HFMA CRCR Test Bank 2026 (151 Questions) | Latest
Update 2026 | 100% Correct Answers | Actual Exam
Questions
1. If a healthcare facility does not include out-of-network providers in its
Financial Assistance Policy (FAP), how might this impact patient access to
financial support?
All patients will receive financial assistance regardless of provider
status.
Patients will have more options for financial assistance.
Out-of-network providers will automatically be included in the FAP.
Patients using out-of-network providers may not receive financial
assistance, limiting their access to care.
2. Which statement is NOT a unique billing rule specific to providers?
When billing services on a UB-04/837-1, specific CPT codes are
collapsed into a single revenue code (520 or 521)
With the exception of physician services, Medicare reimbursement for
hospice care is made at one of four pre-determined rates for each day
of hospice care.
A patient may be balance billed for whatever amount the non-
contracting physician charges above the health plan's
reimbursement
Overall aggregate payments made to a hospice are subject to a "cap
amount", calculated by the MAC at the end of the hospice cap period.
3. Coding systems are:
A method of monitoring disease processes.
, All of the above.
Used to place verbal descriptions of medical conditions or
procedures into alpha-numeric codes.
Used to allow for easier statistical tracking of medical conditions or
procedural uses.
4. What must be done with credit balances in healthcare billing according to
compliance regulations?
Credit balances must be refunded to patients
Credit balances can be ignored
Credit balances can be transferred to other accounts
Credit balances are not reported
5. PPO networks represent one form of discounting commonly used by
commercial payers. The silent PPO represents:
A discounting scheme whereby health plans apply generic PPO
rates to discount a provider's claims, even though there is no
contractual arrangement between the silent PPO and the provider.
A discounting scheme whereby the PPO sets a discount amount
based on its internal calculations of the value of the care provided.
A payment scheme whereby the PPO pays a set percentage of
charges.
A payment scheme which applies APC grouping to determine the cost
to charge ratio to be used in paying claims.
6. Describe the role of KPIs in improving healthcare revenue cycle
management.
KPIs are used to track compliance with healthcare regulations only.
KPIs are only relevant for billing departments and have no effect on
, patient care.
KPIs are primarily used for patient satisfaction surveys and do not
impact financial outcomes.
KPIs help measure the efficiency and effectiveness of revenue cycle
processes, guiding improvements in financial performance and
patient care.
7. Describe how implementing consistent policies can help mitigate the risk of
ethics violations in healthcare.
Inconsistent policies can lead to better patient care.
Consistent policies only benefit financial outcomes, not ethical
behavior.
Policies are irrelevant if staff are trained properly.
Consistent policies help ensure that all staff members understand
and adhere to ethical standards, reducing the likelihood of
misconduct.
8. Describe how inaccuracies in the chargemaster can impact healthcare
revenue cycle management.
Inaccuracies in the chargemaster only affect the scheduling of patient
appointments.
Inaccuracies in the chargemaster only impact compliance with
regulations.
Inaccuracies in the chargemaster have no significant effect on overall
revenue.
Inaccuracies in the chargemaster can lead to billing errors, which
may result in revenue loss and decreased patient trust.
9. Claim edits help to identify errors that will cause a claim to be rejected if not
addressed. An example of an error that can be identified is _.
, Incorrect gender on an appendectomy case
Incorrect discharge disposition
Incorrect admission date
Mutually exclusive CPT/HCPCS codes and medically unlikely
quantities
10. Describe the role of coding systems in the healthcare revenue cycle
management process.
Coding systems are irrelevant to financial outcomes in healthcare.
Coding systems only apply to pharmaceutical billing.
Coding systems are essential for accurately billing services and
ensuring compliance with regulations.
Coding systems are used solely for patient record keeping.
11. If a healthcare organization decides to outsource billing and collections but
keeps Health Care Patient Services in-house, what might be a potential
benefit?
Reduced compliance risks in billing.
Lower operational costs across all departments.
Improved patient satisfaction due to personalized service.
Increased revenue from faster billing processes.
12. Why is enhancing communication with patients about their financial
responsibilities important in healthcare revenue cycle management?
It focuses solely on reducing bad debt.
It reduces the need for compliance programs.
