CRCR Certification Questions and
Answers Updated 2026/2027 Version |
Verified Answers
1. A claim is denied for the following reasons, EXCEPT:
a) The health plan cannot identify the subscriber
b) The frequency of service was outside the coverage timeline
c) The submitted claim does not have the physicians signature
d) The subscriber was not enrolled at the time of service - ANSWER ✅
c) The submitted claim does not have the physicians signature
2. Any provider that has filed a timely cost report may appeal an adverse final
decision received from the Medicare Administrative Contractor (MAC).
This appeal may be filed with
a) A court appointed federal mediator
b) The Department of Health and Human Services Provider Relations
Division
c) The Office of the Inspector General
d) The Provider Reimbursement Review Board - ANSWER ✅ d) The
Provider Reimbursement Review Board
3. Charges, as the most appropriate measurement of utilization, enables
a) Generation of timely and accurate billing
b) Managing of expense budgets
c) Accuracy of expense and cost capture
d) Effective HIM planning - ANSWER ✅ a) Generation of timely and
accurate billing
4. Ambulance services are billed directly to the health plan for
, a) All pre-admission emergency transports
b) Services provided before a patient is admitted and for ambulance rides
arranged to pick up the patient from the hospital after discharge to
take him/her home or to another facility
c) The portion of the bill outside of the patient's self-pay
d) Transports deemed medically necessary by the attending paramedic-
ambulance crew - ANSWER ✅ c) The portion of the bill outside of the
patient's self-pay
5. An individual enrolled in Medicare who is dissatisfied with the government's
claim determination is entitled to reconsideration of the decision. This type
of appeal is known as
a) A beneficiary appeal
b) A Medicare supplemental review
c) A payment review
d) A Medicare determination appeal - ANSWER ✅ a) A beneficiary
appeal
6. The nuanced data resulting from detailed ICD-10 coding allows senior
leadership to work with physicians to do all of the following EXCEPT:
a) Drive significant improvements in the areas of quality and the patient
experience
b) Embrace new reimbursement models
c) Improve outcomes
d) Obtain higher compensation for physicians - ANSWER ✅ d) Obtain
higher compensation for physicians
7. Duplicate payments occur:
a) When providers re-bill claims based on nonpayment from the initial
bill submission
b) When service departments do not process charges with the
organization's suspense days
c) When the payer's coordination of benefits is not captured correctly at
the time of patient registration
, d) When there are other healthcare claims in process and the anticipated
deductibles and co-insurance amounts still show open but will be met by the
in-process claims - ANSWER ✅ a) When providers re-bill claims based on
nonpayment from the initial bill submission
8. The Affordable Care Act legislated the development of Health Insurance
Exchanges, where individuals and small businesses can
a) Purchase qualified health benefit plans regardless of insured's health
status
b) Obtain price estimates for medical services
c) Negotiate the price of medical services with providers
d) Meet federal mandates for insurance coverage and obtain the
corresponding tax deduction - ANSWER ✅ a) Purchase qualified
health benefit plans regardless of insured's health status
9. The most common resolution methods for credit balances include all the
following EXCEPT:
a) Designate the overpayment for charity care
b) Submit the corrected claim to the payer incorporating credits
c) Either send a refund or complete a takeback form as directed by the
payer
d) Determine the correct primary payer and notify incorrect payer of
overpayment - ANSWER ✅ a) Designate the overpayment for charity
care
10.EFT (electronic funds transfer) is
a) An electronic claim submission
b) The record of payments in the hospital's accounting system
c) An electronic confirmation that a payment is due
d) An electronic transfer of funds from payer to payee - ANSWER ✅ d)
An electronic transfer of funds from payer to payee
, 11.Revenue cycle activities occurring at the point-of-service include all the
following EXCEPT:
a) The monitoring of charges
b) The provision of case management and discharge planning services
c) Providing charges to the third-party payer as they are incurred
d) The generation of charges - ANSWER ✅ c) Providing charges to the
third-party payer as they are incurred
12.Medicare beneficiaries remain in the same "benefit period"
a) Up to hospitalization discharge
b) Until the beneficiary is "hospitalization and/or skilled nursing
facility-free" for 60 consecutive days
c) Each calendar year
d) Up to 60 days - ANSWER ✅ b) Until the beneficiary is "hospitalization
and/or skilled nursing facility-free" for 60 consecutive days
13.Key Performance Indicators (KPIs) set standards for accounts receivables
(A/R) and
a) Provide evidence of financial status
b) Provide a method of measuring the collection and control of A/R
c) Establish productivity targets
d) Make allowance for accurate revenue forecasting - ANSWER ✅ b)
Provide a method of measuring the collection and control of A/R
14.Recognizing that health coverage is complicated and not all patients are able
to navigate this terrain, HFMA best practices specify that
a) The patient accounts staff have someone assigned to research
coverage on behalf of patients
b) Patients should be given the opportunity to request a patient advocate,
family member, or other designee to help them in these discussions
c) Patient coverage education may need to be provided by the health
plan
d) A representative of the health plan be included in the patient financial
responsibilities
Answers Updated 2026/2027 Version |
Verified Answers
1. A claim is denied for the following reasons, EXCEPT:
a) The health plan cannot identify the subscriber
b) The frequency of service was outside the coverage timeline
c) The submitted claim does not have the physicians signature
d) The subscriber was not enrolled at the time of service - ANSWER ✅
c) The submitted claim does not have the physicians signature
2. Any provider that has filed a timely cost report may appeal an adverse final
decision received from the Medicare Administrative Contractor (MAC).
