CRCR EXAM MULTIPLE CHOICE,
CRCR Exam Prep, Certified Revenue
Cycle Representative - CRCR 2025
What are collection agency fees based on? - Correct AnswersA percentage of dollars
collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? - Correct AnswersBirthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - Correct AnswersCase rates
What customer service improvements might improve the patient accounts department?
- Correct AnswersHolding staff accountable for customer service during performance
reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
Correct AnswersInform a Medicare beneficiary that Medicare may not pay for the order
or service
What type of account adjustment results from the patient's unwillingness to pay for a
self-pay balance? - Correct AnswersBad debt adjustment
What is the initial hospice benefit? - Correct AnswersTwo 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -
Correct AnswersIf the patient requires ambulance transportation to a skilled nursing
facility
How should a provider resolve a late-charge credit posted after an account is billed? -
Correct AnswersPost a late-charge adjustment to the account
an increase in the dollars aged greater than 90 days from date of service indicate what
about accounts - Correct AnswersThey are not being processed in a timely manner
What is an advantage of a preregistration program? - Correct AnswersIt reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? - Correct
AnswersMedically unnecessary services and custodial care
,What core financial activities are resolved within patient access? - Correct
AnswersScheduling, insurance verification, discharge processing, and payment of point-
of-service receipts
What statement applies to the scheduled outpatient? - Correct AnswersThe services do
not involve an overnight stay
How is a mis-posted contractual allowance resolved? - Correct AnswersComparing the
contract reimbursement rates with the contract on the admittance advice to identify the
correct amount
What type of patient status is used to evaluate the patient's need for inpatient care? -
Correct AnswersObservation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - Correct AnswersMedically necessary inpatient hospital
services for at least 3 consecutive days before the skilled nursing care admission
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - Correct
AnswersWhen the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - Correct AnswersUnscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what
is the status of the subscriber's spouse? - Correct AnswersNeither enrolled not entitled
to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - Correct AnswersDisclosure rules for consumer credit sales and
consumer loans
What is a principal diagnosis? - Correct AnswersPrimary reason for the patient's
admission
Collecting patient liability dollars after service leads to what? - Correct AnswersLower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - Correct
Answers50% of the current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not
billable as an RHC services? - Correct AnswersInpatient care
What code indicates the disposition of the patient at the conclusion of service? - Correct
AnswersPatient discharge status code
,What are hospitals required to do for Medicare credit balance accounts? - Correct
AnswersThey result in lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient and the
third party payer, who is responsible for payment? - Correct AnswersPatient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - Correct AnswersA valid CPT or
HCPCS code
With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - Correct AnswersAccess their information and
perform functions on-line
What date is required on all CMS 1500 claim forms? - Correct Answersonset date of
current illness
What does scheduling allow provider staff to do - Correct AnswersReview
appropriateness of the service request
What code is used to report the provider's most common semiprivate room rate? -
Correct AnswersCondition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: - Correct
Answers2012
What is a primary responsibility of the Recover Audit Contractor? - Correct AnswersTo
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - Correct AnswersComply with state
statutes concerning reporting credit balance
Insurance verification results in what? - Correct AnswersThe accurate identification of
the patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - Correct AnswersCMS 1500
What activities are completed when a scheduled pre-registered patient arrives for
service? - Correct AnswersRegistering the patient and directing the patient to the
service area
In addition to being supported by information found in the patient's chart, a CMS 1500
claim must be coded using what? - Correct AnswersHCPCS (Healthcare Common
Procedure Coding system)
, What results from a denied claim? - Correct AnswersThe provider incurs rework and
appeal costs
Why does the financial counselor need pricing for services? - Correct AnswersTo
calculate the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - Correct
AnswersHospital-based mammography centers
How are disputes with nongovernmental payers resolved? - Correct AnswersAppeal
conditions specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - Correct AnswersRight to appeal a discharge decision if the patient
disagrees with the services
Why do managed care plans have agreements with hospitals, physicians, and other
healthcare providers to offer a range of services to plan members? - Correct AnswersTo
improve access to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30
days, what is the SNF permitted to do? - Correct AnswersSubmit interim bills to the
Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - Correct Answers120 days passes, but the claim then be
withdrawn from the liability carrier
What data are required to establish a new MPI entry? - Correct AnswersThe patient's
full legal name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as primary? -
Correct AnswersDetermine the correct payer and notify the incorrect payer of the
processing error
What do EMTALA regulations require on-call physicians to do? - Correct
AnswersPersonally appear in the emergency department and attend to the patient
within a reasonable time
At the end of each shift, what must happen to cash, checks, and credit card transaction
documents? - Correct AnswersThey must be balanced
What will cause a CMS 1500 claim to be rejected? - Correct AnswersThe provider is
billing with a future date of service
CRCR Exam Prep, Certified Revenue
Cycle Representative - CRCR 2025
What are collection agency fees based on? - Correct AnswersA percentage of dollars
collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or
what other rule? - Correct AnswersBirthday
In what type of payment methodology is a lump sum or bundled payment negotiated
between the payer and some or all providers? - Correct AnswersCase rates
What customer service improvements might improve the patient accounts department?
