HFMA CRCR CERTIFICATION EXAM PREP EXAM 2026||||quEsTIONs ANd
ANswERs wITH RATIONALEs/gRAdEd A+/2026 uPdATE/100%
CORRECT /INsTANT dOwNLOAd
SECTION 1: PATIENT ACCESS AND REGISTRATION
Key Concepts
Patient Access Responsibilities include gathering accurate demographic and insurance information,
verifying eligibility, obtaining necessary authorizations, calculating patient financial responsibility, and
educating patients about their coverage and payment options.
The Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals with emergency
departments to provide a medical screening examination and stabilizing treatment to anyone who
presents regardless of insurance status or ability to pay.
A guarantor is the person financially responsible for the patient's healthcare bills.
The Notice of Privacy Practices acknowledgment is signed by the patient to authorize release of
protected health information for treatment, payment, and healthcare operations under HIPAA.
An Advance Beneficiary Notice (ABN) is a written notice given to Medicare beneficiaries before certain
services are provided when Medicare is not expected to cover the service, allowing the patient to
accept financial responsibility.
Coordination of Benefits (COB) rules determine which insurance plan pays first when a patient has
multiple insurance coverage. For dependents, the birthday rule typically applies.
The Medicare Beneficiary Identifier (MBI) is a unique 11-character alphanumeric identifier required on
all Medicare claims.
Practice Questions 1-10
,Question 1
What is the primary purpose of the patient registration process in the revenue cycle?
A) To collect payment at the time of service
B) To gather accurate demographic and insurance information to ensure proper billing and
reimbursement
C) To schedule follow-up appointments
D) To provide medical treatment
Answer: B) To gather accurate demographic and insurance information to ensure proper billing and
reimbursement
Rationale: The patient registration process is the first step in the revenue cycle. Accurate collection of
demographic data and insurance information is critical to prevent claim denials, delays in payment,
and compliance issues.
Question 2
Which federal law requires that hospitals provide stabilizing treatment to anyone presenting to the
emergency department regardless of insurance status?
A) HIPAA
B) EMTALA
C) ACA
D) Stark Law
Answer: B) EMTALA (Emergency Medical Treatment and Labor Act)
Rationale: EMTALA requires hospitals with emergency departments to provide a medical screening
examination and stabilizing treatment to anyone who presents, regardless of insurance status or
ability to pay.
,Question 3
What is a guarantor in healthcare revenue cycle terms?
A) The insurance company
B) The person financially responsible for the patient's healthcare bills
C) The primary care physician
D) The hospital administrator
Answer: B) The person financially responsible for the patient's healthcare bills
Rationale: The guarantor is the person or entity legally responsible for payment of the patient's
healthcare bills. The patient is often the guarantor, but for dependents, the responsible parent or
spouse may be the guarantor.
Question 4
What is the purpose of an Advance Beneficiary Notice (ABN) for Medicare patients?
A) To notify the patient that a service may not be covered by Medicare, allowing the patient to accept
financial responsibility
B) To confirm insurance eligibility
C) To schedule a procedure
D) To collect payment at the time of service
Answer: A) To notify the patient that a service may not be covered by Medicare, allowing the patient
to accept financial responsibility
Rationale: An ABN is a written notice given to Medicare beneficiaries before certain services are
provided when Medicare is not expected to cover the service. The ABN allows the patient to make an
informed decision and accept financial responsibility.
, Question 5
What is the difference between a copayment, coinsurance, and deductible?
A) Copayment is a fixed dollar amount per service; coinsurance is a percentage of allowed charges;
deductible is the amount the patient must pay before insurance begins paying
B) They are all the same
C) Copayment is a percentage; coinsurance is a fixed amount; deductible is the maximum out-of-
pocket
D) Copayment is paid by the insurance company; coinsurance is paid by the patient; deductible is
waived
Answer: A) Copayment is a fixed dollar amount per service; coinsurance is a percentage of allowed
charges; deductible is the amount the patient must pay before insurance begins paying
Rationale: A copayment is a fixed amount the patient pays for a covered service. Coinsurance is a
percentage of the allowed amount the patient pays after meeting the deductible. A deductible is the
amount the patient must pay out-of-pocket before the insurance plan begins to pay.
Question 6
A patient is covered under two insurance plans. What is the process to determine which plan pays
first?
A) The patient chooses which plan pays first
B) The provider chooses which plan pays first
C) Coordination of Benefits (COB) rules determine the primary and secondary payer
D) Both plans pay equally
Answer: C) Coordination of Benefits (COB) rules determine the primary and secondary payer
Rationale: COB rules determine which insurance plan is primary and which is secondary. For
dependents, the birthday rule typically applies. For working adults, the employer-sponsored plan is
usually primary.