This appeal may be filed with
a) A court appointed federal mediator
b) The Department of Health and Human Services Provider Relations
Division
c) The Office of the Inspector General
d) The Provider Reimbursement Review Board - ANSWER ✅ d) The
Provider Reimbursement Review Board
3. Charges, as the most appropriate measurement of utilization, enables
a) Generation of timely and accurate billing
b) Managing of expense budgets
c) Accuracy of expense and cost capture
d) Effective HIM planning - ANSWER ✅ a) Generation of timely and
accurate billing
4. Ambulance services are billed directly to the health plan for
, a) All pre-admission emergency transports
b) Services provided before a patient is admitted and for ambulance rides
arranged to pick up the patient from the hospital after discharge to
take him/her home or to another facility
c) The portion of the bill outside of the patient's self-pay
d) Transports deemed medically necessary by the attending paramedic-
ambulance crew - ANSWER ✅ c) The portion of the bill outside of the
patient's self-pay
5. An individual enrolled in Medicare who is dissatisfied with the government's
claim determination is entitled to reconsideration of the decision. This type
of appeal is known as
a) A beneficiary appeal
b) A Medicare supplemental review
c) A payment review
d) A Medicare determination appeal - ANSWER ✅ a) A beneficiary
appeal
6. The nuanced data resulting from detailed ICD-10 coding allows senior
leadership to work with physicians to do all of the following EXCEPT:
a) Drive significant improvements in the areas of quality and the patient
experience
b) Embrace new reimbursement models
c) Improve outcomes
d) Obtain higher compensation for physicians - ANSWER ✅ d) Obtain
higher compensation for physicians
7. Duplicate payments occur:
a) When providers re-bill claims based on nonpayment from the initial
bill submission
b) When service departments do not process charges with the
organization's suspense days
c) When the payer's coordination of benefits is not captured correctly at
the time of patient registration
, d) When there are other healthcare claims in process and the anticipated
deductibles and co-insurance amounts still show open but will be met by the
in-process claims - ANSWER ✅ a) When providers re-bill claims based on
nonpayment from the initial bill submission
8. The Affordable Care Act legislated the development of Health Insurance
Exchanges, where individuals and small businesses can
a) Purchase qualified health benefit plans regardless of insured's health
status
b) Obtain price estimates for medical services
c) Negotiate the price of medical services with providers
d) Meet federal mandates for insurance coverage and obtain the
corresponding tax deduction - ANSWER ✅ a) Purchase qualified
health benefit plans regardless of insured's health status
9. The most common resolution methods for credit balances include all the
following EXCEPT:
a) Designate the overpayment for charity care
b) Submit the corrected claim to the payer incorporating credits
c) Either send a refund or complete a takeback form as directed by the
payer
d) Determine the correct primary payer and notify incorrect payer of
overpayment - ANSWER ✅ a) Designate the overpayment for charity
care
10.EFT (electronic funds transfer) is
a) An electronic claim submission
b) The record of payments in the hospital's accounting system
c) An electronic confirmation that a payment is due
d) An electronic transfer of funds from payer to payee - ANSWER ✅ d)
An electronic transfer of funds from payer to payee
, 11.Revenue cycle activities occurring at the point-of-service include all the
following EXCEPT:
a) The monitoring of charges
b) The provision of case management and discharge planning services
c) Providing charges to the third-party payer as they are incurred
d) The generation of charges - ANSWER ✅ c) Providing charges to the
third-party payer as they are incurred
12.Medicare beneficiaries remain in the same "benefit period"
a) Up to hospitalization discharge
b) Until the beneficiary is "hospitalization and/or skilled nursing
facility-free" for 60 consecutive days
c) Each calendar year
d) Up to 60 days - ANSWER ✅ b) Until the beneficiary is "hospitalization
and/or skilled nursing facility-free" for 60 consecutive days
13.Key Performance Indicators (KPIs) set standards for accounts receivables
(A/R) and
a) Provide evidence of financial status
b) Provide a method of measuring the collection and control of A/R
c) Establish productivity targets
d) Make allowance for accurate revenue forecasting - ANSWER ✅ b)
Provide a method of measuring the collection and control of A/R
14.Recognizing that health coverage is complicated and not all patients are able
to navigate this terrain, HFMA best practices specify that
a) The patient accounts staff have someone assigned to research
coverage on behalf of patients
b) Patients should be given the opportunity to request a patient advocate,
family member, or other designee to help them in these discussions
c) Patient coverage education may need to be provided by the health
plan
d) A representative of the health plan be included in the patient financial
responsibilities