- Correct AnswersHolding staff accountable for customer service during performance
reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? -
Correct AnswersInform a Medicare beneficiary that Medicare may not pay for the order
or service
What type of account adjustment results from the patient's unwillingness to pay for a
self-pay balance? - Correct AnswersBad debt adjustment
What is the initial hospice benefit? - Correct AnswersTwo 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? -
Correct AnswersIf the patient requires ambulance transportation to a skilled nursing
facility
How should a provider resolve a late-charge credit posted after an account is billed? -
Correct AnswersPost a late-charge adjustment to the account
an increase in the dollars aged greater than 90 days from date of service indicate what
about accounts - Correct AnswersThey are not being processed in a timely manner
What is an advantage of a preregistration program? - Correct AnswersIt reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? - Correct
AnswersMedically unnecessary services and custodial care
,What core financial activities are resolved within patient access? - Correct
AnswersScheduling, insurance verification, discharge processing, and payment of point-
of-service receipts
What statement applies to the scheduled outpatient? - Correct AnswersThe services do
not involve an overnight stay
How is a mis-posted contractual allowance resolved? - Correct AnswersComparing the
contract reimbursement rates with the contract on the admittance advice to identify the
correct amount
What type of patient status is used to evaluate the patient's need for inpatient care? -
Correct AnswersObservation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - Correct AnswersMedically necessary inpatient hospital
services for at least 3 consecutive days before the skilled nursing care admission
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - Correct
AnswersWhen the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - Correct AnswersUnscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what
is the status of the subscriber's spouse? - Correct AnswersNeither enrolled not entitled
to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - Correct AnswersDisclosure rules for consumer credit sales and
consumer loans
What is a principal diagnosis? - Correct AnswersPrimary reason for the patient's
admission
Collecting patient liability dollars after service leads to what? - Correct AnswersLower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - Correct
Answers50% of the current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not
billable as an RHC services? - Correct AnswersInpatient care
What code indicates the disposition of the patient at the conclusion of service? - Correct
AnswersPatient discharge status code
,What are hospitals required to do for Medicare credit balance accounts? - Correct
AnswersThey result in lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient and the
third party payer, who is responsible for payment? - Correct AnswersPatient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - Correct AnswersA valid CPT or
HCPCS code
With advances in internet security and encryption, revenue-cycle processes are
expanding to allow patients to do what? - Correct AnswersAccess their information and
perform functions on-line
What date is required on all CMS 1500 claim forms? - Correct Answersonset date of
current illness
What does scheduling allow provider staff to do - Correct AnswersReview
appropriateness of the service request
What code is used to report the provider's most common semiprivate room rate? -
Correct AnswersCondition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: - Correct
Answers2012
What is a primary responsibility of the Recover Audit Contractor? - Correct AnswersTo
correctly identify proper payments for Medicare Part A & B claims
How must providers handle credit balances? - Correct AnswersComply with state
statutes concerning reporting credit balance
Insurance verification results in what? - Correct AnswersThe accurate identification of
the patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - Correct AnswersCMS 1500
What activities are completed when a scheduled pre-registered patient arrives for
service? - Correct AnswersRegistering the patient and directing the patient to the
service area
In addition to being supported by information found in the patient's chart, a CMS 1500
claim must be coded using what? - Correct AnswersHCPCS (Healthcare Common
Procedure Coding system)
, What results from a denied claim? - Correct AnswersThe provider incurs rework and
appeal costs
Why does the financial counselor need pricing for services? - Correct AnswersTo
calculate the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - Correct
AnswersHospital-based mammography centers
How are disputes with nongovernmental payers resolved? - Correct AnswersAppeal
conditions specified in the individual payer's contract
The important message from Medicare provides beneficiaries with information
concerning what? - Correct AnswersRight to appeal a discharge decision if the patient
disagrees with the services
Why do managed care plans have agreements with hospitals, physicians, and other
healthcare providers to offer a range of services to plan members? - Correct AnswersTo
improve access to quality healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30
days, what is the SNF permitted to do? - Correct AnswersSubmit interim bills to the
Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - Correct Answers120 days passes, but the claim then be
withdrawn from the liability carrier
What data are required to establish a new MPI entry? - Correct AnswersThe patient's
full legal name, date of birth, and sex
What should the provider do if both of the patient's insurance plans pay as primary? -
Correct AnswersDetermine the correct payer and notify the incorrect payer of the
processing error
What do EMTALA regulations require on-call physicians to do? - Correct
AnswersPersonally appear in the emergency department and attend to the patient
within a reasonable time
At the end of each shift, what must happen to cash, checks, and credit card transaction
documents? - Correct AnswersThey must be balanced
What will cause a CMS 1500 claim to be rejected? - Correct AnswersThe provider is
billing with a future date of service
