automatic expulsion from the Medicare program without appeal.
Correct Answer: B. Treble damages (three times the government’s loss) plus penalties
per claim.
Rationale: The False Claims Act imposes significant civil penalties, including treble
damages and fines of over $10,000 per false claim. Domain: Compliance.
2025/2026 Edition
GRADED A+ | LATEST UPDATE | GUARANTEED PASS!!!
Section 1: CRCR Final Exam – 2025/2026
Question 1: If outpatient diagnostic services are provided within three days of the
admission of a Medicare beneficiary to an Inpatient Prospective Payment System (IPPS)
hospital, what must happen to these charges?
A. They must be included in the inpatient claim.
B. They must be billed separately to the Part B Carrier.
C. They are covered under the outpatient facility fee.
D. They are exempt from billing.
Correct Answer: B. They must be billed separately to the Part B Carrier.
Rationale: Medicare’s 72-hour rule requires that outpatient diagnostic services provided
within three days of an inpatient admission to an IPPS hospital be billed separately to
the Part B Carrier, as they are not included in the inpatient DRG payment.
Question 2: What is a recurring or series registration?
A. A single registration for a one-time service.
B. One registration record created for multiple days of service.
C. A registration updated daily for each patient visit.
D. A registration used only for emergency department visits.
Correct Answer: B. One registration record created for multiple days of service.
Rationale: A recurring or series registration is used for patients receiving ongoing
treatments (e.g., chemotherapy), where one registration covers multiple service dates,
streamlining administrative processes.
Question 3: Which of the following is a benefit of pre-registering a patient for services?
A. It increases the likelihood of claim denials.
B. It expedites the patient arrival process, reducing wait times and delays.
C. It eliminates the need for insurance verification.
D. It ensures all services are pre-authorized.
Correct Answer: B. It expedites the patient arrival process, reducing wait times and
delays.
,Rationale: Pre-registration collects patient demographic and insurance information in
advance, allowing for a smoother check-in process and reduced wait times.
Question 4: Under the Medicare 72-hour rule, if outpatient diagnostic services are
performed within three calendar days before a Medicare inpatient admission, how
should the hospital bill for those services?
A. Include them on the inpatient claim as part of the DRG.
B. Bill them separately to the patient as self-pay.
C. Bill them to the Part B carrier as outpatient services.
D. Write them off as a courtesy allowance.
Correct Answer: C. Bill them to the Part B carrier as outpatient services.
Rationale: The 72-hour rule requires that outpatient diagnostic services provided within
three days of an inpatient admission be billed separately to Medicare Part B, not
included in the inpatient DRG payment. Domain: Reimbursement.
Question 5: What is the primary purpose of a "series registration" in an outpatient
oncology clinic?
A. To create a new registration for each chemotherapy visit.
B. To create a single registration record that covers multiple scheduled visits over a
period of time.
C. To eliminate the need for insurance verification.
D. To automatically discharge the patient after each visit.
Correct Answer: B. To create a single registration record that covers multiple scheduled
visits over a period of time.
Rationale: Series registrations streamline administrative work for patients receiving
recurring treatments (e.g., chemotherapy, dialysis) by using one record for multiple
service dates. Domain: Patient Access.
Question 6: Which of the following is a key benefit of pre-registering a patient before a
scheduled procedure?
A. Guarantees that the procedure will be covered in full.
B. Eliminates the need for a signed consent form.
C. Allows time to verify insurance, obtain authorizations, and identify patient financial
responsibility.
D. Automatically waives all deductibles.
Correct Answer: C. Allows time to verify insurance, obtain authorizations, and identify
patient financial responsibility.
Rationale: Pre-registration gives staff time to complete financial clearance tasks before
the patient arrives, reducing denials and improving patient experience. Domain: Patient
Access.
,Question 7: The HCAHPS survey measures patient perspectives on hospital care. Which
of the following domains is included in HCAHPS?
A. Physician board certification status.
B. Communication with nurses and doctors.
C. Hospital profitability.
D. Staff parking availability.
Correct Answer: B. Communication with nurses and doctors.
Rationale: HCAHPS (Hospital Consumer Assessment of Healthcare Providers and
Systems) includes domains such as communication, responsiveness, cleanliness, and
discharge information. Domain: Patient Experience / Compliance.
Question 8: A patient presents for an elective surgery. The registrar discovers that the
required prior authorization was never obtained. What should happen next?
A. Proceed with the surgery as scheduled.
B. Cancel the surgery and refuse to reschedule.
C. Notify the physician and the patient, and attempt to obtain a retroactive
authorization or reschedule once authorization is secured.
D. Bill the patient for the full cost of the surgery.
Correct Answer: C. Notify the physician and the patient, and attempt to obtain a
retroactive authorization or reschedule once authorization is secured.
Rationale: Performing surgery without prior authorization risks denial; best practice is
to delay until authorization is obtained unless it is an emergency. Domain: Patient
Access.
Question 9: What is the "Notice of Admission" (NOA) for Medicare Advantage plans?
A. A form signed by the patient waiving their right to appeal.
B. A notification that the hospital must submit to the Medicare Advantage plan within a
specified timeframe (often 24-48 hours) to receive full payment.
C. A patient satisfaction survey.
D. A discharge planning document.
Correct Answer: B. A notification that the hospital must submit to the Medicare
Advantage plan within a specified timeframe (often 24-48 hours) to receive full
payment.
Rationale: Many Medicare Advantage plans require a NOA to be submitted within 24-
48 hours of admission; failure to do so can result in payment penalties or
denials. Domain: Billing.
Question 10: Which of the following is an example of a "late charge" in hospital billing?
A. A copayment collected at registration.
B. A charge for an emergency department service entered into the system three days
after the patient was discharged.
, C. A contractual adjustment posted at the time of payment.
D. A patient payment made after discharge.
Correct Answer: B. A charge for an emergency department service entered into the
system three days after the patient was discharged.
Rationale: Late charges are those added after the initial claim has been generated or
submitted, often causing delays and increased denials. Domain: Charge Capture.
Question 11: What is the primary function of a "claims clearinghouse"?
A. To adjudicate claims and send payments to providers.
B. To receive claims from providers, perform format and data edits, and forward them to
the correct payers.
C. To assign ICD-10 codes to patient records.
D. To collect patient copayments at the time of service.
Correct Answer: B. To receive claims from providers, perform format and data edits,
and forward them to the correct payers.
Rationale: Clearinghouses act as intermediaries that standardize and route electronic
claims, reducing rejections due to formatting errors. Domain: Billing.
Question 12: A patient has Medicare Part A and Part B. They are admitted as an
inpatient for a hip fracture repair. Which part of Medicare covers the inpatient hospital
stay?
A. Part A
B. Part B
C. Part C
D. Part D
Correct Answer: A. Part A
Rationale: Medicare Part A covers inpatient hospital stays, skilled nursing facility care,
hospice, and some home health services. Domain: Reimbursement.
Question 13: Under the False Claims Act, a provider who knowingly submits a
fraudulent claim can face:
A. A warning letter only.
B. Treble damages (three times the government’s loss) plus penalties per claim.
C. A reduction in future payments by 10%.
D. Automatic expulsion from the Medicare program without appeal.
Correct Answer: B. Treble damages (three times the government’s loss) plus penalties
per claim.
Rationale: The False Claims Act imposes significant civil penalties, including treble
damages and fines of over $10,000 per false claim. Domain: Compliance.
