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HFMA CRCR EXAM LATEST 2024-2025 ACTUAL EXAM
AND PRACTICE EXAM COMPLETE 300 QUESTIONS AND
DETAILED CORRECT ANSWERS
HFMA CRCR EXAM A
The Affordable Health Care Act legislated the development of Health Insurance Exchange, where individuals and small businesses can: - ANSWER-Purchase health benefits plans regardless of insured's health status
Before classifying and subsequently writing off an account to financial assistance or bad debit, the hospital must establish policy define appropriate criteria, implement procedures for
identifying accounts and: - ANSWER-Monitor compliance
The Electronic Remittance Advice (ERA) data sets are: - ANSWER-A standardized for that provides 3rd party payment details to providers
The first and most critical step in registering a patient, whether scheduled or unscheduled is: - ANSWER-Verifying the patient's identification
The standard claim form used for the billing by hospitals, nursing facilities, and other inpatient
services is called the: - ANSWER-UB-04
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2 A four-digit number code established by the National Uniform Billing Committee (NUBC) that categorizes/classifies a line in the charge master is known as: - ANSWER-Revenue codes
Internal controls addressing coding and reimbursement charges are put in place to guard
against: - ANSWER-Compliance fraud by "upcoding"
The 501(R) regulations require non-for-profit providers (501) ©(3) organizations to do which of the following activities: - ANSWER-Complete a community needs assessment and develop a discount program for patient's balances after insurance payment
During pre-registration, a search for the patient's MRI number is initiated using which of the following data sets: - ANSWER-Patient's full legal name and date of birth or the patient's Social Security number
To maximize the value derived from customer complaints, all consumer complaints should be: - ANSWER-Tracked and shared to improve the customer experience
The Business ethics, or organizational ethics represent: - ANSWER-The principles and standards by which organizations operate
Providers are advised that it is best to establish patient financial responsibility and assistance policies and make sure they are followed internally and by: - ANSWER-Third-party payers 2 / 4
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The advantage to using a third-part, collection agency includes all of the following EXCEPT: - ANSWER-Providers pay pennies on each dollar collected.
Local Coverage Determination (LCD) and National Coverage Determinations (NCD) are Medicare established guidelines used to determine: - ANSWER-Which diagnosis, signs, or symptoms are reimbursable
Claims with the dates of service received later than one calendar year beyond the date of
service will be: - ANSWER-Denied by Medicare
in the pre-service stage, the requested service is screened for medical necessity, health plan
coverage and benefits are verified and: - ANSWER-Pre-authorization are obtained
For scheduled patients, important revenue cycle activities in the time-of -service stage DO NOT
include: - ANSWER-Final bill is presented for payment
If a medical service authorization, who is typically responsible for obtaining the authorization: - ANSWER-The provider scheduling
Concurrent review and discharge planning - ANSWER-Occurs during service 3 / 4
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The fundamental approach in managing denials is: - ANSWER-To analyze the type and sources of denials and consider process changes to eliminate further denials
The first thing a health plan does when processing a claim is: - ANSWER-Check if the patient is a health plan beneficiary and what is the coverage
Outsourcing options should be evaluated as - ANSWER-Any other business service purchase
Insurance verification results in which of the following: - ANSWER-The accurate identification of the patient's eligibility and benefits
EMTLA and HFMA best practices specify that in an Emergency Department setting: - ANSWER- No patient financial discussions should occur before a patient is screened and stabilized
he HCCAHPS (Hospital Consumer Assessment of Healthcare Provider's and Systems) initiative was launched to: - ANSWER-Provide a standardized method for evaluation patients' perspective on hospital care
All of the following are potential causes of credit balances EXCEPT: - ANSWER-A patient's choice to build up a credit against future medical bills
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