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HFMA CRCR EXAM LATEST 2024 -2025 ACTUAL EXAM
QUESTIONS WITH CORRECT VERIFIED ANSWERS/
GRADED A+
Medicare Part B has an annual deductible, and the beneficiary is responsible for
a) A co-insurance payment for all Part B covered services
b) Physicians office fees
c) Tests outside of an inpatient setting
d) Prescriptions - Correct Answer - A
The importance of medical records being maintained by HIM is that the patient records
a) Are the primary source for clinical data required for reimbursement by
health plans and liability payers
b) Are the strongest evidence and defense in the event of a Medicare audit
c) Are evidence used in assessing the quality of care
d) Are the evidence cited in quality review - Correct Answer - A
A decision on whether a patient should be admitted as an inpatient or become an outpatient observation patient requires medical judgments based on all of the following
EXCEPT
a) The patient's home care coverage
b) Current medical needs
c) The likelihood of an adverse event occurring to the patient
d) The patient's medical history - Correct Answer - A
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pg. 2 Medicare has established guidelines called the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) that establish
a) Provider and physician reimbursement for specific diagnoses and tests
b) Prospective Medicare patient financial responsibilities for a given
diagnosis
c) Reasonable and customary prices for services in a given area
d) What services or healthcare items are covered under Medicare - Correct Answer - D
What are some core elements if a board-approved financial assistance policy?
a) Payment requirements, staffing hours, and admission policies
b) Case management, payment methods, and discharge policies
c) Deposit requirements, pre-registration calling hours, and charity care policy
d) Eligibility, application process, and nonpayment collection activities - Correct Answer -
D
Which of the following is NOT contained in a collection agency agreement?
a) A clear understanding that the provider retains ownership of any outsourced activities
b) Specific language as to who will pay legal fees, if needed
c) An annual renewal clause
d) A mutual hold-harmless clause - Correct Answer - D
Maintaining routine contact with the health plan or liability payer, making sure all required information is provided and all needed approvals are obtained is the
responsibility of:
a) Patient Accounts
b) Managed Care Contract Staff
c) HIM staff
d) Case Management - Correct Answer - D 2 / 4
pg. 3 What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare?
a) Revenue codes
b) Correct Part A and B procedural codes
c) The CMS 1500 Part B attachment
d) Medical necessity documentation - Correct Answer - A
Before classifying and subsequently writing off an account to financial assistance or bad debt, the hospital must establish policy, define appropriate criteria, implement
procedures for identifying and processing accounts:
a) Monitor compliance
b) Have the account triaged for any partial payment possibilities
c) Assist in arranging for a commercial bank loan
d) Obtain the patients income tax statements from the prior 2 years - Correct Answer - A
For routine scenarios, such as patients with insurance coverage or a known ability to
pay, financial discussions:
a) Are optional
b) Should take place between the patient or guarantor and properly trained provider
representatives
c) May take place between the patient and discharge planning
d) Are focused on verifying required third-party payer information - Correct Answer - B
The purpose of a financial report is to:
a) Provide a public record, if requested
b) Present financial information to decision makers
c) Prepare tax documents
d) Monitor expenses - Correct Answer - B 3 / 4
pg. 4 Which statement is an EMTALA (Emergency Medical Treatment and Active Labor Act) violation?
a) Registration staff may routinely contact managed are plans for prior authorizations
before the patient is seen by the on-duty physician
b) Initial registration activities may occur so long as these activities do not delay
treatment or suggest that treatment with not be provided to uninsured individuals
c) Co-payments may be collected at the time of service once the medical screening and
stabilization activities are completed
d) Signage must be posted where it can be easily seen and read by patients - Correct
Answer - A
A claim is denied for the following reasons, EXCEPT:
a) The health plan cannot identify the subscriber
b) The frequency of service was outside the coverage timeline
c) The submitted claim does not have the physicians signature
d) The subscriber was not enrolled at the time of service - Correct Answer - C
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
a) A court appointed federal mediator
b) The Department of Health and Human Services Provider Relations
Division
c) The Office of the Inspector General
d) The Provider Reimbursement Review Board - Correct Answer - D
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