CRCR Exam Prep, Multiple Choice, Certified
Revenue Cycle Representative – exam questions
with correct answers 2026
1. In what situation(s) should a provider NOT use a modifier?: - CPT already indicates 2-4
lesions
- CPT indicates multiple extremities
2. What are other names for Three-Day Payment Window?: ALL OF THE ABOVE
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
3. What happens during the post-service stage?: Final coding, preparation and submission of
claims, payment processing, balance billing and resolution.
4. What are the below tasks part of?
- Educate patients
- Coordinate to avoid duplicate patient contacts
- Be consistent in key aspects of account resolution
- Follow best practices for communication: Best practices created by the Medical Debt Task Force
5. Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle
initiative?: Process Compliance
6. Which option is NOT a continuum of care provider?
A. Physician
B. Health Plan Contracting
C. Hospice
,D. Skilled Nursing Facility: B. Health Plan Contracting
7. What is "implied certification"?: When it is implied that a provider met all compliance standards
before submitting a claim
8. Which of the following are essential elements of an effective compliance
program?
A. Established compliance standards and procedures.
B. Designation of a compliance officer employed within the Billing Depart-
ment.
C. Oversight of personnel by high-level personnel.
D. Automatic dismissal of any employee excluded from participation in a federal
,healthcare program.
A. Reasonable methods to achieve compliance with standards, including mon-itoring
systems and hotlines.: A. Established compliance standards and procedures.
C. Oversight of personnel by high-level personnel.
E. Reasonable methods to achieve compliance with standards, including monitoring systems and hotlines.
1. When was Health Information Technology for Economic and Clinical Health
(HITECH) Act signed into law?: FEB 17, 2009
2. When did HITECH Act become effective?: 2013
3. Annually, the OIG publishes a work plan of compliance issues and objectives
that will be focused on throughout the following year. Identify which option is
NOT a work plan task mentioned in this course.
A. Payments to Physicians for Co-Surgery Procedures
B. Denials and Appeals in Medicare Part D
C. Medicare Hospital Payments for Claims Involving the Acute- and
Post-Acute-Care Transfer Policies
D. Standard Unique Employer Identifier: D. Standard Unique Employer Identifier
4. What Plan are the tasks below a part of?
- Medicare Payments Made Outside of the Hospice Benefit
- Denials and Appeals in Medicare Part C and Part D
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits: The 2020
OIG Work Plan
5. When was the Preservation of Access to Care for Medicare Beneficiaries and
Pension Relief Act signed into law?: JUNE 25 2010
6. What is the Medicare DRG Three-Day Payment Window?: All Diagnostic services
provided to a Medicare patient by a hospital on the Date of the patient's Inpatient admission or during the 3 calendar
, days (or in the case of a non-IPPS hospital: 1 calendar day) immediately BEFORE the Date of Admission are REQUIRED
to be included on the bill for the IP stay (unless there is no Part A coverage)
7. Do Outpatient Non-Diagnostic Services qualify for separate payments if
provided with the Three-Day Payment Window?: No
8. What is modifier 59?: Used to identify CPTs OTHER THAN E&M services, NOT normally reported together,
but are appropriate under the circumstances.
Documentation must support a ditterent session, ditterent procedure or surgery, ditterent site or organ system,
separate.
9. What is condition code 51?: Code noted on the separate UB-04 OP claim, thus indicating the charge
is unrelated to the admission.
10. What kind of hospitals are the following:
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's
hospitals for examples: Non-IPPS hospitals
11. What are the 3 types of medical necessity screenings and noncoverage no-
tifications required in the Medicare program?: 1. Advanced Beneficiary Notice of Noncoverage
(ABN) for Part B services.
2. SNF ABN for Part A SNF services.
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
12. What is Medicare Part B ABN?: Used to explain to a Medicare patient that the ordered test or services
probably WILL NOT be covered by the Medicare b/c the DX info provided by the Dr. does NOT support the need for
these services.
****May also be used for voluntary notifications, in place of the Notice of Exclusion for Medicare Benefits (NEMB).
13. What is the Two-Midnight Rule?: Hospital admissions spanning 2 midnights would be considered
appropriate for payment under the IPPS rule
14. What are some MSP claims that require additional review by the OIG to
ensure compliance?: - W/C
- Black Lung Program services
Revenue Cycle Representative – exam questions
with correct answers 2026
1. In what situation(s) should a provider NOT use a modifier?: - CPT already indicates 2-4
lesions
- CPT indicates multiple extremities
2. What are other names for Three-Day Payment Window?: ALL OF THE ABOVE
72-hour rule, DRG window, Three-Day Window, 1 day window or 24-hour rule
3. What happens during the post-service stage?: Final coding, preparation and submission of
claims, payment processing, balance billing and resolution.
