HFMA CRCR EXAM AND PR ACTICE EXAM NEWEST

• | P a g e

pg. 1

HFMA CRCR EXAM AND PR ACTICE EXAM NEWEST

2025 ACTUAL EXAM TEST BANK| COMPLETE 450

QUESTIONS AND CORRECT DETAILED ANSWERS

(VERIFIED ANSWERS) ALREADY GRADED A+| HFMA

CRCR EXAM PREP |BRAND NEW!!

Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of

persons on a monthly fee is known as a:

A. HMO

B. PPO

C. MSO

• GPO - Correct Answer - A. HMO

Any provider that has filed a timely cost report may appeal an adverse final decision received from the Medicare Administrative Contractor

(MAC). This appeal may be filed with:

• The Provider Reimbursement Review Board
• The Department of Health and Human Services Provider Relations

Division

• A court appointed federal mediator
• The Office of the Inspector General - Correct Answer - A. The

Provider Reimbursement Review Board

• / 4

• | P a g e

pg. 2 Applying the contracted payment methodology to the total charges

yields:

• An estimated price
• An anticipated health plan payment
• A price justified revenue accrual
• A pricing agreement - Correct Answer - A. An estimated price

Appropriate training for the patient financial counselling staff must

cover all of the following EXCEPT:

• Patient financial communications best practices specific to staff role
• Financial assistance policies
• Documenting the conversation in the medical record
• Available patient financing options - Correct Answer - C.

Documenting the conversation in the medical record

The basis for qualification in Medicaid is typically:

• The Federal Poverty Guidelines
• Financial need as demonstrated by the prior two-years federal income

tax fillings

• The patient's score on the Internal Revenue Service's Personal Wealth

and Spending indicator

• Bank statements for the previous 18 months - Correct Answer - A.

The Federal Poverty Guidelines

• / 4

• | P a g e

pg. 3 Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implementation, identifying and processing

accounts and:

• Obtain the patients income tax statements from the prior 2 years
• Having the account triaged for any partial payment possibilities
• Monitor compliance
• Assist in arranging for a commercial bank loan - Correct Answer - C.

Monitor compliance

The concept encompasses all activities required to send a request for

payment to a third-party health plan for payment of benefits:

• Billing
• Account resolution
• Claims Processing
• Third-party invoicing - Correct Answer - C. Claims processing

The benefit of a Medicare Advantage Plan is:

• It is a less costly plan compared to traditional Medicare
• Patients may retain a primary care physician and see another

physician for a second opinion at no charge

• Patients generally have their entire Medicare-covered healthcare

through the plan and do not need to worry about "Part A" or "Part B' benefits

• Patients receive significant discounting on services contracted by the

federal government - Correct Answer - C. 3 / 4

• | P a g e

pg. 4

A benefit period begins:

• With admission as an inpatient
• Upon the day the coverage premium is paid
• The first day in which a patient is furnished extended care services in

the period the patient is entitled to hospital insurance

• Immediately once authorization for treatment is provided by the

health plan - Correct Answer - C. The first day in which a patient is furnished extended care services in the period the patient is entitled to hospital insurance

The best practice in billing is to generate bills and financial information

that is:

• Timely and specifies the patient's next steps
• Clear, concise, correct and patient-friendly
• Comprehensive and all-inclusive
• Direct in summarizing charges and in requesting prompt payment -

Correct Answer - B. Clear, concise, correct and patient-friendly

Case management requires that a case manager be assigned:

• To a select group of resource intensive patient cases
• To every patient
• To specific cases designated by third-party contractual agreement
• To patients of any physician requesting case management - Correct

Answer - B. To every patient

• / 4