CRCR Certification Exam Actual
Questions with Revised Answers (2025 /
2026), (A+ Guarantee)best testbank for
2026
DOMAIN: Patient Access & Front-End Revenue Cycle
1. Which activity has the GREATEST impact on preventing downstream
claim denials?
A. Point-of-service collections
B. Accurate insurance eligibility verification
C. Timely charge capture
D. Posting remittance advice promptly
Correct Answer: B
Rationale:
Eligibility verification ensures coverage is active, services are covered,
correct payer is billed, and authorization rules are known. Most
preventable denials originate before the patient is seen, making eligibility
verification the single most impactful front-end control.
2. What information is MOST critical when verifying eligibility?
A. Subscriber address
B. Copayment amount
,C. Plan effective dates
D. Employer name
Correct Answer: C
Rationale:
If coverage is not active on the date of service, the claim will deny
regardless of all other data. Effective and termination dates determine
whether the payer has financial responsibility at all.
3. Which document allows a provider to bill insurance on the patient’s
behalf?
A. Notice of Privacy Practices
B. Assignment of Benefits
C. Explanation of Benefits
D. Financial policy
Correct Answer: B
Rationale:
The Assignment of Benefits (AOB) authorizes direct payment to the
provider. Without it, payment may be sent to the patient, delaying or
preventing reimbursement.
4. What is the PRIMARY purpose of prior authorization?
A. Confirm patient identity
B. Determine medical necessity before services are rendered
C. Reduce patient responsibility
D. Assign diagnosis codes
, Correct Answer: B
Rationale:
Prior authorization confirms medical necessity and coverage approval
before the service occurs. Failure to obtain it commonly results in non-
appealable denials.
DOMAIN: Coding, Charging & Documentation
5. Who is ultimately responsible for accurate documentation
supporting billed services?
A. Coding staff
B. Billing department
C. Rendering provider
D. Compliance officer
Correct Answer: C
Rationale:
While coders translate documentation into codes, the provider’s
documentation is the legal foundation. Inadequate documentation =
noncompliance, regardless of coding accuracy.
6. Which code set describes WHY a service was provided?
A. CPT
B. HCPCS Level II
C. ICD-10-CM
D. DRG
, Correct Answer: C
Rationale:
ICD-10-CM diagnosis codes establish medical necessity by explaining
the patient’s condition or reason for care.
7. What is the PRIMARY function of CPT codes?
A. Identify supplies
B. Describe procedures and services
C. Assign reimbursement amounts
D. Define medical necessity
Correct Answer: B
Rationale:
CPT codes describe what was done, while diagnosis codes explain why it
was done. Payment is later determined by payer policy and fee schedules.
DOMAIN: Billing, Claims & Reimbursement
8. Which claim type is used by hospitals for outpatient and inpatient
services?
A. CMS-1500
B. UB-04
C. ADA claim form
D. EDI 270
Correct Answer: B
Questions with Revised Answers (2025 /
2026), (A+ Guarantee)best testbank for
2026
DOMAIN: Patient Access & Front-End Revenue Cycle
1. Which activity has the GREATEST impact on preventing downstream
claim denials?
A. Point-of-service collections
B. Accurate insurance eligibility verification
C. Timely charge capture
D. Posting remittance advice promptly
Correct Answer: B
Rationale:
Eligibility verification ensures coverage is active, services are covered,
correct payer is billed, and authorization rules are known. Most
preventable denials originate before the patient is seen, making eligibility
verification the single most impactful front-end control.
2. What information is MOST critical when verifying eligibility?
A. Subscriber address
B. Copayment amount
,C. Plan effective dates
D. Employer name
Correct Answer: C
Rationale:
If coverage is not active on the date of service, the claim will deny
regardless of all other data. Effective and termination dates determine
whether the payer has financial responsibility at all.
3. Which document allows a provider to bill insurance on the patient’s
behalf?
A. Notice of Privacy Practices
B. Assignment of Benefits
C. Explanation of Benefits
D. Financial policy
Correct Answer: B
Rationale:
The Assignment of Benefits (AOB) authorizes direct payment to the
provider. Without it, payment may be sent to the patient, delaying or
preventing reimbursement.
4. What is the PRIMARY purpose of prior authorization?
A. Confirm patient identity
B. Determine medical necessity before services are rendered
C. Reduce patient responsibility
D. Assign diagnosis codes
, Correct Answer: B
Rationale:
Prior authorization confirms medical necessity and coverage approval
before the service occurs. Failure to obtain it commonly results in non-
appealable denials.
DOMAIN: Coding, Charging & Documentation
5. Who is ultimately responsible for accurate documentation
supporting billed services?
A. Coding staff
B. Billing department
C. Rendering provider
D. Compliance officer
Correct Answer: C
Rationale:
While coders translate documentation into codes, the provider’s
documentation is the legal foundation. Inadequate documentation =
noncompliance, regardless of coding accuracy.
6. Which code set describes WHY a service was provided?
A. CPT
B. HCPCS Level II
C. ICD-10-CM
D. DRG
, Correct Answer: C
Rationale:
ICD-10-CM diagnosis codes establish medical necessity by explaining
the patient’s condition or reason for care.
7. What is the PRIMARY function of CPT codes?
A. Identify supplies
B. Describe procedures and services
C. Assign reimbursement amounts
D. Define medical necessity
Correct Answer: B
Rationale:
CPT codes describe what was done, while diagnosis codes explain why it
was done. Payment is later determined by payer policy and fee schedules.
DOMAIN: Billing, Claims & Reimbursement
8. Which claim type is used by hospitals for outpatient and inpatient
services?
A. CMS-1500
B. UB-04
C. ADA claim form
D. EDI 270
Correct Answer: B