4. What are the below tasks part of?
- Educate patients
- Coordinate to avoid duplicate patient contacts
- Be consistent in key aspects of account resolution
- Follow best practices for communication: Best practices created by the Medical Debt Task Force
5. Which option is NOT a main HFMA Healthcare Dollars & Sense® revenue cycle
initiative?: Process Compliance
6. Which option is NOT a continuum of care provider?
A. Physician
B. Health Plan Contracting
C. Hospice
,D. Skilled Nursing Facility: B. Health Plan Contracting
7. What is "implied certification"?: When it is implied that a provider met all compliance standards
before submitting a claim
8. Which of the following are essential elements of an effective compliance
program?
A. Established compliance standards and procedures.
B. Designation of a compliance officer employed within the Billing Depart-
ment.
C. Oversight of personnel by high-level personnel.
D. Automatic dismissal of any employee excluded from participation in a federal
,healthcare program.
A. Reasonable methods to achieve compliance with standards, including mon-itoring
systems and hotlines.: A. Established compliance standards and procedures.
C. Oversight of personnel by high-level personnel.
E. Reasonable methods to achieve compliance with standards, including monitoring systems and hotlines.
1. When was Health Information Technology for Economic and Clinical Health
(HITECH) Act signed into law?: FEB 17, 2009
2. When did HITECH Act become effective?: 2013
3. Annually, the OIG publishes a work plan of compliance issues and objectives
that will be focused on throughout the following year. Identify which option is
NOT a work plan task mentioned in this course.
A. Payments to Physicians for Co-Surgery Procedures
B. Denials and Appeals in Medicare Part D
C. Medicare Hospital Payments for Claims Involving the Acute- and
Post-Acute-Care Transfer Policies
D. Standard Unique Employer Identifier: D. Standard Unique Employer Identifier
4. What Plan are the tasks below a part of?
- Medicare Payments Made Outside of the Hospice Benefit
- Denials and Appeals in Medicare Part C and Part D
- Medicare Part B Payments for End-Stage Renal Disease Dialysis Services
- Review of Home Health Claims for Services With 5 to 10 Skilled Visits: The 2020
OIG Work Plan
5. When was the Preservation of Access to Care for Medicare Beneficiaries and
Pension Relief Act signed into law?: JUNE 25 2010
6. What is the Medicare DRG Three-Day Payment Window?: All Diagnostic services
provided to a Medicare patient by a hospital on the Date of the patient's Inpatient admission or during the 3 calendar
, days (or in the case of a non-IPPS hospital: 1 calendar day) immediately BEFORE the Date of Admission are REQUIRED
to be included on the bill for the IP stay (unless there is no Part A coverage)
7. Do Outpatient Non-Diagnostic Services qualify for separate payments if
provided with the Three-Day Payment Window?: No
8. What is modifier 59?: Used to identify CPTs OTHER THAN E&M services, NOT normally reported together,
but are appropriate under the circumstances.
Documentation must support a ditterent session, ditterent procedure or surgery, ditterent site or organ system,
separate.
9. What is condition code 51?: Code noted on the separate UB-04 OP claim, thus indicating the charge
is unrelated to the admission.
10. What kind of hospitals are the following:
Cancer treatment facilities, psychiatric, IP rehabilitation, LTC and children's
hospitals for examples: Non-IPPS hospitals
11. What are the 3 types of medical necessity screenings and noncoverage no-
tifications required in the Medicare program?: 1. Advanced Beneficiary Notice of Noncoverage
(ABN) for Part B services.
2. SNF ABN for Part A SNF services.
3. HINN - Hospital-Issued Notice of Non-Coverage (Part A)
12. What is Medicare Part B ABN?: Used to explain to a Medicare patient that the ordered test or services
probably WILL NOT be covered by the Medicare b/c the DX info provided by the Dr. does NOT support the need for
these services.
****May also be used for voluntary notifications, in place of the Notice of Exclusion for Medicare Benefits (NEMB).
13. What is the Two-Midnight Rule?: Hospital admissions spanning 2 midnights would be considered
appropriate for payment under the IPPS rule
14. What are some MSP claims that require additional review by the OIG to
ensure compliance?: - W/C
- Black Lung Program services
