HFMA CRCR AND PRACTICE EXAM TEST BANK –
2026/2027 EDITION – VERIFIED QUESTIONS AND
ANSWERS
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include:
Documentation of the medical necessity for the test
What is the advantage of a pre-registration program
It reduces processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry
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?
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
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?
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?
Medical screening and stabilizing treatment
Which of the following is a step in the discharge process?
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?
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?
$100.00
When is a patient considered to be medically indigent?
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?
Sources of readily available funds , vehicles, campers, boats and saving accounts
If the patient cannot agree to payment arrangements, What is the next option?
Warn the patient that unpaid accounts are placed with collection agencies for further processing
, What core financial activities are resolved within patient access?
scheduling , pre-registration, insurance verification and managed care processing
What is an unscheduled direct admission?
A patient who arrives at the hospital via ambulance for treatment in the emergency department
When is it not appropriate to use observation status?
As a substitute for an inpatient admission
Patients who require periodic skilled nursing or therapeutic care receive services from
what type of program?
Home health agency
Every patient who is new to the healthcare provider must be offered what?
A printed copy of the provider privacy notice
Which of the following statements apples to self insured insurance plans?
The employer provides a traditional HMO health plan
In addition to the member's identification number, what information is recorded in a 270
transaction
Name
What process does a patient's health plan use to retroactively collect payments from
liability automobile or worker's compensation plan?
Subrogation
2026/2027 EDITION – VERIFIED QUESTIONS AND
ANSWERS
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include:
Documentation of the medical necessity for the test
What is the advantage of a pre-registration program
It reduces processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry
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?
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
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?
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?
Medical screening and stabilizing treatment
Which of the following is a step in the discharge process?
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?
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?
$100.00
When is a patient considered to be medically indigent?
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?
Sources of readily available funds , vehicles, campers, boats and saving accounts
If the patient cannot agree to payment arrangements, What is the next option?
Warn the patient that unpaid accounts are placed with collection agencies for further processing
, What core financial activities are resolved within patient access?
scheduling , pre-registration, insurance verification and managed care processing
What is an unscheduled direct admission?
A patient who arrives at the hospital via ambulance for treatment in the emergency department
When is it not appropriate to use observation status?
As a substitute for an inpatient admission
Patients who require periodic skilled nursing or therapeutic care receive services from
what type of program?
Home health agency
Every patient who is new to the healthcare provider must be offered what?
A printed copy of the provider privacy notice
Which of the following statements apples to self insured insurance plans?
The employer provides a traditional HMO health plan
In addition to the member's identification number, what information is recorded in a 270
transaction
Name
What process does a patient's health plan use to retroactively collect payments from
liability automobile or worker's compensation plan?
Subrogation
