HFMA CRCR EXAM STUDY GUIDE 2025 – 170+
Accurate Questions with Correct Detailed Answers ||
Certified Revenue Cycle Representative || Verified
**1. What is the primary purpose of patient pre-registration?**
**A.** To collect payment in full before service.
**B.** To verify insurance eligibility and benefits in advance of service.
**C.** To schedule the patient's follow-up appointment.
**D.** To complete all clinical documentation.
**Answer: B.** To verify insurance eligibility and benefits in advance of service.
**Detail:** Pre-registration is a proactive step to gather patient demographic and insurance
information, verify coverage, identify patient responsibility (copay, deductible, coinsurance),
and address potential issues *before* the day of service, reducing denials and improving cash
flow.
**2. Which of the following is a critical data element required for accurate patient
identification?**
**A.** Patient's employer name.
**B.** Patient's primary care physician.
**C.** Patient's full name and date of birth.
**D.** Patient's emergency contact.
**Answer: C.** Patient's full name and date of birth.
**Detail:** Using at least two patient identifiers (most commonly full name and date of birth) is
a National Patient Safety Goal and is crucial to prevent medical record mix-ups, ensure safety,
and ensure billing is sent to the correct insurer.
**3. What is an Advance Beneficiary Notice of Noncoverage (ABN)?**
,**A.** A form for patients to assign benefits to the provider.
**B.** A form that informs a Medicare patient they may be financially responsible for a service
Medicare is not expected to cover.
**C.** A form that guarantees Medicare will pay for a service.
**D.** A form used to verify a patient's identity.
**Answer: B.** A form that informs a Medicare patient they may be financially responsible for a
service Medicare is not expected to cover.
**Detail:** The ABN (Form CMS-R-131) allows patients to make an informed decision about
receiving a service that may not be medically necessary under Medicare rules. If they choose to
receive the service after signing the ABN, they agree to pay for it if Medicare denies the claim.
**4. What is the main goal of the pre-authorization process?**
**A.** To guarantee payment from the insurance company.
**B.** To obtain a promise of payment from the insurer for a specific, medically necessary
service.
**C.** To schedule the patient's procedure.
**D.** To collect the patient's copayment.
**Answer: B.** To obtain a promise of payment from the insurer for a specific, medically
necessary service.
**Detail:** Pre-authorization (or pre-certification) is a requirement by many payers where the
provider must obtain approval *before* rendering a service. It confirms that the insurer deems
the service medically necessary, which significantly reduces the risk of a denial.
**5. A patient's insurance card lists a copayment of $30 for a specialist visit. When is this
payment typically collected?**
**A.** After the insurance has paid its portion.
**B.** At the time of service.
**C.** Within 60 days of the date of service.
**D.** It is billed to the patient later.
, **Answer: B.** At the time of service.
**Detail:** Copays are a fixed amount the patient is contractually obligated to pay for a covered
service (e.g., $30 for a doctor's visit). Best practice and many payer contracts require collecting
this known amount at the time of service to reduce accounts receivable.
**6. What does the term "coinsurance" refer to?**
**A.** A fixed dollar amount paid per service.
**B.** The monthly premium paid for insurance.
**C.** A percentage of the allowed charge that the patient owes after the deductible is met.
**D.** The maximum amount a patient will pay in a year.
**Answer: C.** A percentage of the allowed charge that the patient owes after the deductible is
met.
**Detail:** For example, if a plan has 20% coinsurance, the patient pays 20% of the allowed
amount for a service, and the insurance pays 80%, but only after the patient's annual deductible
has been satisfied.
**7. What is a "deductible" in health insurance?**
**A.** The amount the insurance company pays to the provider.
**B.** The amount the patient must pay out-of-pocket for covered services before the
insurance plan begins to pay.
**C.** The maximum limit of what the insurance will pay in a year.
**D.** The cost-sharing amount paid at the time of service.
**Answer: B.** The amount the patient must pay out-of-pocket for covered services before the
insurance plan begins to pay.
**Detail:** A deductible is an annual amount (e.g., $1,500) that the patient is responsible for
paying before the insurance company starts paying its share for covered services (excluding
typically preventive care and copays).
