CERTIFIED REVENUE CYCLE REPRESENTATIVE
EXAM 2 KEY CONCEPTS AND REVENUE CYCLE
PROCESSES 2026
◉ Self-funded benefit plans may choose to coordinate benefits using
the gender rule or what other rule? Answer: Birthday
◉ In what type of payment methodology is a lump sum or bundled
payment negotiated between the payer and some or all providers?
Answer: Case rates
◉ What customer service improvements might improve the patient
accounts department? Answer: Holding staff accountable for
customer service during performance reviews
◉ What is an ABN (Advance Beneficiary Notice of Non-coverage)
required to do? Answer: Inform a Medicare beneficiary that
Medicare may not pay for the order or service
◉ What type of account adjustment results from the patient's
unwillingness to pay for a self-pay balance? Answer: Bad debt
adjustment
,◉ What is the initial hospice benefit? Answer: Two 90-day periods
and an unlimited number of subsequent periods
◉ When does a hospital add ambulance charges to the Medicare
inpatient claim? Answer: If the patient requires ambulance
transportation to a skilled nursing facility
◉ How should a provider resolve a late-charge credit posted after an
account is billed? Answer: Post a late-charge adjustment to the
account
◉ an increase in the dollars aged greater than 90 days from date of
service indicate what about accounts Answer: They are not being
processed in a timely manner
◉ What is an advantage of a preregistration program? Answer: It
reduces processing times at the time of service
◉ What are the two statutory exclusions from hospice coverage?
Answer: Medically unnecessary services and custodial care
◉ What core financial activities are resolved within patient access?
Answer: Scheduling, insurance verification, discharge processing,
and payment of point-of-service receipts
,◉ What statement applies to the scheduled outpatient? Answer: The
services do not involve an overnight stay
◉ How is a mis-posted contractual allowance resolved? Answer:
Comparing the contract reimbursement rates with the contract on
the admittance advice to identify the correct amount
◉ What type of patient status is used to evaluate the patient's need
for inpatient care? Answer: Observation
◉ Coverage rules for Medicare beneficiaries receiving skilled
nursing care require that the beneficiary has received what?
Answer: Medically necessary inpatient hospital services for at least
3 consecutive days before the skilled nursing care admission
◉ When is the word "SAME" entered on the CMS 1500 billing form
in Field 0$? Answer: When the patient is the insured
◉ What are non-emergency patients who come for service without
prior notification to the provider called? Answer: Unscheduled
patients
◉ If the insurance verification response reports that a subscriber
has a single policy, what is the status of the subscriber's spouse?
Answer: Neither enrolled not entitled to benefits
, ◉ Regulation Z of the Consumer Credit Protection Act, also known as
the Truth in Lending Act, establishes what? Answer: Disclosure rules
for consumer credit sales and consumer loans
◉ What is a principal diagnosis? Answer: Primary reason for the
patient's admission
◉ Collecting patient liability dollars after service leads to what?
Answer: Lower accounts receivable levels
◉ What is the daily out-of-pocket amount for each lifetime reserve
day used? Answer: 50% of the current deductible amount
◉ What service provided to a Medicare beneficiary in a rural health
clinic (RHC) is not billable as an RHC services? Answer: Inpatient
care
◉ What code indicates the disposition of the patient at the
conclusion of service? Answer: Patient discharge status code
◉ What are hospitals required to do for Medicare credit balance
accounts? Answer: They result in lost reimbursement and additional
cost to collect
EXAM 2 KEY CONCEPTS AND REVENUE CYCLE
PROCESSES 2026
◉ Self-funded benefit plans may choose to coordinate benefits using
the gender rule or what other rule? Answer: Birthday
◉ In what type of payment methodology is a lump sum or bundled
payment negotiated between the payer and some or all providers?
Answer: Case rates
◉ What customer service improvements might improve the patient
accounts department? Answer: Holding staff accountable for
customer service during performance reviews
◉ What is an ABN (Advance Beneficiary Notice of Non-coverage)
required to do? Answer: Inform a Medicare beneficiary that
Medicare may not pay for the order or service
◉ What type of account adjustment results from the patient's
unwillingness to pay for a self-pay balance? Answer: Bad debt
adjustment
,◉ What is the initial hospice benefit? Answer: Two 90-day periods
and an unlimited number of subsequent periods
◉ When does a hospital add ambulance charges to the Medicare
inpatient claim? Answer: If the patient requires ambulance
transportation to a skilled nursing facility
◉ How should a provider resolve a late-charge credit posted after an
account is billed? Answer: Post a late-charge adjustment to the
account
◉ an increase in the dollars aged greater than 90 days from date of
service indicate what about accounts Answer: They are not being
processed in a timely manner
◉ What is an advantage of a preregistration program? Answer: It
reduces processing times at the time of service
◉ What are the two statutory exclusions from hospice coverage?
Answer: Medically unnecessary services and custodial care
◉ What core financial activities are resolved within patient access?
Answer: Scheduling, insurance verification, discharge processing,
and payment of point-of-service receipts
,◉ What statement applies to the scheduled outpatient? Answer: The
services do not involve an overnight stay
◉ How is a mis-posted contractual allowance resolved? Answer:
Comparing the contract reimbursement rates with the contract on
the admittance advice to identify the correct amount
◉ What type of patient status is used to evaluate the patient's need
for inpatient care? Answer: Observation
◉ Coverage rules for Medicare beneficiaries receiving skilled
nursing care require that the beneficiary has received what?
Answer: Medically necessary inpatient hospital services for at least
3 consecutive days before the skilled nursing care admission
◉ When is the word "SAME" entered on the CMS 1500 billing form
in Field 0$? Answer: When the patient is the insured
◉ What are non-emergency patients who come for service without
prior notification to the provider called? Answer: Unscheduled
patients
◉ If the insurance verification response reports that a subscriber
has a single policy, what is the status of the subscriber's spouse?
Answer: Neither enrolled not entitled to benefits
, ◉ Regulation Z of the Consumer Credit Protection Act, also known as
the Truth in Lending Act, establishes what? Answer: Disclosure rules
for consumer credit sales and consumer loans
◉ What is a principal diagnosis? Answer: Primary reason for the
patient's admission
◉ Collecting patient liability dollars after service leads to what?
Answer: Lower accounts receivable levels
◉ What is the daily out-of-pocket amount for each lifetime reserve
day used? Answer: 50% of the current deductible amount
◉ What service provided to a Medicare beneficiary in a rural health
clinic (RHC) is not billable as an RHC services? Answer: Inpatient
care
◉ What code indicates the disposition of the patient at the
conclusion of service? Answer: Patient discharge status code
◉ What are hospitals required to do for Medicare credit balance
accounts? Answer: They result in lost reimbursement and additional
cost to collect
