CRCR Certification Exam | Healthcare Financial Management Association | 2026/2027 | Q&A

Exam

1/ 67 CRCR Certification Exam | Healthcare Financial Management Association | 2026/2027 | Questions and Correct Answers | 100% guaranteed pa ... ss 2026/2027 | QUESTIONS & CORRECT ANSWERS | 100% VERIFIED STUDY MATERIAL The disadvantages of outsourcing include all of the following EXCEPT: a) The impact of customer service or patient relations b) The impact of loss of direct control of accounts receivable services c) Increased costs due to vendor ineffectiveness d) Reduced internal staffing costs and a reliance on outsourced staff d) Reduced internal staffing costs and a reliance on outsourced staff The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT: a) Medical necessity review by an independent physician's panel b) Judicial review by a federal district court c) Redetermination by the company that handles claims for Medicare d) Review by the Medicare Appeals Council (Appeals Council) b) Judicial review by a federal district court Business ethics, or organizational ethics represent: a) The principles and standards by which organizations operate b) Regulations that must be followed by law c) Definitions of appropriate customer service d) The code of acceptable conduct a) The principles and standards by which organizations operate 2/ 67 A portion of the accounts receivable inventory which has NOT qualified for billing includes: a) Charitable pledges b) Accounts created during pre- registration but not activated c) Accounts coded but held within the suspense period d) Accounts assigned to a pre- collection agency a) Charitable pledges Local Coverage Determinations c) Which diagnoses, signs, or symptoms are (LCD) and National Coverage reimbursable Determinations (NCD) are Medicare established guideline(s) used to determine: a) Medicare and Medicaid provider eligibility b) Medicare outpatient reimbursement rates c) Which diagnoses, signs, or symptoms are reimbursable d) What Medicare reimburses and what should be referred to Medicaid Days in A/R is calculated based on c) The time it takes to collect anticipated revenue the value of: a) The total accounts receivable on a specific date b) Total anticipated revenue minus expenses c) The time it takes to collect anticipated revenue d) Total cash received to date 3/ 67 Patients are contacting hospitals to b) The fact that charge master lists the total charge, proactively inquire about costs and not net charges fees prior to that reflect charges after a payer's contractual agreeing to service. The problem for adjustment hospitals in providing such information is: a) That hospitals don't want to establish a price without knowing if the patient has insurance and how much reimbursement can be expected b) The fact that charge master lists the total charge, not net charges that reflect charges after a payer's contractual adjustment c) That hospitals don't want to be put in the position of "guaranteeing" price without having room for additional charges that may arise in the course of treatment d) Their reluctance to share proprietary information Across all care settings, if a patient c) Support that choice, providing that the discussion consents to a financial discussion does not interfere with patient care or disrupt patient during a medical flow encounter to expedite discharge, the HFMA best practice is to: a) Make sure that the attending staff can answer questions and assist in obtaining required patient financial data b) Have a patient responsibilities kit ready for the patient, containing all of the required registration forms and instructions c) Support that choice, providing that the discussion does not interfere with patient care or disrupt patient flow d) Decline such request as finance discussions can disrupt patient care and patient flow 4/ 67 A comprehensive "Compliance c) Systematic procedures to ensure that the Program" is defined as provisions of regulations imposed by a government a) Annual legal audit and review for adherence to regulations b) Educating staff on regulations c) Systematic procedures to ensure that the provisions of regulations imposed by a government agency are being met d) The development of operational policies that correspond to regulations 10. Case Management requires that a b) To a select patient group case manager be assigned a) To patients of any physician requesting case management b) To a select patient group c) To every patient d) To specific cases designated by third party contractual agreement 5/ 67 Pricing transparency is defined as a) Identify, compare, and choose providers that offer readily available information on the the desired level of value price of healthcare services, that together with other information, help define the value of those services and enable consumers to a) Identify, compare, and choose providers that offer the desired level of value b) Customize health care with a personally chosen mix of providers c) Negotiate the cost of health plan premiums d) Verify the cost of individual clinicians Any healthcare insurance plan that b) HMO provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a monthly fee is known as a a) MSO b) HMO c) PPO d) GPO In a Chapter 7 Straight Bankruptcy a) The court liquidates the debtor's nonexempt filing property, pays creditors, and discharges the debtor a) The court liquidates the debtor's from the debt nonexempt property, pays creditors, and discharges the debtor from the debt b) The