CRCR EXAM MULTIPLE CHOICE, CRCR EXAM PREP, CERTIFIED
REVENUE CYCLE REPRESENTATIVE - CRCR (2025-2026)
What are collection agency fees based on? - A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what another rule? -
Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and
some or all providers? - Case rates
What customer service improvements might improve the patient accounts department? - Holding staff
accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - Inform a Medicare beneficiary
that Medicare may not pay for the order or service
What type of account adjustment results from the patient's unwillingness to pay for a self-pay balance? - Bad
debt adjustment
What is the initial hospice benefit? - Two 90-day periods and an unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - If the patient requires
ambulance transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account is billed? - Post a late-charge
adjustment to the account
an increase in the dollars aged greater than 90 days from date of service indicate what about accounts - They
are not being processed in a timely manner
What is an advantage of a preregistration program? - It reduces processing times at the time of service
What are the two statutory exclusions from hospice coverage? - Medically unnecessary services and custodial
care
What core financial activities are resolved within patient access? - Scheduling, insurance verification, discharge
processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - The services do not involve an overnight stay
How is a mis-posted contractual allowance resolved? - Comparing the contract reimbursement rates with the
contract on the admittance advice to identify the correct amount
What type of patient status is used to evaluate the patient's need for inpatient care? - Observation
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
How are disputes with nongovernmental payers resolved? - Appeal conditions specified in the individual payer's
contract
The important message from Medicare provides beneficiaries with information concerning what? - Right to
appeal a discharge decision if the patient disagrees with the services
Why do managed care plans have agreements with hospitals, physicians, and other healthcare providers to offer
a range of services to plan members? - To improve access to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days, what is the SNF
permitted to do? - Submit interim bills to the Medicare program.
MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims after what happens? -
120 days passes, but the claim then be withdrawn from the liability carrier
What data are required to establish a new MPI entry? - The patient's full legal name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as primary? - Determine the correct
payer and notify the incorrect payer of the processing error
What do EMTALA regulations require on-call physicians to do? - Personally appear in the emergency department
and attend to the patient within a reasonable time
At the end of each shift, what must happen to cash, checks, and credit card transaction documents? - They must
be balanced
What will cause a CMS 1500 claim to be rejected? - The provider is billing with a future date of service
Under Medicare regulations, which of the following is not included on a valid physician's order for services? -
The cost of the test
how are HCPCS codes and the appropriate modifiers used? - To report the level 1, 2, or 3 code that correctly
describes the service provided
, If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? -
Diagnostic and clinically-related non-diagnostic charges provided on the Tuesday, Wednesday, Thursday, and
Friday before admission
What is a benefit of pre-registering patients for service? - Patient arrival processing is expedited, reducing wait
times and delays
What is a characteristic of a managed contracting methodology? - Prospectively set rates for inpatient and
outpatient services
What do the MSP disability rules require? - That the patient's spouse's employer must have less than 20
employees in the group health plan
what organization originated the concept of insuring prepaid health care services? - Blue Cross and blue Shield
What is true about screening a beneficiary for possible MSP situations? - It is acceptable to complete the
screening form after the patient has completed the registration process and been sent to the service
department
If the patient cannot agree to payment arrangements, what is the next option? - Warn the patient that unpaid
accounts are placed with collection agencies for further processing
What will comprehensive patient access processing accomplish? - Minimize the need for follow- up on insurance
accounts
In services lines such as cardiology or orthopedics, what does the case-rate payment methodology allow
providers to do? - Receive a fixed for specific procedures
Through what document does a hospital establish compliance standards? - Code of conduct
How does utilization review staff use correct insurance information? - To obtain approval for inpatient days and
coordinate services
When is it not appropriate to use observation status? - As a substitute for an inpatient admission
What is a serious consequence of misidentifying a patient in the MPI? - The services will be documented in the
wrong record
When a patient reports directly to a clinical department for service, what will the clinical department staff do? -
Redirect the patient to the patient access department for registration
What process can be used to shorten claim turnaround time? - Send high-dollar hard-copy claims with required
attachments by overnight mail or registered mail
How are patient reminder calls used? - To make sure the patient follows the prep instructions and arrives at the
scheduled time for service
If a patient declares a straight bankruptcy, what must the provider do? - Write off the account to the contractual
