CRCR CERTIFICATION (HFMA) ACTUAL EXAM 2026/2027 HIGH
QUALITY PRACTICE QUESTIONS AND STUDY GUIDE ACCURATE
QUESTIONS AND CORRECT DETAILED SOLUTIONS WITH
RATIONALES (100% CORRECT VERIFIED ANSWERS) LATEST
UPDATED VERSION 2026 EDITION |GUARANTEED PASS A+ |FULL
REVISED CRCR CERTIFICATION (HFMA) EXAM |INSTANT
DOWNOAD PDF
1. A patient present for an outpatient surgical procedure. The registrar
collects the insurance card and verifies eligibility. Which revenue cycle
key performance indicator (KPI) is most directly impacted by accurate
eligibility verification at this point?
A) Days in Accounts Receivable (A/R)
B) Clean claim rate
C) Bad debt percentage
D) Point-of-service collection rate
Correct Answer: B) Clean claim rate (Ensuring eligibility upfront
reduces denials, increasing clean claim rate.)
2. Under the CMS Inpatient Prospective Payment System (IPPS), what
payment methodology is used to reimburse hospitals for inpatient stays?
A) Per diem
B) Fee-for-service (FFS)
C) Diagnosis-Related Group (DRG)
D) Percentage of charges
Correct Answer: C) Diagnosis-Related Group (DRG) (IPPS uses
DRG-based fixed payment per discharge.)
,3. A patient has a commercial insurance plan with
a 2,000deductibleandan80/20coinsuranceafterdeductible.Iftheallowedam
ountforaprocedureis2,000deductibleandan80/20coinsuranceafterdeducti
ble.Iftheallowedamountforaprocedureis5,000 and the patient has
met 500ofthedeductible,howmuchwillthepatientowe?A)500ofthededucti
ble,howmuchwillthepatientowe?A)1,000
B) 1,500C)1,500C)2,400
D) $3,500
**Correct Answer: C) 2,400∗∗ (2,400∗∗ (1,500 remaining deductible +
20% coinsurance on remaining 3,500=3,500=700, total $2,400.)
4. Which of the following is a core requirement of the HIPAA Privacy
Rule regarding patient health information (PHI)?
A) Using PHI for marketing without authorization
B) Providing patients with access to their PHI upon request
C) Storing PHI unencrypted on public servers
D) Disclosing PHI to employers without consent
Correct Answer: B) Providing patients with access to their PHI
upon request (HIPAA gives patients right to access and obtain copies of
their PHI.)
5. In revenue cycle management, what is the primary goal of a denial
management process?
A) Reduce the number of claims submitted
B) Identify root causes of denials and prevent recurrence
C) Increase days in A/R
D) Write off all denied claims as bad debt
,Correct Answer: B) Identify root causes of denials and prevent
recurrence (Denial management aims to correct processes and appeal
valid denials.)
6. Which coding system is used primarily for outpatient services,
physician offices, and emergency department visits to report procedures
and services?
A) ICD-10-CM
B) ICD-10-PCS
C) CPT/HCPCS Level I
D) HCPCS Level II
Correct Answer: C) CPT/HCPCS Level I (CPT codes report medical
procedures and services in outpatient/physician settings.)
7. A patient is readmitted to the same hospital within 30 days of
discharge for a related condition. Under the Hospital Readmissions
Reduction Program (HRRP), which condition is NOT currently targeted
for payment reduction?
A) Acute Myocardial Infarction (AMI)
B) Chronic Obstructive Pulmonary Disease (COPD)
C) Hip/knee arthroplasty
D) Generalized anxiety disorder
Correct Answer: D) Generalized anxiety disorder (HRRP targets
AMI, COPD, heart failure, pneumonia, and hip/knee arthroplasty.)
, 8. What is the purpose of the Medicare Outpatient Observation Notice
(MOON)?
A) To notify a patient they are being admitted as an inpatient
B) To inform a Medicare patient they are an outpatient receiving
observation services for >24 hours
C) To bill a patient for a denied inpatient stay
D) To request prior authorization for surgery
Correct Answer: B) To inform a Medicare patient they are an
outpatient receiving observation services for >24 hours (MOON
explains observation status and potential SNF coverage implications.)
9. Which of the following is a best practice for point-of-service (POS)
collections?
A) Waiting until after insurance processes the claim to collect
B) Estimating patient liability accurately using a real-time eligibility and
benefit tool
C) Never discussing costs with patients before service
D) Sending all patients to collections immediately after service
Correct Answer: B) Estimating patient liability accurately using a
real-time eligibility and benefit tool (POS collections rely on accurate
estimates to collect patient responsibility upfront.)