It helps patients understand their financial obligations and
improves overall patient satisfaction.
Update 2026 | 100% Correct Answers | Actual Exam
Questions
1. If a healthcare facility does not include out-of-network providers in its
Financial Assistance Policy (FAP), how might this impact patient access to
financial support?
All patients will receive financial assistance regardless of provider
status.
Patients will have more options for financial assistance.
Out-of-network providers will automatically be included in the FAP.
Patients using out-of-network providers may not receive financial
assistance, limiting their access to care.
2. Which statement is NOT a unique billing rule specific to providers?
When billing services on a UB-04/837-1, specific CPT codes are
collapsed into a single revenue code (520 or 521)
With the exception of physician services, Medicare reimbursement for
hospice care is made at one of four pre-determined rates for each day
of hospice care.
A patient may be balance billed for whatever amount the non-
contracting physician charges above the health plan's
reimbursement
Overall aggregate payments made to a hospice are subject to a "cap
amount", calculated by the MAC at the end of the hospice cap period.
3. Coding systems are:
A method of monitoring disease processes.
, All of the above.
Used to place verbal descriptions of medical conditions or
procedures into alpha-numeric codes.
Used to allow for easier statistical tracking of medical conditions or
procedural uses.
4. What must be done with credit balances in healthcare billing according to
compliance regulations?
Credit balances must be refunded to patients
Credit balances can be ignored
Credit balances can be transferred to other accounts
Credit balances are not reported
5. PPO networks represent one form of discounting commonly used by
commercial payers. The silent PPO represents:
A discounting scheme whereby health plans apply generic PPO
rates to discount a provider's claims, even though there is no
contractual arrangement between the silent PPO and the provider.
A discounting scheme whereby the PPO sets a discount amount
based on its internal calculations of the value of the care provided.
A payment scheme whereby the PPO pays a set percentage of
charges.
A payment scheme which applies APC grouping to determine the cost
to charge ratio to be used in paying claims.
6. Describe the role of KPIs in improving healthcare revenue cycle
management.
KPIs are used to track compliance with healthcare regulations only.
KPIs are only relevant for billing departments and have no effect on
, patient care.
KPIs are primarily used for patient satisfaction surveys and do not
impact financial outcomes.
KPIs help measure the efficiency and effectiveness of revenue cycle
processes, guiding improvements in financial performance and
patient care.
7. Describe how implementing consistent policies can help mitigate the risk of
ethics violations in healthcare.
Inconsistent policies can lead to better patient care.
Consistent policies only benefit financial outcomes, not ethical
behavior.
Policies are irrelevant if staff are trained properly.
Consistent policies help ensure that all staff members understand
and adhere to ethical standards, reducing the likelihood of
misconduct.
8. Describe how inaccuracies in the chargemaster can impact healthcare
revenue cycle management.
Inaccuracies in the chargemaster only affect the scheduling of patient
appointments.
Inaccuracies in the chargemaster only impact compliance with
regulations.
Inaccuracies in the chargemaster have no significant effect on overall
revenue.
Inaccuracies in the chargemaster can lead to billing errors, which
may result in revenue loss and decreased patient trust.
9. Claim edits help to identify errors that will cause a claim to be rejected if not
addressed. An example of an error that can be identified is _.
, Incorrect gender on an appendectomy case
Incorrect discharge disposition
Incorrect admission date
Mutually exclusive CPT/HCPCS codes and medically unlikely
quantities
10. Describe the role of coding systems in the healthcare revenue cycle
management process.
Coding systems are irrelevant to financial outcomes in healthcare.
Coding systems only apply to pharmaceutical billing.
Coding systems are essential for accurately billing services and
ensuring compliance with regulations.
Coding systems are used solely for patient record keeping.
11. If a healthcare organization decides to outsource billing and collections but
keeps Health Care Patient Services in-house, what might be a potential
benefit?
Reduced compliance risks in billing.
Lower operational costs across all departments.
Improved patient satisfaction due to personalized service.
Increased revenue from faster billing processes.
12. Why is enhancing communication with patients about their financial
responsibilities important in healthcare revenue cycle management?
It focuses solely on reducing bad debt.
It reduces the need for compliance programs.
It helps patients understand their financial obligations and
improves overall patient satisfaction.
