CERTIFIED REVENUE CYCLE REPRESENTATIVE KEY CONCEPTS AND PROCEDURES UPDATED ACTUAL EXAM QUESTIONS CORRECT ANSWERS GRADED A PLUS

CERTIFIED REVENUE CYCLE REPRESENTATIVE KEY CONCEPTS AND PROCEDURES
UPDATED ACTUAL EXAM QUESTIONS CORRECT ANSWERS GRADED A PLUS
Certified Revenue Cycle Representative KEY
Concepts AND Procedures Questions and Answers
Verified Solutions Latest Update 2026/2027

Question:
What is the purpose of a compliance program?

Answer:
Mitigate potential fraud and abuse in the industry-specific key risk areas



Question:
What is important about an effective corporate compliance program?

Answer:
A program that embodies many elements to create a program that is transparent, clearly articulated
and emphasized at all employee levels as a seriously held personal and organizational responsibility,
one that relies on full communication inside and outside the organization



Question:
What is a CCO

Answer:
Chief compliance officer - they typically report directly to the board of directors/trustees as well as
the chief executive officer, and has limited responsibilities for other operational aspects of the
organization



Question:
What are the situations where another payer may be completely responsible for payment?

Answer:
Work-related accidents, black lung program services, patient is enrolled in Medicare Advantage,
Federal grant programs

,Question:
Under Medicare rules, certain outpatient services that are provided within three days of the
admission date, by hospitals or by entities owned or controlled by hospitals, must be billed as part of
an inpatient stay.

Answer:
TRUE



Question:
The OIG has issued compliance guidance/model compliance plans for all of the following entities:

Answer:
hospices. physician practices. ambulance providers



Question:
Providers who are found to be in violation of CMS regulations are subject to:

Answer:
Corporate integrity agreements



Question:
What MSP situation requires LGHP

Answer:
Disability



Question:
The disadvantages of outsourcing include all of the following EXCEPT: a) The impact of customer
service or patient relations b) The impact of loss of direct control of accounts receivable services c)
Increased costs due to vendor ineffectiveness d) Reduced internal staffing costs and a reliance on
outsourced staff

,Answer:
D



Question:
The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the
following levels EXCEPT: a) Medical necessity review by an independent physician's panel b)
Judicial review by a federal district court c) Redetermination by the company that handles claims for
Medicare d) Review by the Medicare Appeals Council (Appeals Council)

Answer:
B



Question:
Business ethics, or organizational ethics represent: a) The principles and standards by which
organizations operate b) Regulations that must be followed by law c) Definitions of appropriate
customer service d) The code of acceptable conduct

Answer:
A



Question:
A portion of the accounts receivable inventory which has NOT qualified for billing includes: a)
Charitable pledges b) Accounts created during pre-registration but not activated c) Accounts coded
but held within the suspense period d) Accounts assigned to a pre-collection agency

Answer:
A



Question:
Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) are Medicare
established guideline(s) used to determine: a) Medicare and Medicaid provider eligibility b)
Medicare outpatient reimbursement rates c) Which diagnoses, signs, or symptoms are reimbursable
d) What Medicare reimburses and what should be referred to Medicaid

, Answer:
C



Question:
Days in A/R is calculated based on the value of: a) The total accounts receivable on a specific date
b) Total anticipated revenue minus expenses c) The time it takes to collect anticipated revenue d)
Total cash received to date

Answer:
C



Question:
Patients are contacting hospitals to proactively inquire about costs and fees prior to agreeing to
service. The problem for hospitals in providing such information is: a) That hospitals don't want to
establish a price without knowing if the patient has insurance and how much reimbursement can be
expected b) The fact that charge master lists the total charge, not net charges that reflect charges
after a payer's contractual adjustment c) That hospitals don't want to be put in the position of
"guaranteeing" price without having room for additional charges that may arise in the course of
treatment d) Their reluctance to share proprietary information

Answer:
B



Question:
Across all care settings, if a patient consents to a financial discussion during a medical encounter to
expedite discharge, the HFMA best practice is to: a) Make sure that the attending staff can answer
questions and assist in obtaining required patient financial data b) Have a patient financial
responsibilities kit ready for the patient, containing all of the required registration forms and
instructions c) Support that choice, providing that the discussion does not interfere with patient care
or disrupt patient flow d) Decline such request as finance discussions can disrupt patient care and
patient flow

Answer:
C