Certified Revenue Cycle Representative -
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CRCR (2025) exam with correct detailed
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answers
What |are |collection |agency |fees |based |on? |- |correct |answer |A |percentage |of |dollars |collected
Self-funded |benefit |plans |may |choose |to |coordinate |benefits |using |the |gender |rule |or |what |
other |rule? |- |correct |answer |Birthday
In |what |type |of |payment |methodology |is |a |lump |sum |or |bundled |payment |negotiated |
between |the |payer |and |some |or |all |providers? |- |correct |answer |Case |rates
What |customer |service |improvements |might |improve |the |patient |accounts |department? |- |
correct |answer |Holding |staff |accountable |for |customer |service |during |performance |reviews
What |is |an |ABN |(Advance |Beneficiary |Notice |of |Non-coverage) |required |to |do? |- |correct |
answer |Inform |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 |answer |Bad |debt |adjustment
What |is |the |initial |hospice |benefit? |- |correct |answer |Two |90-day |periods |and |an |unlimited |
number |of |subsequent |periods
When |does |a |hospital |add |ambulance |charges |to |the |Medicare |inpatient |claim? |- |correct |
answer |If |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 |
answer |Post |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 |answer |They |are |not |being |processed |in |a |timely |manner
What |is |an |advantage |of |a |preregistration |program? |- |correct |answer |It |reduces |processing |
times |at |the |time |of |service
What |are |the |two |statutory |exclusions |from |hospice |coverage? |- |correct |answer |Medically |
unnecessary |services |and |custodial |care
What |core |financial |activities |are |resolved |within |patient |access? |- |correct |answer |Scheduling, |
insurance |verification, |discharge |processing, |and |payment |of |point-of-service |receipts
What |statement |applies |to |the |scheduled |outpatient? |- |correct |answer |The |services |do |not |
involve |an |overnight |stay
How |is |a |mis-posted |contractual |allowance |resolved? |- |correct |answer |Comparing |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
|answer |Observation
Coverage |rules |for |Medicare |beneficiaries |receiving |skilled |nursing |care |require |that |the |
beneficiary |has |received |what? |- |correct |answer |Medically |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 |answer
|When |the |patient |is |the |insured
What |are |non-emergency |patients |who |come |for |service |without |prior |notification |to |the |
provider |called? |- |correct |answer |Unscheduled |patients
If |the |insurance |verification |response |reports |that |a |subscriber |has |a |single |policy, |what |is |the |
status |of |the |subscriber's |spouse? |- |correct |answer |Neither |enrolled |not |entitled |to |benefits
Regulation |Z |of |the |Consumer |Credit |Protection |Act, |also |known |as |the |Truth |in |Lending |Act, |
establishes |what? |- |correct |answer |Disclosure |rules |for |consumer |credit |sales |and |consumer |
loans
What |is |a |principal |diagnosis? |- |correct |answer |Primary |reason |for |the |patient's |admission
Collecting |patient |liability |dollars |after |service |leads |to |what? |- |correct |answer |Lower |accounts
|receivable |levels
What |is |the |daily |out-of-pocket |amount |for |each |lifetime |reserve |day |used? |- |correct |answer |
50% |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 |answer |Inpatient |care
What |code |indicates |the |disposition |of |the |patient |at |the |conclusion |of |service? |- |correct |
answer |Patient |discharge |status |code
What |are |hospitals |required |to |do |for |Medicare |credit |balance |accounts? |- |correct |answer |
They |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 |answer |Patient
Medicare |guidelines |require |that |when |a |test |is |ordered |for |a |LCD |or |NCD |exists, |the |
information |provided |on |the |order |must |include: |- |correct |answer |A |valid |CPT |or |HCPCS |code
With |advances |in |internet |security |and |encryption, |revenue-cycle |processes |are |expanding |to |
allow |patients |to |do |what? |- |correct |answer |Access |their |information |and |perform |functions |
on-line
What |date |is |required |on |all |CMS |1500 |claim |forms? |- |correct |answer |onset |date |of |current |
illness
What |does |scheduling |allow |provider |staff |to |do |- |correct |answer |Review |appropriateness |of |
the |service |request
What |code |is |used |to |report |the |provider's |most |common |semiprivate |room |rate? |- |correct |
answer |Condition |code
Regulations |and |requirements |for |coding |accountable |care |organizations, |which |allows |
providers |to |begin |creating |these |organizations, |were |finalized |in: |- |correct |answer |2012
What |is |a |primary |responsibility |of |the |Recover |Audit |Contractor? |- |correct |answer |To |
correctly |identify |proper |payments |for |Medicare |Part |A |& |B |claims
How |must |providers |handle |credit |balances? |- |correct |answer |Comply |with |state |statutes |
