HFMA
Certified Revenue Cycle Representative
Complete Exam Review
(With Solutions)
2026
1
,1. Case: A hospital’s charge master contains inconsistent pricing for
the same implant across departments, causing denials and audit
flags.
Question: Which immediate revenue cycle control should be
implemented to reduce risk?
- A. Increase patient co‑pays at registration
- B. Centralize charge master governance with routine reconciliation
and change control
- C. Stop using implants until audit completes
- D. Outsource all billing to a third party without oversight
Answer: B. Centralize charge master governance with routine
reconciliation and change control
Rationale: Central governance and formal change control ensure
consistent pricing, reduce coding/charge errors, and mitigate audit
exposure.
2. Case: A health system notices a rising accounts receivable (A/R)
days trend despite stable volumes.
Question: Which metric analysis most directly identifies root
causes?
- A. A/R days by payer and by aging bucket
- B. Total number of patients seen last year
- C. Number of clinical staff per unit
- D. Average length of stay only
Answer: A. A/R days by payer and by aging bucket
Rationale: Segmenting A/R by payer and aging reveals whether
denials, slow payers, or billing delays drive the trend.
3. Case: A physician practice is preparing for a payer audit of medical
necessity. Which documentation practice best defends billed
services?
- A. Document only the diagnosis code
- B. Document clinical rationale, relevant exam findings,
2
, decision‑making complexity, and time when applicable
- C. Use templated notes without personalization
- D. Remove any mention of comorbidities to simplify charts
Answer: B. Document clinical rationale, relevant exam findings,
decision‑making complexity, and time when applicable
Rationale: Comprehensive documentation supports medical
necessity and coding level, reducing audit risk.
4. Case: A health system considers implementing robotic process
automation (RPA) in the revenue cycle. Which task is the best initial
candidate?
- A. Clinical decision making for treatment plans
- B. High‑volume, rules‑based tasks such as eligibility verification
and claim status checks
- C. Strategic contracting negotiations
- D. Patient counseling on financial assistance
Answer: B. High‑volume, rules‑based tasks such as eligibility
verification and claim status checks
Rationale: RPA is most effective for repetitive, rule‑based processes
that free staff for complex tasks.
#### True / False (3)
5. Statement: A higher case mix index (CMI) always guarantees higher
net revenue for a hospital.
Answer: False
Rationale: Higher CMI indicates greater complexity and potential
reimbursement, but net revenue depends on payer mix, contract
rates, and cost structure.
6. Statement: Denial prevention is more cost‑effective than denial
recovery.
Answer: True
Rationale: Preventing denials avoids rework, reduces A/R days, and
3
Certified Revenue Cycle Representative
Complete Exam Review
(With Solutions)
2026
1
,1. Case: A hospital’s charge master contains inconsistent pricing for
the same implant across departments, causing denials and audit
flags.
Question: Which immediate revenue cycle control should be
implemented to reduce risk?
- A. Increase patient co‑pays at registration
- B. Centralize charge master governance with routine reconciliation
and change control
- C. Stop using implants until audit completes
- D. Outsource all billing to a third party without oversight
Answer: B. Centralize charge master governance with routine
reconciliation and change control
Rationale: Central governance and formal change control ensure
consistent pricing, reduce coding/charge errors, and mitigate audit
exposure.
2. Case: A health system notices a rising accounts receivable (A/R)
days trend despite stable volumes.
Question: Which metric analysis most directly identifies root
causes?
- A. A/R days by payer and by aging bucket
- B. Total number of patients seen last year
- C. Number of clinical staff per unit
- D. Average length of stay only
Answer: A. A/R days by payer and by aging bucket
Rationale: Segmenting A/R by payer and aging reveals whether
denials, slow payers, or billing delays drive the trend.
3. Case: A physician practice is preparing for a payer audit of medical
necessity. Which documentation practice best defends billed
services?
- A. Document only the diagnosis code
- B. Document clinical rationale, relevant exam findings,
2
, decision‑making complexity, and time when applicable
- C. Use templated notes without personalization
- D. Remove any mention of comorbidities to simplify charts
Answer: B. Document clinical rationale, relevant exam findings,
decision‑making complexity, and time when applicable
Rationale: Comprehensive documentation supports medical
necessity and coding level, reducing audit risk.
4. Case: A health system considers implementing robotic process
automation (RPA) in the revenue cycle. Which task is the best initial
candidate?
- A. Clinical decision making for treatment plans
- B. High‑volume, rules‑based tasks such as eligibility verification
and claim status checks
- C. Strategic contracting negotiations
- D. Patient counseling on financial assistance
Answer: B. High‑volume, rules‑based tasks such as eligibility
verification and claim status checks
Rationale: RPA is most effective for repetitive, rule‑based processes
that free staff for complex tasks.
#### True / False (3)
5. Statement: A higher case mix index (CMI) always guarantees higher
net revenue for a hospital.
Answer: False
Rationale: Higher CMI indicates greater complexity and potential
reimbursement, but net revenue depends on payer mix, contract
rates, and cost structure.
6. Statement: Denial prevention is more cost‑effective than denial
recovery.
Answer: True
Rationale: Preventing denials avoids rework, reduces A/R days, and
3
