pg. 1
,CRCR Certification Exam Actual Questions with Revised Answers ()
Q1. Which statement best defines the healthcare revenue cycle?
A. The billing department's claim submission activities only
B. All administrative and clinical functions that contribute to the capture, management, and
collection of patient service revenue from the request for service through account closure
C. The process of collecting patient copayments at the point of service
D. The hospital's annual budget preparation and financial reporting cycle
Correct Answer: B
Rationale: The revenue cycle encompasses every function that touches the capture and collection of
revenue for services rendered, beginning with scheduling and pre-registration and ending when the
account reaches a zero balance and is purged. It is not limited to billing or point-of-service
collections; those are individual components within the broader cycle. Budget preparation is a
financial management function, not the revenue cycle itself.
Q2. During which phase of the revenue cycle does insurance eligibility verification occur?
A. Pre-service
B. Time of service
C. Post-service
D. Account resolution
Correct Answer: A
Rationale: Insurance verification is a pre-service function performed before the patient receives
care. Verifying eligibility and benefits at this stage prevents denials and allows financial counseling to
occur before services are rendered. Time-of-service activities include registration and point-of-
service collections, while post-service encompasses claims and follow-up.
Q3. A patient schedules an outpatient MRI. The registration staff confirms demographic information,
verifies insurance eligibility, and obtains prior authorization. Which revenue cycle phase do these
activities represent?
A. Post-service financial care
B. Time-of-service financial care
C. Pre-service financial care
D. Account resolution
Correct Answer: C
Rationale: Scheduling, pre-registration, insurance verification, and prior authorization are all pre-
service activities completed before the patient arrives for care. These steps establish the financial
foundation for the encounter. Time-of-service activities occur when the patient presents for care,
and post-service activities begin after services are delivered.
pg. 2
,Q4. What is the primary purpose of a chargemaster (Charge Description Master)?
A. To list all employed physicians and their credentials
B. To serve as a comprehensive listing of billable items, services, and their associated charges and
codes
C. To document patient satisfaction scores
D. To track employee payroll deductions
Correct Answer: B
Rationale: The chargemaster is the provider's master file of billable services and items, each with an
assigned charge and corresponding codes (such as CPT/HCPCS and revenue codes). It is the
foundation for charge capture and claim generation. It does not contain physician employment
records, patient satisfaction data, or payroll information.
Q5. A claim that passes all payer edits and is accepted for adjudication without requiring additional
information or correction is called a:
A. Clean claim
B. Secondary claim
C. Adjusted claim
D. Paper claim
Correct Answer: A
Rationale: A clean claim contains all required, accurate data elements and passes payer edits on first
submission, allowing it to move directly into adjudication. Clean claim rate is a key performance
indicator for revenue cycle efficiency. Secondary claims are billed to a secondary payer after primary
adjudication, and adjusted claims correct previously submitted claims.
Q6. Which of the following is a key performance indicator that measures the average number of
days it takes to collect payment after a service is rendered?
A. Clean claim rate
B. Denial rate
C. Days in accounts receivable
D. Net collection rate
Correct Answer: C
Rationale: Days in accounts receivable (A/R) measures the average time required to convert services
into cash. A lower number generally indicates more efficient collection processes. Clean claim rate
measures first-pass acceptance, denial rate measures the percentage of claims denied, and net
collection rate measures the percentage of allowed revenue actually collected.
Q7. A hospital's revenue cycle team notices that Days in A/R has increased from 38 to 52 over the
past quarter. Which action represents the most appropriate first step in addressing this trend?
pg. 3
, A. Immediately write off all accounts older than 90 days
B. Analyze the aging categories to identify where delays are occurring and root causes
C. Reduce staffing in the billing department to cut costs
D. Stop accepting patients with certain insurance plans
Correct Answer: B
Rationale: Before taking corrective action, the team must understand where and why the delay is
occurring. Analyzing the A/R aging by payer, service line, and process step identifies whether the
problem lies in claim submission, payer adjudication, denial management, or patient collections.
Writing off accounts or reducing staff addresses symptoms rather than causes and may worsen
financial performance.
Q8. Which statement accurately describes the relationship between patient satisfaction and revenue
cycle performance?
A. Patient satisfaction is unrelated to revenue cycle outcomes
B. A positive patient financial experience can influence patient payment behavior and retention
C. Revenue cycle staff should avoid discussing finances with patients to protect satisfaction scores
D. Patient satisfaction scores only reflect clinical care, not billing processes
Correct Answer: B
Rationale: The patient-centric revenue cycle recognizes that how patients are treated during
financial interactions affects their willingness to pay and their likelihood of returning for care. The
HCAHPS survey includes a question about whether patients would recommend the hospital, which
encompasses the entire experience including registration and billing. Clear communication and
patient-friendly processes support both satisfaction and collection outcomes.
Q9. The HCAHPS survey question that most directly encompasses the revenue cycle experience asks
patients:
A. "How often was your pain well controlled?"
B. "Would you recommend this hospital to your friends and family?"
C. "How clean was your room?"
D. "Did your doctor explain things in a way you could understand?"
Correct Answer: B
Rationale: While many HCAHPS questions relate to clinical care, the recommendation question
captures the overall patient experience, including registration, billing, and collection activities. Pain
control, room cleanliness, and physician communication are important clinical and environmental
measures but do not directly reflect revenue cycle performance.