**8. Verifying eligibility and benefits provides all of the following EXCEPT:**
Accurate Questions with Correct Detailed Answers ||
Certified Revenue Cycle Representative || Verified
**1. What is the primary purpose of patient pre-registration?**
**A.** To collect payment in full before service.
**B.** To verify insurance eligibility and benefits in advance of service.
**C.** To schedule the patient's follow-up appointment.
**D.** To complete all clinical documentation.
**Answer: B.** To verify insurance eligibility and benefits in advance of service.
**Detail:** Pre-registration is a proactive step to gather patient demographic and insurance
information, verify coverage, identify patient responsibility (copay, deductible, coinsurance),
and address potential issues *before* the day of service, reducing denials and improving cash
flow.
**2. Which of the following is a critical data element required for accurate patient
identification?**
**A.** Patient's employer name.
**B.** Patient's primary care physician.
**C.** Patient's full name and date of birth.
**D.** Patient's emergency contact.
**Answer: C.** Patient's full name and date of birth.
**Detail:** Using at least two patient identifiers (most commonly full name and date of birth) is
a National Patient Safety Goal and is crucial to prevent medical record mix-ups, ensure safety,
and ensure billing is sent to the correct insurer.
**3. What is an Advance Beneficiary Notice of Noncoverage (ABN)?**
,**A.** A form for patients to assign benefits to the provider.
**B.** A form that informs a Medicare patient they may be financially responsible for a service
Medicare is not expected to cover.
**C.** A form that guarantees Medicare will pay for a service.
**D.** A form used to verify a patient's identity.
**Answer: B.** A form that informs a Medicare patient they may be financially responsible for a
service Medicare is not expected to cover.
**Detail:** The ABN (Form CMS-R-131) allows patients to make an informed decision about
receiving a service that may not be medically necessary under Medicare rules. If they choose to
receive the service after signing the ABN, they agree to pay for it if Medicare denies the claim.
**4. What is the main goal of the pre-authorization process?**
**A.** To guarantee payment from the insurance company.
**B.** To obtain a promise of payment from the insurer for a specific, medically necessary
service.
**C.** To schedule the patient's procedure.
**D.** To collect the patient's copayment.
**Answer: B.** To obtain a promise of payment from the insurer for a specific, medically
necessary service.
**Detail:** Pre-authorization (or pre-certification) is a requirement by many payers where the
provider must obtain approval *before* rendering a service. It confirms that the insurer deems
the service medically necessary, which significantly reduces the risk of a denial.
**5. A patient's insurance card lists a copayment of $30 for a specialist visit. When is this
payment typically collected?**
**A.** After the insurance has paid its portion.
**B.** At the time of service.
**C.** Within 60 days of the date of service.
**D.** It is billed to the patient later.
, **Answer: B.** At the time of service.
**Detail:** Copays are a fixed amount the patient is contractually obligated to pay for a covered
service (e.g., $30 for a doctor's visit). Best practice and many payer contracts require collecting
this known amount at the time of service to reduce accounts receivable.
**6. What does the term "coinsurance" refer to?**
**A.** A fixed dollar amount paid per service.
**B.** The monthly premium paid for insurance.
**C.** A percentage of the allowed charge that the patient owes after the deductible is met.
**D.** The maximum amount a patient will pay in a year.
**Answer: C.** A percentage of the allowed charge that the patient owes after the deductible is
met.
**Detail:** For example, if a plan has 20% coinsurance, the patient pays 20% of the allowed
amount for a service, and the insurance pays 80%, but only after the patient's annual deductible
has been satisfied.
**7. What is a "deductible" in health insurance?**
**A.** The amount the insurance company pays to the provider.
**B.** The amount the patient must pay out-of-pocket for covered services before the
insurance plan begins to pay.
**C.** The maximum limit of what the insurance will pay in a year.
**D.** The cost-sharing amount paid at the time of service.
**Answer: B.** The amount the patient must pay out-of-pocket for covered services before the
insurance plan begins to pay.
**Detail:** A deductible is an annual amount (e.g., $1,500) that the patient is responsible for
paying before the insurance company starts paying its share for covered services (excluding
typically preventive care and copays).
**8. Verifying eligibility and benefits provides all of the following EXCEPT:**