court liquidates the debtor's nonexempt property, pays creditors, and begins to pay off the largest claims first. All claims are paid some portion of the amount owed c) The court vacates all claims against a debtor with the understanding that the debtor may not apply for credit without court supervision d) The court establishes a creditor payment schedule with the longest outstanding claims paid first 6/ 67 14. The core financial activities a) Scheduling, pre-registration, insurance resolved within patient access verification and managed care processing include: a) Scheduling, pre-registration, insurance verification and managed care processing b) Scheduling, insurance verification, clinical discharge processing and payment posting of point of service receipts c) Scheduling, registration, charge entry and managed care processing d) Scheduling, pre-registration, registration, medical necessity screening and patient refunds 15. Which of the following is NOT d) A mutual hold-harmless clause 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 16. Maintaining routine contact with d) Case Management 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 What is required for the UB-04/837-I, a) Revenue codes 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 7/ 67 Before classifying and subsequently a) Monitor compliance 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 For routine scenarios, such as b) Should take place between the patient or patients with insurance coverage or a guarantor and properly trained provider known ability to pay, financial representatives 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 The purpose of a financial report is to: b) Present financial information to decision makers a) Provide a public record, if requested b) Present financial information to decision makers c) Prepare tax documents d) Monitor expenses 8/ 67 Which statement is an EMTALA a) Registration staff may routinely contact managed (Emergency Medical Treatment and are plans for prior authorizations before the patient Active Labor Act) violation? is seen by the on-duty physician 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 A claim is denied for the following c) The submitted claim does not have the physicians reasons, EXCEPT: signature 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 Any provider that has filed a timely d) The Provider Reimbursement Review Board 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 9/ 67 Charges, as the most appropriate a) Generation of timely and accurate billing measurement of utilization, enables a) Generation of timely and accurate billing b) Managing of expense budgets c) Accuracy of expense and cost capture d) Effective HIM planning Ambulance services are billed directly c) The portion of the bill outside of the patient's self- to the health plan for pay a) All pre-admission emergency transports b) Services provided before a patient is admitted and for ambulance rides arranged to pick up the patient from the hospital after discharge to take him/her home or to another facility c) The portion of the bill outside of the patient's self-pay d) Transports deemed medically necessary by the attending paramedic-ambulance crew An individual enrolled in Medicare a) A beneficiary appeal who is dissatisfied with the government's claim determination is entitled to reconsideration of the decision. This type of appeal is known as a) A beneficiary appeal b) A Medicare supplemental review c) A payment review d) A Medicare determination appeal The nuanced data resulting from d) Obtain higher compensation for physicians detailed ICD-10 coding allows senior leadership to work with physicians to do all of the following EXCEPT: a) Drive significant improvements in the areas of quality and the patient experience b) Embrace new reimbursement models c) Improve outcomes d) Obtain higher compensation for physicians 10 / Duplicate payments occur: a) When providers re-bill claims based on a) When providers re-bill claims nonpayment from the initial bill submission based on nonpayment from the initial bill submission b) When service departments do not process charges with the organization's suspense days c) When the payer's coordination of benefits is not captured correctly at the time of patient registration d) When there are other healthcare claims in process and the anticipated deductibles and co- insurance amounts still show open but will be met by the in-process claims The Affordable Care Act legislated the a) Purchase qualified health benefit plans regardless development of Health Insurance of insured's health status Exchanges, where individuals and small businesses can a) Purchase qualified health benefit plans regardless of insured's health status b) Obtain price estimates for medical services c) Negotiate the price of medical services with providers d) Meet federal mandates for insurance coverage and obtain the corresponding tax deduction The most common resolution a) Designate the overpayment for charity care methods for credit balances include all the following EXCEPT: a) Designate the overpayment for charity care b) Submit the corrected claim to the payer incorporating credits c) Either send a refund or complete a takeback form as directed by the payer d) Determine the correct primary payer and notify incorrect payer of overpayment 11 / EFT (electronic funds transfer) is d) An electronic transfer of funds from payer to a) An electronic claim submission payee b) The record of