Q10. A patient arrives for a scheduled procedure and states that her insurance card has changed
since pre-registration. What is the most appropriate action?
pg. 4
,CRCR Certification Exam Actual Questions with Revised Answers ()
Q1. Which statement best defines the healthcare revenue cycle?
A. The billing department's claim submission activities only
B. All administrative and clinical functions that contribute to the capture, management, and
collection of patient service revenue from the request for service through account closure
C. The process of collecting patient copayments at the point of service
D. The hospital's annual budget preparation and financial reporting cycle
Correct Answer: B
Rationale: The revenue cycle encompasses every function that touches the capture and collection of
revenue for services rendered, beginning with scheduling and pre-registration and ending when the
account reaches a zero balance and is purged. It is not limited to billing or point-of-service
collections; those are individual components within the broader cycle. Budget preparation is a
financial management function, not the revenue cycle itself.
Q2. During which phase of the revenue cycle does insurance eligibility verification occur?
A. Pre-service
B. Time of service
C. Post-service
D. Account resolution
Correct Answer: A
Rationale: Insurance verification is a pre-service function performed before the patient receives
care. Verifying eligibility and benefits at this stage prevents denials and allows financial counseling to
occur before services are rendered. Time-of-service activities include registration and point-of-
service collections, while post-service encompasses claims and follow-up.
Q3. A patient schedules an outpatient MRI. The registration staff confirms demographic information,
verifies insurance eligibility, and obtains prior authorization. Which revenue cycle phase do these
activities represent?
A. Post-service financial care
B. Time-of-service financial care
C. Pre-service financial care
D. Account resolution
Correct Answer: C
Rationale: Scheduling, pre-registration, insurance verification, and prior authorization are all pre-
service activities completed before the patient arrives for care. These steps establish the financial
foundation for the encounter. Time-of-service activities occur when the patient presents for care,
and post-service activities begin after services are delivered.
pg. 2
,Q4. What is the primary purpose of a chargemaster (Charge Description Master)?
A. To list all employed physicians and their credentials
B. To serve as a comprehensive listing of billable items, services, and their associated charges and
codes
C. To document patient satisfaction scores
D. To track employee payroll deductions
Correct Answer: B
Rationale: The chargemaster is the provider's master file of billable services and items, each with an
assigned charge and corresponding codes (such as CPT/HCPCS and revenue codes). It is the
foundation for charge capture and claim generation. It does not contain physician employment
records, patient satisfaction data, or payroll information.
Q5. A claim that passes all payer edits and is accepted for adjudication without requiring additional
information or correction is called a:
A. Clean claim
B. Secondary claim
C. Adjusted claim
D. Paper claim
Correct Answer: A
Rationale: A clean claim contains all required, accurate data elements and passes payer edits on first
submission, allowing it to move directly into adjudication. Clean claim rate is a key performance
indicator for revenue cycle efficiency. Secondary claims are billed to a secondary payer after primary
adjudication, and adjusted claims correct previously submitted claims.
Q6. Which of the following is a key performance indicator that measures the average number of
days it takes to collect payment after a service is rendered?
A. Clean claim rate
B. Denial rate
C. Days in accounts receivable
D. Net collection rate
Correct Answer: C
Rationale: Days in accounts receivable (A/R) measures the average time required to convert services
into cash. A lower number generally indicates more efficient collection processes. Clean claim rate
measures first-pass acceptance, denial rate measures the percentage of claims denied, and net
collection rate measures the percentage of allowed revenue actually collected.
Q7. A hospital's revenue cycle team notices that Days in A/R has increased from 38 to 52 over the
past quarter. Which action represents the most appropriate first step in addressing this trend?
pg. 3
, A. Immediately write off all accounts older than 90 days
B. Analyze the aging categories to identify where delays are occurring and root causes
C. Reduce staffing in the billing department to cut costs
D. Stop accepting patients with certain insurance plans
Correct Answer: B
Rationale: Before taking corrective action, the team must understand where and why the delay is
occurring. Analyzing the A/R aging by payer, service line, and process step identifies whether the
problem lies in claim submission, payer adjudication, denial management, or patient collections.
Writing off accounts or reducing staff addresses symptoms rather than causes and may worsen
financial performance.
Q8. Which statement accurately describes the relationship between patient satisfaction and revenue
cycle performance?
A. Patient satisfaction is unrelated to revenue cycle outcomes
B. A positive patient financial experience can influence patient payment behavior and retention
C. Revenue cycle staff should avoid discussing finances with patients to protect satisfaction scores
D. Patient satisfaction scores only reflect clinical care, not billing processes
Correct Answer: B
Rationale: The patient-centric revenue cycle recognizes that how patients are treated during
financial interactions affects their willingness to pay and their likelihood of returning for care. The
HCAHPS survey includes a question about whether patients would recommend the hospital, which
encompasses the entire experience including registration and billing. Clear communication and
patient-friendly processes support both satisfaction and collection outcomes.
Q9. The HCAHPS survey question that most directly encompasses the revenue cycle experience asks
patients:
A. "How often was your pain well controlled?"
B. "Would you recommend this hospital to your friends and family?"
C. "How clean was your room?"
D. "Did your doctor explain things in a way you could understand?"
Correct Answer: B
Rationale: While many HCAHPS questions relate to clinical care, the recommendation question
captures the overall patient experience, including registration, billing, and collection activities. Pain
control, room cleanliness, and physician communication are important clinical and environmental
measures but do not directly reflect revenue cycle performance.
Q10. A patient arrives for a scheduled procedure and states that her insurance card has changed
since pre-registration. What is the most appropriate action?
pg. 4
