CERTIFIED REVENUE CYCLE REPRESENTATIVE
EXAM 2 FINAL PREPARATION MANUAL 2026
◉ What will cause a CMS 1500 claim to be rejected? Answer: 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? Answer: The cost
of the test
◉ how are HCPCS codes and the appropriate modifiers used?
Answer: 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? Answer: Diagnostic and
clinically-related non-diagnostic charges provided on the Tuesday,
Wednesday, Thursday, and Friday before admission
◉ What is a benefit of pre-registering patient's for service? Answer:
Patient arrival processing is expedited, reducing wait times and
delays
,◉ What is a characteristic of a managed contracting methodology?
Answer: Prospectively set rates for inpatient and outpatient services
◉ What do the MSP disability rules require? Answer: 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? Answer: Blue Cross and blue Shield
◉ What is true about screening a beneficiary for possible MSP
situations? Answer: 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? Answer: Warn the patient that unpaid accounts are
placed with collection agencies for further processing
◉ In services lines such as cardiology or orthopedics, what does the
case-rate payment methodology allow providers to do? Answer:
Receive a fixed for specific procedures
◉ What will comprehensive patient access processing accomplish?
Answer: Minimize the need for follow-up on insurance accounts
,◉ Through what document does a hospital establish compliance
standards? Answer: Code of conduct
◉ How does utilization review staff use correct insurance
information? Answer: To obtain approval for inpatient days and
coordinate services
◉ When is it not appropriate to use observation status? Answer: As
a substitute for an inpatient admission
◉ What is a serious consequence of misidentifying a patient in the
MPI? Answer: 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? Answer: Redirect
the patient to the patient access department for registration
◉ What process can be used to shorten claim turnaround time?
Answer: Send high-dollar hard-copy claims with required
attachments by overnight mail or registered mail
◉ How are patient reminder calls used? Answer: 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? Answer: Write off the account to the contractual adjustment
account
◉ According to the Department of Health and Human Services
guidelines, what is NOT considered income? Answer: Sale of
property, house, or car
◉ The situation where neither the patient nor spouse is employed is
described to the patient using: Answer: A condition code
◉ What option is an alternative to valid long-term payment plans?
Answer: Bank loans
◉ What is an advantage of using a collection agency to collect
delinquent patient accounts? Answer: Collection agencies collect
accounts faster than hospital does
◉ What statement DOES NOT apply to revenue codes? Answer:
revenue codes identify the payer
◉ When a patient's illness results in an unusually high amount of
medical bills not covered by insurance or other patient pay
EXAM 2 FINAL PREPARATION MANUAL 2026
◉ What will cause a CMS 1500 claim to be rejected? Answer: 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? Answer: The cost
of the test
◉ how are HCPCS codes and the appropriate modifiers used?
Answer: 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? Answer: Diagnostic and
clinically-related non-diagnostic charges provided on the Tuesday,
Wednesday, Thursday, and Friday before admission
◉ What is a benefit of pre-registering patient's for service? Answer:
Patient arrival processing is expedited, reducing wait times and
delays
,◉ What is a characteristic of a managed contracting methodology?
Answer: Prospectively set rates for inpatient and outpatient services
◉ What do the MSP disability rules require? Answer: 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? Answer: Blue Cross and blue Shield
◉ What is true about screening a beneficiary for possible MSP
situations? Answer: 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? Answer: Warn the patient that unpaid accounts are
placed with collection agencies for further processing
◉ In services lines such as cardiology or orthopedics, what does the
case-rate payment methodology allow providers to do? Answer:
Receive a fixed for specific procedures
◉ What will comprehensive patient access processing accomplish?
Answer: Minimize the need for follow-up on insurance accounts
,◉ Through what document does a hospital establish compliance
standards? Answer: Code of conduct
◉ How does utilization review staff use correct insurance
information? Answer: To obtain approval for inpatient days and
coordinate services
◉ When is it not appropriate to use observation status? Answer: As
a substitute for an inpatient admission
◉ What is a serious consequence of misidentifying a patient in the
MPI? Answer: 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? Answer: Redirect
the patient to the patient access department for registration
◉ What process can be used to shorten claim turnaround time?
Answer: Send high-dollar hard-copy claims with required
attachments by overnight mail or registered mail
◉ How are patient reminder calls used? Answer: 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? Answer: Write off the account to the contractual adjustment
account
◉ According to the Department of Health and Human Services
guidelines, what is NOT considered income? Answer: Sale of
property, house, or car
◉ The situation where neither the patient nor spouse is employed is
described to the patient using: Answer: A condition code
◉ What option is an alternative to valid long-term payment plans?
Answer: Bank loans
◉ What is an advantage of using a collection agency to collect
delinquent patient accounts? Answer: Collection agencies collect
accounts faster than hospital does
◉ What statement DOES NOT apply to revenue codes? Answer:
revenue codes identify the payer
◉ When a patient's illness results in an unusually high amount of
medical bills not covered by insurance or other patient pay