payments in the hospital's accounting system c) An electronic confirmation that a payment is due d) An electronic transfer of funds from payer to payee Revenue cycle activities occurring at c) Providing charges to the third-party payer as they the point-of-service include all the are incurred following EXCEPT: a) The monitoring of charges b) The provision of case management and discharge planning services c) Providing charges to the third-party payer as they are incurred d) The generation of charges Medicare beneficiaries remain in the b) Until the beneficiary is "hospitalization and/or same "benefit period" skilled nursing facility-free" for 60 consecutive days a) Up to hospitalization discharge b) Until the beneficiary is "hospitalization and/or skilled nursing facility-free" for 60 consecutive days c) Each calendar year d) Up to 60 days Key Performance Indicators (KPIs) b) Provide a method of measuring the collection and set standards for accounts control of A/R receivables (A/R) and a) Provide evidence of financial status b) Provide a method of measuring the collection and control of A/R c) Establish productivity targets d) Make allowance for accurate revenue forecasting 12 / Recognizing that health coverage is b) Patients should be given the opportunity to complicated and not all patients are request a patient advocate, family member, or other able to navigate this terrain, HFMA designee to help them in these discussions best practices specify that a) The patient accounts staff have someone assigned to research coverage on behalf of patients b) Patients should be given the opportunity to request a patient advocate, family member, or other designee to help them in these discussions c) Patient coverage education may need to be provided by the health plan d) A representative of the health plan be included in the patient financial responsibilities discussion When there is a request for service, d) Ensure that she/he accesses the correct the scheduling staff member must information in the historical database confirm the patient's unique identification information to a) Check if there is any patient balance due b) Verify the patient's insurance coverage if the patient is a returning customer c) Confirm that physician orders have been received d) Ensure that she/he accesses the correct information in the historical database Once the price is estimated in the a) Explain to the patient their financial responsibility pre-service stage, a provider's and to determine the plan for payment financial best practice is to a) Explain to the patient their financial responsibility and to determine the plan for payment b) Allow the patient time to compare prices with other providers c) Lock-in the prices d) Have another employee double check the price estimate 13 / What type of account adjustment b) Bad debt adjustment results from the patient's unwillingness to pay a self-pay balance? a) Charity adjustment b) Bad debt adjustment c) Contractual adjustment d) Administrative adjustment All of the following are conditions that d) Services and procedures that are custodial in disqualify a procedure or service from nature being paid for by Medicare EXCEPT a) Medically unnecessary b) Not delivered in a Medicare licensed care setting c) Offered in an outpatient setting d) Services and procedures that are custodial in nature All of the following are forms of a) Contracted Rebating hospital payment contracting EXCEPT a) Contracted Rebating b) Per Diem Payment c) Fixed Contracting d) Bundled Payment Overall aggregate payments made to d) The Medicare Administrative Contractor (MAC) at a hospice are subject to a computed the end of the hospice cap period "cap amount" calculated by: a) The Center for Medicare and Medicaid Services (CMS) b) Each state's Medicaid plan c) Medicare d) The Medicare Administrative Contractor (MAC) at the end of the hospice cap period 14 / With the advent of the Affordable d) Assist patients in understanding their insurance Care Act Health Insurance coverage and their financial obligation Marketplaces and the expansion of Medicaid in some states, it is out than ever for hospitals to a) Reschedule the visit for non- payment of a prior balance b) Strictly limit charity care and bad- debt c) Collect patient's self-pay and deductibles in the first encounter d) Assist patients in understanding their insurance coverage and their financial obligation A nightly room charge will be incorrect d) Transfer from ICU (intensive care unit) to the if the patient's Medical/Surgical floor is not reflected in the a) Discharge for the next day has not registration system been charted b) Condition has not been discussed during the shift change report meeting c) Pharmacy orders to the ICU have not been entered in the pharmacy system d) Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system Which of the following is required for a) Meet income and assets requirements participation in Medicaid? a) Meet income and assets requirements b) Meet a minimum yearly premium c) Be free of chronic conditions d) Obtain a health insurance policy HFMA best practices call for patient b) By copying the provider's attorney on a written financial discussions to be reinforced statement of conversation a) By issuing a new invoice to the patient b) By copying the provider's attorney on a written statement of conversation c) By obtaining some type of collateral d) By changing policies to programs 1

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