adjustment account
REVENUE CYCLE REPRESENTATIVE - CRCR (2025-2026)
What are collection agency fees based on? - A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what another rule? -
Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and
some or all providers? - Case rates
What customer service improvements might improve the patient accounts department? - Holding staff
accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - Inform a Medicare beneficiary
that Medicare may not pay for the order or service
What type of account adjustment results from the patient's unwillingness to pay for a self-pay balance? - Bad
debt adjustment
What is the initial hospice benefit? - Two 90-day periods and an unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - If the patient requires
ambulance transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account is billed? - Post a late-charge
adjustment to the account
an increase in the dollars aged greater than 90 days from date of service indicate what about accounts - They
are not being processed in a timely manner
What is an advantage of a preregistration program? - It reduces processing times at the time of service
What are the two statutory exclusions from hospice coverage? - Medically unnecessary services and custodial
care
What core financial activities are resolved within patient access? - Scheduling, insurance verification, discharge
processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - The services do not involve an overnight stay
How is a mis-posted contractual allowance resolved? - Comparing the contract reimbursement rates with the
contract on the admittance advice to identify the correct amount
What type of patient status is used to evaluate the patient's need for inpatient care? - Observation
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
How are disputes with nongovernmental payers resolved? - Appeal conditions specified in the individual payer's
contract
The important message from Medicare provides beneficiaries with information concerning what? - Right to
appeal a discharge decision if the patient disagrees with the services
Why do managed care plans have agreements with hospitals, physicians, and other healthcare providers to offer
a range of services to plan members? - To improve access to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days, what is the SNF
permitted to do? - Submit interim bills to the Medicare program.
MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability claims after what happens? -
120 days passes, but the claim then be withdrawn from the liability carrier
What data are required to establish a new MPI entry? - The patient's full legal name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as primary? - Determine the correct
payer and notify the incorrect payer of the processing error
What do EMTALA regulations require on-call physicians to do? - Personally appear in the emergency department
and attend to the patient within a reasonable time
At the end of each shift, what must happen to cash, checks, and credit card transaction documents? - They must
be balanced
What will cause a CMS 1500 claim to be rejected? - The provider is billing with a future date of service
Under Medicare regulations, which of the following is not included on a valid physician's order for services? -
The cost of the test
how are HCPCS codes and the appropriate modifiers used? - To report the level 1, 2, or 3 code that correctly
describes the service provided
, If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? -
Diagnostic and clinically-related non-diagnostic charges provided on the Tuesday, Wednesday, Thursday, and
Friday before admission
What is a benefit of pre-registering patients for service? - Patient arrival processing is expedited, reducing wait
times and delays
What is a characteristic of a managed contracting methodology? - Prospectively set rates for inpatient and
outpatient services
What do the MSP disability rules require? - That the patient's spouse's employer must have less than 20
employees in the group health plan
what organization originated the concept of insuring prepaid health care services? - Blue Cross and blue Shield
What is true about screening a beneficiary for possible MSP situations? - It is acceptable to complete the
screening form after the patient has completed the registration process and been sent to the service
department
If the patient cannot agree to payment arrangements, what is the next option? - Warn the patient that unpaid
accounts are placed with collection agencies for further processing
What will comprehensive patient access processing accomplish? - Minimize the need for follow- up on insurance
accounts
In services lines such as cardiology or orthopedics, what does the case-rate payment methodology allow
providers to do? - Receive a fixed for specific procedures
Through what document does a hospital establish compliance standards? - Code of conduct
How does utilization review staff use correct insurance information? - To obtain approval for inpatient days and
coordinate services
When is it not appropriate to use observation status? - As a substitute for an inpatient admission
What is a serious consequence of misidentifying a patient in the MPI? - The services will be documented in the
wrong record
When a patient reports directly to a clinical department for service, what will the clinical department staff do? -
Redirect the patient to the patient access department for registration
What process can be used to shorten claim turnaround time? - Send high-dollar hard-copy claims with required
attachments by overnight mail or registered mail
How are patient reminder calls used? - To make sure the patient follows the prep instructions and arrives at the
scheduled time for service
If a patient declares a straight bankruptcy, what must the provider do? - Write off the account to the contractual
adjustment account
