CRCR FINAL EVALUATION EXAM QUESTIONS WITH
SOLUTIONS A+ 2025/2026
✔✔Coverage rules for Medicare beneficiaries receiving skilled nursing care require that
the beneficiary has received what? - ✔✔Medically necessary inpatient hospital services
for at least 3 consecutive days before the skilled nursing care admission
✔✔When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? -
✔✔When the patient is the insured
✔✔What are non-emergency patients who come for service without prior notification to
the provider called? - ✔✔Unscheduled patients
✔✔If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse? - ✔✔Neither enrolled not entitled to
benefits
✔✔Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
Lending Act, establishes what? - ✔✔Disclosure rules for consumer credit sales and
consumer loans
✔✔What is a principal diagnosis? - ✔✔Primary reason for the patient's admission
✔✔Collecting patient liability dollars after service leads to what? - ✔✔Lower accounts
receivable levels
✔✔What is the daily out-of-pocket amount for each lifetime reserve day used? - ✔✔50%
of the current deductible amount
✔✔What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not
billable as an RHC services? - ✔✔Inpatient care
✔✔What code indicates the disposition of the patient at the conclusion of service? -
✔✔Patient discharge status code
✔✔What are hospitals required to do for Medicare credit balance accounts? - ✔✔They
result in lost reimbursement and additional cost to collect
✔✔When an undue delay of payment results from a dispute between the patient and
the third party payer, who is responsible for payment? - ✔✔Patient
✔✔Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - ✔✔A valid CPT or HCPCS code
, ✔✔With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - ✔✔Access their information and perform
functions on-line
✔✔What date is required on all CMS 1500 claim forms? - ✔✔onset date of current
illness
✔✔What does scheduling allow provider staff to do - ✔✔Review appropriateness of the
service request
✔✔What code is used to report the provider's most common semiprivate room rate? -
✔✔Condition code
✔✔Regulations and requirements for coding accountable care organizations, which
allows providers to begin creating these organizations, were finalized in: - ✔✔2012
✔✔What is a primary responsibility of the Recover Audit Contractor? - ✔✔To correctly
identify proper payments for Medicare Part A & B claims
✔✔How must providers handle credit balances? - ✔✔Comply with state statutes
concerning reporting credit balance
✔✔Insurance verification results in what? - ✔✔The accurate identification of the
patient's eligibility and benefits
✔✔What form is used to bill Medicare for rural health clinics? - ✔✔CMS 1500
✔✔What activities are completed when a scheduled pre-registered patient arrives for
service? - ✔✔Registering the patient and directing the patient to the service area
✔✔In addition to being supported by information found in the patient's chart, a CMS
1500 claim must be coded using what? - ✔✔HCPCS (Healthcare Common Procedure
Coding system)
✔✔What results from a denied claim? - ✔✔The provider incurs rework and appeal costs
✔✔Why does the financial counselor need pricing for services? - ✔✔To calculate the
patient's financial responsibility
✔✔What type of provider bills third-party payers using CMS 1500 form - ✔✔Hospital-
based mammography centers
SOLUTIONS A+ 2025/2026
✔✔Coverage rules for Medicare beneficiaries receiving skilled nursing care require that
the beneficiary has received what? - ✔✔Medically necessary inpatient hospital services
for at least 3 consecutive days before the skilled nursing care admission
✔✔When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? -
✔✔When the patient is the insured
✔✔What are non-emergency patients who come for service without prior notification to
the provider called? - ✔✔Unscheduled patients
✔✔If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse? - ✔✔Neither enrolled not entitled to
benefits
✔✔Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
Lending Act, establishes what? - ✔✔Disclosure rules for consumer credit sales and
consumer loans
✔✔What is a principal diagnosis? - ✔✔Primary reason for the patient's admission
✔✔Collecting patient liability dollars after service leads to what? - ✔✔Lower accounts
receivable levels
✔✔What is the daily out-of-pocket amount for each lifetime reserve day used? - ✔✔50%
of the current deductible amount
✔✔What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not
billable as an RHC services? - ✔✔Inpatient care
✔✔What code indicates the disposition of the patient at the conclusion of service? -
✔✔Patient discharge status code
✔✔What are hospitals required to do for Medicare credit balance accounts? - ✔✔They
result in lost reimbursement and additional cost to collect
✔✔When an undue delay of payment results from a dispute between the patient and
the third party payer, who is responsible for payment? - ✔✔Patient
✔✔Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - ✔✔A valid CPT or HCPCS code
, ✔✔With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - ✔✔Access their information and perform
functions on-line
✔✔What date is required on all CMS 1500 claim forms? - ✔✔onset date of current
illness
✔✔What does scheduling allow provider staff to do - ✔✔Review appropriateness of the
service request
✔✔What code is used to report the provider's most common semiprivate room rate? -
✔✔Condition code
✔✔Regulations and requirements for coding accountable care organizations, which
allows providers to begin creating these organizations, were finalized in: - ✔✔2012
✔✔What is a primary responsibility of the Recover Audit Contractor? - ✔✔To correctly
identify proper payments for Medicare Part A & B claims
✔✔How must providers handle credit balances? - ✔✔Comply with state statutes
concerning reporting credit balance
✔✔Insurance verification results in what? - ✔✔The accurate identification of the
patient's eligibility and benefits
✔✔What form is used to bill Medicare for rural health clinics? - ✔✔CMS 1500
✔✔What activities are completed when a scheduled pre-registered patient arrives for
service? - ✔✔Registering the patient and directing the patient to the service area
✔✔In addition to being supported by information found in the patient's chart, a CMS
1500 claim must be coded using what? - ✔✔HCPCS (Healthcare Common Procedure
Coding system)
✔✔What results from a denied claim? - ✔✔The provider incurs rework and appeal costs
✔✔Why does the financial counselor need pricing for services? - ✔✔To calculate the
patient's financial responsibility
✔✔What type of provider bills third-party payers using CMS 1500 form - ✔✔Hospital-
based mammography centers
