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Exam (elaborations)

CRCR Exam Prep 2025 – 130+ Multiple-Choice Questions with Answers – Billing, Medicare, Compliance, Revenue Cycle – HFMA Certification

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This document is a complete and exam-aligned multiple-choice question bank for the Certified Revenue Cycle Representative (CRCR) Exam, relevant for the 2025/2026 certification cycle under the Healthcare Financial Management Association (HFMA). It contains over 130 fully answered and explained multiple-choice questions, tailored to reflect the format, complexity, and core focus areas of the actual CRCR exam. The material comprehensively covers essential revenue cycle domains including patient registration, insurance verification, claims processing, denial management, billing and collections, financial assistance policy, and key metrics such as A/R and KPIs. It also includes in-depth content on Medicare and Medicaid billing rules, the Affordable Care Act, HIPAA and EMTALA regulations, payment integrity, charity care documentation, compliance audits, and revenue code classifications (UB-04, 1500, CPT, ICD-10). This prep set is ideal for individuals aiming to pass the CRCR certification exam or seeking a deeper understanding of the U.S. healthcare revenue cycle. It is structured for efficient self-testing, review, and reinforcement of knowledge in practical, real-world healthcare finance contexts. Relevant for: Professionals preparing for the HFMA CRCR certification exam Staff in medical billing, hospital revenue cycle teams, patient access services, healthcare compliance, and reimbursement departments Learners in healthcare finance, health information management (HIM), or medical office administration programs Individuals working in or entering roles in hospital operations, insurance claims, or RHC billing environments Keywords: CRCR, revenue cycle, HFMA, CRCR exam, medical billing, Medicare, Medicaid, UB-04, CPT, ICD-10, compliance, EMTALA, HIPAA, financial assistance, denial management, patient access, insurance verification, healthcare finance, charity care, claims processing, billing systems, AR days, KPIs, healthcare reimbursement, 1500 form, collections

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Uploaded on
September 29, 2025
Number of pages
156
Written in
2025/2026
Type
Exam (elaborations)
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Questions & answers

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CRCR EXAM MULTIPLE CHOICE Exam
Prep (Certified Revenue Cycle
Representative) 2025 Expert Verified |
Ace the Test



What are collection agency fees based on? - 🧠 ANSWER ✔✔A percentage

of dollars collected

Self-funded benefit plans may choose to coordinate benefits using the

gender rule or what other rule? - 🧠 ANSWER ✔✔Birthday


In what type of payment methodology is a lump sum or bundled payment

negotiated between the payer and some or all providers? - 🧠 ANSWER

✔✔Case rates

,What customer service improvements might improve the patient accounts

department? - 🧠 ANSWER ✔✔Holding staff accountable for customer

service during performance reviews

What is an ABN (Advance Beneficiary Notice of Non-coverage) required to

do? - 🧠 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? - 🧠 ANSWER ✔✔Bad debt adjustment


What is the initial hospice benefit? - 🧠 ANSWER ✔✔Two 90-day periods

and an unlimited number of subsequent periods

When does a hospital add ambulance charges to the Medicare inpatient

claim? - 🧠 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? - 🧠 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 - 🧠 ANSWER ✔✔They are not being

processed in a timely manner


What is an advantage of a preregistration program? - 🧠 ANSWER ✔✔It

reduces processing times at the time of service

What are the two statutory exclusions from hospice coverage? - 🧠

ANSWER ✔✔Medically unnecessary services and custodial care


What core financial activities are resolved within patient access? - 🧠

ANSWER ✔✔Scheduling, insurance verification, discharge processing, and

payment of point-of-service receipts


What statement applies to the scheduled outpatient? - 🧠 ANSWER ✔✔The

services do not involve an overnight stay

How is a mis-posted contractual allowance resolved? - 🧠 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? - 🧠 ANSWER ✔✔Observation



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, Coverage rules for Medicare beneficiaries receiving skilled nursing care

require that the beneficiary has received what? - 🧠 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$? - 🧠 ANSWER ✔✔When the patient is the insured


What are non-emergency patients who come for service without prior

notification to the provider called? - 🧠 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? - 🧠 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? - 🧠 ANSWER ✔✔Disclosure rules

for consumer credit sales and consumer loans


What is a principal diagnosis? - 🧠 ANSWER ✔✔Primary reason for the

patient's admission

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