CRCR Certification Exam Actual Questions
with Revised Answers (), (A+
Guarantee)
Q: The revenue cycle begins and ends with:
A. Coding → Payment
B. Scheduling → Payment posting
C. Patient access → Final payment
D. Charge capture → Denial management
Answer: C
Rationale: RC spans from patient access through final payment
resolution.
Q: Medical necessity is primarily determined by:
A. Provider preference
B. Payer policies
C. Patient request
D. Hospital policy
Answer: B
Q: An Advance Beneficiary Notice (ABN) is used when:
A. Medicare denies due to lack of coverage
B. The patient has Medicaid
C. Services are emergent
D. The claim is already denied
,Answer: A
Rationale: ABNs notify Medicare patients when services may not be
covered.
Q: The most effective way to prevent downstream denials is:
A. Aggressive collections
B. Front-end verification
C. Appeals management
D. Secondary billing
Answer: B
Q: HIPAA primarily protects:
A. Hospital revenue
B. Provider credentials
C. Patient health information
D. Insurance contracts
Answer: C
Q: Which is considered PHI?
A. Zip code alone
B. Diagnosis with patient name
C. CPT code only
D. De-identified data
Answer: B
Q: CPT codes describe:
A. Diagnoses
B. Inpatient procedures
,C. Outpatient procedures/services
D. Supplies only
Answer: C
Q: ICD-10-CM codes represent:
A. Procedures
B. Supplies
C. Diagnoses
D. Payments
Answer: C
Q: Modifiers are used to:
A. Increase reimbursement automatically
B. Clarify services rendered
C. Replace CPT codes
D. Identify diagnosis severity
Answer: B
Q: National Correct Coding Initiative (NCCI) edits prevent:
A. Late filing
B. Duplicate billing
C. Eligibility errors
D. Coordination of benefits
Answer: B
Q: A clean claim is one that:
A. Is paid within 24 hours
B. Has no errors or omissions
, C. Is electronic only
D. Has secondary insurance
Answer: B
12) Denial Types
Q: A denial due to missing authorization is considered:
A. Clinical denial
B. Technical/administrative denial
C. Medical necessity denial
D. Coding denial
Answer: B
13) COB
Q: Coordination of Benefits determines:
A. Diagnosis priority
B. Which payer pays first
C. Patient copay amount
D. Coding sequence
Answer: B
14) Medicare Parts
Q: Medicare Part B covers:
A. Inpatient hospital stays
B. Prescription drugs
C. Outpatient services
D. Hospice care
with Revised Answers (), (A+
Guarantee)
Q: The revenue cycle begins and ends with:
A. Coding → Payment
B. Scheduling → Payment posting
C. Patient access → Final payment
D. Charge capture → Denial management
Answer: C
Rationale: RC spans from patient access through final payment
resolution.
Q: Medical necessity is primarily determined by:
A. Provider preference
B. Payer policies
C. Patient request
D. Hospital policy
Answer: B
Q: An Advance Beneficiary Notice (ABN) is used when:
A. Medicare denies due to lack of coverage
B. The patient has Medicaid
C. Services are emergent
D. The claim is already denied
,Answer: A
Rationale: ABNs notify Medicare patients when services may not be
covered.
Q: The most effective way to prevent downstream denials is:
A. Aggressive collections
B. Front-end verification
C. Appeals management
D. Secondary billing
Answer: B
Q: HIPAA primarily protects:
A. Hospital revenue
B. Provider credentials
C. Patient health information
D. Insurance contracts
Answer: C
Q: Which is considered PHI?
A. Zip code alone
B. Diagnosis with patient name
C. CPT code only
D. De-identified data
Answer: B
Q: CPT codes describe:
A. Diagnoses
B. Inpatient procedures
,C. Outpatient procedures/services
D. Supplies only
Answer: C
Q: ICD-10-CM codes represent:
A. Procedures
B. Supplies
C. Diagnoses
D. Payments
Answer: C
Q: Modifiers are used to:
A. Increase reimbursement automatically
B. Clarify services rendered
C. Replace CPT codes
D. Identify diagnosis severity
Answer: B
Q: National Correct Coding Initiative (NCCI) edits prevent:
A. Late filing
B. Duplicate billing
C. Eligibility errors
D. Coordination of benefits
Answer: B
Q: A clean claim is one that:
A. Is paid within 24 hours
B. Has no errors or omissions
, C. Is electronic only
D. Has secondary insurance
Answer: B
12) Denial Types
Q: A denial due to missing authorization is considered:
A. Clinical denial
B. Technical/administrative denial
C. Medical necessity denial
D. Coding denial
Answer: B
13) COB
Q: Coordination of Benefits determines:
A. Diagnosis priority
B. Which payer pays first
C. Patient copay amount
D. Coding sequence
Answer: B
14) Medicare Parts
Q: Medicare Part B covers:
A. Inpatient hospital stays
B. Prescription drugs
C. Outpatient services
D. Hospice care