ANswERs wITH RATIONALEs/gRAdEd A+/2026 uPdATE/100%
CORRECT /INsTANT dOwNLOAd
SECTION 1: PATIENT ACCESS AND REGISTRATION
Key Concepts
Patient Access Responsibilities include gathering accurate demographic and insurance information,
verifying eligibility, obtaining necessary authorizations, calculating patient financial responsibility, and
educating patients about their coverage and payment options.
The Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals with emergency
departments to provide a medical screening examination and stabilizing treatment to anyone who
presents regardless of insurance status or ability to pay.
A guarantor is the person financially responsible for the patient's healthcare bills.
The Notice of Privacy Practices acknowledgment is signed by the patient to authorize release of
protected health information for treatment, payment, and healthcare operations under HIPAA.
An Advance Beneficiary Notice (ABN) is a written notice given to Medicare beneficiaries before certain
services are provided when Medicare is not expected to cover the service, allowing the patient to
accept financial responsibility.
Coordination of Benefits (COB) rules determine which insurance plan pays first when a patient has
multiple insurance coverage. For dependents, the birthday rule typically applies.
The Medicare Beneficiary Identifier (MBI) is a unique 11-character alphanumeric identifier required on
all Medicare claims.
Practice Questions 1-10
,Question 1
What is the primary purpose of the patient registration process in the revenue cycle?
A) To collect payment at the time of service
B) To gather accurate demographic and insurance information to ensure proper billing and
reimbursement
C) To schedule follow-up appointments
D) To provide medical treatment
Answer: B) To gather accurate demographic and insurance information to ensure proper billing and
reimbursement
Rationale: The patient registration process is the first step in the revenue cycle. Accurate collection of
demographic data and insurance information is critical to prevent claim denials, delays in payment,
and compliance issues.
Question 2
Which federal law requires that hospitals provide stabilizing treatment to anyone presenting to the
emergency department regardless of insurance status?
A) HIPAA
B) EMTALA
C) ACA
D) Stark Law
Answer: B) EMTALA (Emergency Medical Treatment and Labor Act)
Rationale: EMTALA requires hospitals with emergency departments to provide a medical screening
examination and stabilizing treatment to anyone who presents, regardless of insurance status or
ability to pay.
,Question 3
What is a guarantor in healthcare revenue cycle terms?
A) The insurance company
B) The person financially responsible for the patient's healthcare bills
C) The primary care physician
D) The hospital administrator
Answer: B) The person financially responsible for the patient's healthcare bills
Rationale: The guarantor is the person or entity legally responsible for payment of the patient's
healthcare bills. The patient is often the guarantor, but for dependents, the responsible parent or
spouse may be the guarantor.
Question 4
What is the purpose of an Advance Beneficiary Notice (ABN) for Medicare patients?
A) To notify the patient that a service may not be covered by Medicare, allowing the patient to accept
financial responsibility
B) To confirm insurance eligibility
C) To schedule a procedure
D) To collect payment at the time of service
Answer: A) To notify the patient that a service may not be covered by Medicare, allowing the patient
to accept financial responsibility
Rationale: An ABN is a written notice given to Medicare beneficiaries before certain services are
provided when Medicare is not expected to cover the service. The ABN allows the patient to make an
informed decision and accept financial responsibility.
, Question 5
What is the difference between a copayment, coinsurance, and deductible?
A) Copayment is a fixed dollar amount per service; coinsurance is a percentage of allowed charges;
deductible is the amount the patient must pay before insurance begins paying
B) They are all the same
C) Copayment is a percentage; coinsurance is a fixed amount; deductible is the maximum out-of-
D) Copayment is paid by the insurance company; coinsurance is paid by the patient; deductible is
waived
Answer: A) Copayment is a fixed dollar amount per service; coinsurance is a percentage of allowed
charges; deductible is the amount the patient must pay before insurance begins paying
Rationale: A copayment is a fixed amount the patient pays for a covered service. Coinsurance is a
percentage of the allowed amount the patient pays after meeting the deductible. A deductible is the
amount the patient must pay out-of-pocket before the insurance plan begins to pay.
Question 6
A patient is covered under two insurance plans. What is the process to determine which plan pays
first?
A) The patient chooses which plan pays first
B) The provider chooses which plan pays first
C) Coordination of Benefits (COB) rules determine the primary and secondary payer
D) Both plans pay equally
Answer: C) Coordination of Benefits (COB) rules determine the primary and secondary payer
Rationale: COB rules determine which insurance plan is primary and which is secondary. For
dependents, the birthday rule typically applies. For working adults, the employer-sponsored plan is
usually primary.
