CERTIFIED REVENUE CYCLE REPRESENTATIVE
QUESTION SET WITH RATIONALES AND
HEALTHCARE FINANCE AND COMPLIANCE
REVIEW 2026
◉ The patient experience includes all of the following except:
Answer: The average number of positive mentions received by the
health system or practice and the public comments refuting
unfriendly posts on social media sites.
◉ Corporate compliance programs play an important role in
protecting the integrity of operations and ensuring compliance with
federal and state requirements. The code of conduct is:
Answer: All of the above
◉ Specific to Medicare fee-for-service patients, which of the
following payers have always been liable for payment?
Answer: Public health service programs, Federal grant programs,
veteran affairs programs, black lung program services and work-
related injuries and accidents (worker' compensation claims)
◉ Provider policies and procedures should be in place to reduce the
risk of ethics violations. Examples of ethics violations include:
,Answer: All of the above
◉ Providers are now being reimbursed with a focus on the value of
the services provided, rather than volume, which requires
collaboration among providers.
What is the intended outcome of collaborations made through an
ACO delivery system for a population of patients?
Answer: To eliminate duplicate services, prevent medical errors and
ensure appropriateness of care.
◉ Historically, revenue cycle has delt with contractual adjustments,
bad debt and charity deductions from gross revenue. Although
deductions continue to exist, the definition of net revenue has been
modified through the implementation of ASC 606. Developed by the
Financial Accounting Standards Board (FASB), this change became
effective in 2018.
What is the new terminology now employed in the calculation of net
patient services revenues?
Answer: Explicit prices concessions and implicit price concessions
◉ Key performance indicators set standards for A/R and provide a
method for measuring the control and collection of A/R.
,What are the two KPIs used to monitor performance related to the
production and submission of claims to third party payers and
patients (self-pay)?
Answer: Elapsed days from discharge to final bill and elapsed days
from final bill to claim/bill submission.
◉ Consents are signed as part of the post-services process.
Answer: True
**False
◉ Patient service costs are calculated in the pre-service process for
schedule patients
Answer: **True
False
◉ The patient is scheduled and registered for service is a time-of-
service activity
Answer: True
**False
◉ The patient account is monitored for payment is a time-of-service
activity
Answer: True
, **False
◉ Case management and discharge planning services are a post-
service activty
Answer: True
**False
◉ Sending the bill electronically to the health plan is a time-of-
service activity
Answer: True
**False
◉ What happens during the post-service stage?
Answer: **A. Final coding of all services, preparation and
submission of claims, payment processing and balance billing and
resolution.
B. Orders are entered, results are reported, charges are generated,
and diagnostic and procedural coding is initiated.
C. The encounter record is generated, and the patient and guarantor
information is obtained and/or updated as required.
D. The focus is on the patient and his/her financial care, in addition
to the clinical care provided for the patient.
QUESTION SET WITH RATIONALES AND
HEALTHCARE FINANCE AND COMPLIANCE
REVIEW 2026
◉ The patient experience includes all of the following except:
Answer: The average number of positive mentions received by the
health system or practice and the public comments refuting
unfriendly posts on social media sites.
◉ Corporate compliance programs play an important role in
protecting the integrity of operations and ensuring compliance with
federal and state requirements. The code of conduct is:
Answer: All of the above
◉ Specific to Medicare fee-for-service patients, which of the
following payers have always been liable for payment?
Answer: Public health service programs, Federal grant programs,
veteran affairs programs, black lung program services and work-
related injuries and accidents (worker' compensation claims)
◉ Provider policies and procedures should be in place to reduce the
risk of ethics violations. Examples of ethics violations include:
,Answer: All of the above
◉ Providers are now being reimbursed with a focus on the value of
the services provided, rather than volume, which requires
collaboration among providers.
What is the intended outcome of collaborations made through an
ACO delivery system for a population of patients?
Answer: To eliminate duplicate services, prevent medical errors and
ensure appropriateness of care.
◉ Historically, revenue cycle has delt with contractual adjustments,
bad debt and charity deductions from gross revenue. Although
deductions continue to exist, the definition of net revenue has been
modified through the implementation of ASC 606. Developed by the
Financial Accounting Standards Board (FASB), this change became
effective in 2018.
What is the new terminology now employed in the calculation of net
patient services revenues?
Answer: Explicit prices concessions and implicit price concessions
◉ Key performance indicators set standards for A/R and provide a
method for measuring the control and collection of A/R.
,What are the two KPIs used to monitor performance related to the
production and submission of claims to third party payers and
patients (self-pay)?
Answer: Elapsed days from discharge to final bill and elapsed days
from final bill to claim/bill submission.
◉ Consents are signed as part of the post-services process.
Answer: True
**False
◉ Patient service costs are calculated in the pre-service process for
schedule patients
Answer: **True
False
◉ The patient is scheduled and registered for service is a time-of-
service activity
Answer: True
**False
◉ The patient account is monitored for payment is a time-of-service
activity
Answer: True
, **False
◉ Case management and discharge planning services are a post-
service activty
Answer: True
**False
◉ Sending the bill electronically to the health plan is a time-of-
service activity
Answer: True
**False
◉ What happens during the post-service stage?
Answer: **A. Final coding of all services, preparation and
submission of claims, payment processing and balance billing and
resolution.
B. Orders are entered, results are reported, charges are generated,
and diagnostic and procedural coding is initiated.
C. The encounter record is generated, and the patient and guarantor
information is obtained and/or updated as required.
D. The focus is on the patient and his/her financial care, in addition
to the clinical care provided for the patient.