concerning |reporting |credit |balance
| | | | |
CRCR (2025) exam with correct detailed
| | | | | |
answers
What |are |collection |agency |fees |based |on? |- |correct |answer |A |percentage |of |dollars |collected
Self-funded |benefit |plans |may |choose |to |coordinate |benefits |using |the |gender |rule |or |what |
other |rule? |- |correct |answer |Birthday
In |what |type |of |payment |methodology |is |a |lump |sum |or |bundled |payment |negotiated |
between |the |payer |and |some |or |all |providers? |- |correct |answer |Case |rates
What |customer |service |improvements |might |improve |the |patient |accounts |department? |- |
correct |answer |Holding |staff |accountable |for |customer |service |during |performance |reviews
What |is |an |ABN |(Advance |Beneficiary |Notice |of |Non-coverage) |required |to |do? |- |correct |
answer |Inform |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 |answer |Bad |debt |adjustment
What |is |the |initial |hospice |benefit? |- |correct |answer |Two |90-day |periods |and |an |unlimited |
number |of |subsequent |periods
When |does |a |hospital |add |ambulance |charges |to |the |Medicare |inpatient |claim? |- |correct |
answer |If |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 |
answer |Post |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 |answer |They |are |not |being |processed |in |a |timely |manner
What |is |an |advantage |of |a |preregistration |program? |- |correct |answer |It |reduces |processing |
times |at |the |time |of |service
What |are |the |two |statutory |exclusions |from |hospice |coverage? |- |correct |answer |Medically |
unnecessary |services |and |custodial |care
What |core |financial |activities |are |resolved |within |patient |access? |- |correct |answer |Scheduling, |
insurance |verification, |discharge |processing, |and |payment |of |point-of-service |receipts
What |statement |applies |to |the |scheduled |outpatient? |- |correct |answer |The |services |do |not |
involve |an |overnight |stay
How |is |a |mis-posted |contractual |allowance |resolved? |- |correct |answer |Comparing |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
|answer |Observation
Coverage |rules |for |Medicare |beneficiaries |receiving |skilled |nursing |care |require |that |the |
beneficiary |has |received |what? |- |correct |answer |Medically |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 |answer
|When |the |patient |is |the |insured
What |are |non-emergency |patients |who |come |for |service |without |prior |notification |to |the |
provider |called? |- |correct |answer |Unscheduled |patients
If |the |insurance |verification |response |reports |that |a |subscriber |has |a |single |policy, |what |is |the |
status |of |the |subscriber's |spouse? |- |correct |answer |Neither |enrolled |not |entitled |to |benefits
Regulation |Z |of |the |Consumer |Credit |Protection |Act, |also |known |as |the |Truth |in |Lending |Act, |
establishes |what? |- |correct |answer |Disclosure |rules |for |consumer |credit |sales |and |consumer |
loans
What |is |a |principal |diagnosis? |- |correct |answer |Primary |reason |for |the |patient's |admission
Collecting |patient |liability |dollars |after |service |leads |to |what? |- |correct |answer |Lower |accounts
|receivable |levels
What |is |the |daily |out-of-pocket |amount |for |each |lifetime |reserve |day |used? |- |correct |answer |
50% |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 |answer |Inpatient |care
What |code |indicates |the |disposition |of |the |patient |at |the |conclusion |of |service? |- |correct |
answer |Patient |discharge |status |code
What |are |hospitals |required |to |do |for |Medicare |credit |balance |accounts? |- |correct |answer |
They |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 |answer |Patient
Medicare |guidelines |require |that |when |a |test |is |ordered |for |a |LCD |or |NCD |exists, |the |
information |provided |on |the |order |must |include: |- |correct |answer |A |valid |CPT |or |HCPCS |code
With |advances |in |internet |security |and |encryption, |revenue-cycle |processes |are |expanding |to |
allow |patients |to |do |what? |- |correct |answer |Access |their |information |and |perform |functions |
on-line
What |date |is |required |on |all |CMS |1500 |claim |forms? |- |correct |answer |onset |date |of |current |
illness
What |does |scheduling |allow |provider |staff |to |do |- |correct |answer |Review |appropriateness |of |
the |service |request
What |code |is |used |to |report |the |provider's |most |common |semiprivate |room |rate? |- |correct |
answer |Condition |code
Regulations |and |requirements |for |coding |accountable |care |organizations, |which |allows |
providers |to |begin |creating |these |organizations, |were |finalized |in: |- |correct |answer |2012
What |is |a |primary |responsibility |of |the |Recover |Audit |Contractor? |- |correct |answer |To |
correctly |identify |proper |payments |for |Medicare |Part |A |& |B |claims
How |must |providers |handle |credit |balances? |- |correct |answer |Comply |with |state |statutes |
concerning |reporting |credit |balance