10. What does the term "charity care" refer to in a hospital setting?
A) Discounts offered to all uninsured patients regardless of income
B) Free or reduced-cost care provided to patients who meet specific
financial need criteria
C) Bad debt written off from self-pay accounts
D) Medicaid disproportionate share hospital (DSH) payments
QUALITY PRACTICE QUESTIONS AND STUDY GUIDE ACCURATE
QUESTIONS AND CORRECT DETAILED SOLUTIONS WITH
RATIONALES (100% CORRECT VERIFIED ANSWERS) LATEST
UPDATED VERSION 2026 EDITION |GUARANTEED PASS A+ |FULL
REVISED CRCR CERTIFICATION (HFMA) EXAM |INSTANT
DOWNOAD PDF
1. A patient present for an outpatient surgical procedure. The registrar
collects the insurance card and verifies eligibility. Which revenue cycle
key performance indicator (KPI) is most directly impacted by accurate
eligibility verification at this point?
A) Days in Accounts Receivable (A/R)
B) Clean claim rate
C) Bad debt percentage
D) Point-of-service collection rate
Correct Answer: B) Clean claim rate (Ensuring eligibility upfront
reduces denials, increasing clean claim rate.)
2. Under the CMS Inpatient Prospective Payment System (IPPS), what
payment methodology is used to reimburse hospitals for inpatient stays?
A) Per diem
B) Fee-for-service (FFS)
C) Diagnosis-Related Group (DRG)
D) Percentage of charges
Correct Answer: C) Diagnosis-Related Group (DRG) (IPPS uses
DRG-based fixed payment per discharge.)
,3. A patient has a commercial insurance plan with
a 2,000deductibleandan80/20coinsuranceafterdeductible.Iftheallowedam
ountforaprocedureis2,000deductibleandan80/20coinsuranceafterdeducti
ble.Iftheallowedamountforaprocedureis5,000 and the patient has
met 500ofthedeductible,howmuchwillthepatientowe?A)500ofthededucti
ble,howmuchwillthepatientowe?A)1,000
B) 1,500C)1,500C)2,400
D) $3,500
**Correct Answer: C) 2,400∗∗ (2,400∗∗ (1,500 remaining deductible +
20% coinsurance on remaining 3,500=3,500=700, total $2,400.)
4. Which of the following is a core requirement of the HIPAA Privacy
Rule regarding patient health information (PHI)?
A) Using PHI for marketing without authorization
B) Providing patients with access to their PHI upon request
C) Storing PHI unencrypted on public servers
D) Disclosing PHI to employers without consent
Correct Answer: B) Providing patients with access to their PHI
upon request (HIPAA gives patients right to access and obtain copies of
their PHI.)
5. In revenue cycle management, what is the primary goal of a denial
management process?
A) Reduce the number of claims submitted
B) Identify root causes of denials and prevent recurrence
C) Increase days in A/R
D) Write off all denied claims as bad debt
,Correct Answer: B) Identify root causes of denials and prevent
recurrence (Denial management aims to correct processes and appeal
valid denials.)
6. Which coding system is used primarily for outpatient services,
physician offices, and emergency department visits to report procedures
and services?
A) ICD-10-CM
B) ICD-10-PCS
C) CPT/HCPCS Level I
D) HCPCS Level II
Correct Answer: C) CPT/HCPCS Level I (CPT codes report medical
procedures and services in outpatient/physician settings.)
7. A patient is readmitted to the same hospital within 30 days of
discharge for a related condition. Under the Hospital Readmissions
Reduction Program (HRRP), which condition is NOT currently targeted
for payment reduction?
A) Acute Myocardial Infarction (AMI)
B) Chronic Obstructive Pulmonary Disease (COPD)
C) Hip/knee arthroplasty
D) Generalized anxiety disorder
Correct Answer: D) Generalized anxiety disorder (HRRP targets
AMI, COPD, heart failure, pneumonia, and hip/knee arthroplasty.)
, 8. What is the purpose of the Medicare Outpatient Observation Notice
(MOON)?
A) To notify a patient they are being admitted as an inpatient
B) To inform a Medicare patient they are an outpatient receiving
observation services for >24 hours
C) To bill a patient for a denied inpatient stay
D) To request prior authorization for surgery
Correct Answer: B) To inform a Medicare patient they are an
outpatient receiving observation services for >24 hours (MOON
explains observation status and potential SNF coverage implications.)
9. Which of the following is a best practice for point-of-service (POS)
collections?
A) Waiting until after insurance processes the claim to collect
B) Estimating patient liability accurately using a real-time eligibility and
benefit tool
C) Never discussing costs with patients before service
D) Sending all patients to collections immediately after service
Correct Answer: B) Estimating patient liability accurately using a
real-time eligibility and benefit tool (POS collections rely on accurate
estimates to collect patient responsibility upfront.)
10. What does the term "charity care" refer to in a hospital setting?
A) Discounts offered to all uninsured patients regardless of income
B) Free or reduced-cost care provided to patients who meet specific
financial need criteria
C) Bad debt written off from self-pay accounts
D) Medicaid disproportionate share hospital (DSH) payments
