CERTIFIED REVENUE CYCLE REPRESENTATIVE EXAM REVIEW SOLVED QUESTIONS COMPLETE ANSWERS GRADED A PLUS

CERTIFIED REVENUE CYCLE REPRESENTATIVE EXAM REVIEW SOLVED QUESTIONS
COMPLETE ANSWERS GRADED A PLUS
Certified Revenue Cycle Representative Examination
TEST 2026/2027 FULL Questions and Answers
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Question:
Business ethics, or organizational ethics represent: a) The principles and standards by which
organizations operate b) Regulations that must be followed by law c) Definitions of appropriate
customer service d) The code of acceptable conduct

Answer:
A



Question:
A portion of the accounts receivable inventory which has NOT qualified for billing includes: a)
Charitable pledges b) Accounts created during pre-registration but not activated c) Accounts coded
but held within the suspense period d) Accounts assigned to a pre-collection agency

Answer:
A



Question:
Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare
established guideline(s) used to determine: a) Medicare and Medicaid provider eligibility b)
Medicare outpatient reimbursement rates c) Which diagnoses, signs, or symptoms are reimbursable
d) What Medicare reimburses and what should be referred to Medicaid

Answer:
C



Question:
Days in A/R is calculated based on the value of: a) The total accounts receivable on a specific date
b) Total anticipated revenue minus expenses c) The time it takes to collect anticipated revenue d)

,Total cash received to date

Answer:
C



Question:
Patients are contacting hospitals to proactively inquire about costs and fees prior to agreeing to
service. The problem for hospitals in providing such information is: a) That hospitals don't want to
establish a price without knowing if the patient has insurance and how much reimbursement can be
expected b) The fact that charge master lists the total charge, not net charges that reflect charges
after a payer's contractual adjustment c) That hospitals don't want to be put in the position of
"guaranteeing" price without having room for additional charges that may arise in the course of
treatment d) Their reluctance to share proprietary information

Answer:
B



Question:
Across all care settings, if a patient consents to a financial discussion during a medical encounter to
expedite discharge, the HFMA best practice is to: a) Make sure that the attending staff can answer
questions and assist in obtaining required patient financial data b) Have a patient financial
responsibilities kit ready for the patient, containing all of the required registration forms and
instructions c) Support that choice, providing that the discussion does not interfere with patient care
or disrupt patient flow d) Decline such request as finance discussions can disrupt patient care and
patient flow

Answer:
C



Question:
A comprehensive "Compliance Program" is defined as a) Annual legal audit and review for
adherence to regulations b) Educating staff on regulations c) Systematic procedures to ensure that
the provisions of regulations imposed by a government agency are being met d) The development of
operational policies that correspond to regulations

Answer:

,C



Question:
Case Management requires that a case manager be assigned a) To patients of any physician
requesting case management b) To a select patient group c) To every patient d) To specific cases
designated by third party contractual agreement

Answer:
B



Question:
Pricing transparency is defined as readily available information on the price of healthcare services,
that together with other information, help define the value of those services and enable consumers to
a) Identify, compare, and choose providers that offer the desired level of value b) Customize health
care with a personally chosen mix of providers c) Negotiate the cost of health plan premiums d)
Verify the cost of individual clinicians

Answer:
A



Question:
Any healthcare insurance plan that provides or ensures comprehensive health maintenance and
treatment services for an enrolled group of persons based on a monthly fee is known as a a) MSO b)
HMO c) PPO d) GPO

Answer:
B



Question:
In a Chapter 7 Straight Bankruptcy filing a) The court liquidates the debtor's nonexempt property,
pays creditors, and discharges the debtor from the debt b) The court liquidates the debtor's
nonexempt property, pays creditors, and begins to pay off the largest claims first. All claims are paid
some portion of the amount owed c) The court vacates all claims against a debtor with the
understanding that the debtor may not apply for credit without court supervision d) The court

, establishes a creditor payment schedule with the longest outstanding claims paid first

Answer:
A



Question:
The core financial activities resolved within patient access include: a) Scheduling, pre-registration,
insurance verification and managed care processing b) Scheduling, insurance verification, clinical
discharge processing and payment posting of point of service receipts c) Scheduling, registration,
charge entry and managed care processing d) Scheduling, pre-registration, registration, medical
necessity screening and patient refunds

Answer:
A



Question:
Which of the following is NOT contained in a collection agency agreement? a) A clear
understanding that the provider retains ownership of any outsourced activities b) Specific language
as to who will pay legal fees, if needed c) An annual renewal clause d) A mutual hold-harmless
clause

Answer:
D



Question:
Maintaining routine contact with the health plan or liability payer, making sure all required
information is provided and all needed approvals are obtained is the responsibility of: a) Patient
Accounts b) Managed Care Contract Staff c) HIM staff d) Case Management

Answer:
D



Question: