HFMA CRCR PRACTICE EXAM QUESTIONS
AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF
1. Which phase of the revenue cycle involves capturing patient
information and verifying insurance coverage?
A. Claims Management
B. Coding
C. Patient Access
D. Accounts Receivable
Rationale: Patient Access is responsible for registration,
insurance verification, authorization, and collecting upfront
payments.
2. Medical necessity is validated using which tool?
A. Value-based index
B. National Coverage Determinations (NCDs)
C. Chargemaster audit
D. Payor scorecards
,Rationale: NCDs determine conditions under which Medicare
covers certain procedures.
3. Coordination of Benefits (COB) determines:
A. Medical necessity
B. Denial root causes
C. Primary and secondary payor order
D. Provider credentialing
Rationale: COB determines which insurance pays first,
preventing duplicate payment.
4. What is the primary purpose of the chargemaster?
A. Store diagnostic codes
B. Maintain all billable services and prices
C. Promote charity care
D. Generate cash flow reports
Rationale: The chargemaster lists every billable item/service
with its related price and code.
5. The HIPAA 270/271 transaction pair is used for:
A. Claims submission
B. Remittance advice
,C. Eligibility verification
D. Coordination of benefits
Rationale: 270 is the request; 271 is the response for eligibility
and benefits.
6. Which document lists all expected reimbursement by
payor?
A. Charge reconciliation
B. Contract terms matrix
C. Remittance log
D. Medical necessity file
Rationale: A contract terms matrix outlines payor
reimbursement rules for staff.
7. Which best describes a "clean claim"?
A. Has been appealed
B. Generated without clinical coding
C. Contains no errors and is processed on first submission
D. Submitted with attachments
Rationale: Clean claims meet all data requirements without
errors or missing fields.
8. What is the purpose of pre-authorization?
, A. Verify patient identity
B. Obtain payor approval before providing services
C. Review claim edits
D. Collect deductibles
Rationale: Authorization avoids denials for lack of medical
approval.
9. Which payor typically reimburses based on DRGs?
A. Medicaid MCO
B. Commercial PPO
C. Workers’ Compensation
D. Medicare Inpatient Prospective Payment System
Rationale: Medicare uses DRG methodology for inpatient
hospital reimbursement.
10. The HIPAA 835 file is used for:
A. Insurance eligibility
B. Remittance advice (payment + denial reason codes)
C. Provider updates
D. Coding validation
Rationale: The 835 file communicates adjudication, payments,
and denials.
AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF
1. Which phase of the revenue cycle involves capturing patient
information and verifying insurance coverage?
A. Claims Management
B. Coding
C. Patient Access
D. Accounts Receivable
Rationale: Patient Access is responsible for registration,
insurance verification, authorization, and collecting upfront
payments.
2. Medical necessity is validated using which tool?
A. Value-based index
B. National Coverage Determinations (NCDs)
C. Chargemaster audit
D. Payor scorecards
,Rationale: NCDs determine conditions under which Medicare
covers certain procedures.
3. Coordination of Benefits (COB) determines:
A. Medical necessity
B. Denial root causes
C. Primary and secondary payor order
D. Provider credentialing
Rationale: COB determines which insurance pays first,
preventing duplicate payment.
4. What is the primary purpose of the chargemaster?
A. Store diagnostic codes
B. Maintain all billable services and prices
C. Promote charity care
D. Generate cash flow reports
Rationale: The chargemaster lists every billable item/service
with its related price and code.
5. The HIPAA 270/271 transaction pair is used for:
A. Claims submission
B. Remittance advice
,C. Eligibility verification
D. Coordination of benefits
Rationale: 270 is the request; 271 is the response for eligibility
and benefits.
6. Which document lists all expected reimbursement by
payor?
A. Charge reconciliation
B. Contract terms matrix
C. Remittance log
D. Medical necessity file
Rationale: A contract terms matrix outlines payor
reimbursement rules for staff.
7. Which best describes a "clean claim"?
A. Has been appealed
B. Generated without clinical coding
C. Contains no errors and is processed on first submission
D. Submitted with attachments
Rationale: Clean claims meet all data requirements without
errors or missing fields.
8. What is the purpose of pre-authorization?
, A. Verify patient identity
B. Obtain payor approval before providing services
C. Review claim edits
D. Collect deductibles
Rationale: Authorization avoids denials for lack of medical
approval.
9. Which payor typically reimburses based on DRGs?
A. Medicaid MCO
B. Commercial PPO
C. Workers’ Compensation
D. Medicare Inpatient Prospective Payment System
Rationale: Medicare uses DRG methodology for inpatient
hospital reimbursement.
10. The HIPAA 835 file is used for:
A. Insurance eligibility
B. Remittance advice (payment + denial reason codes)
C. Provider updates
D. Coding validation
Rationale: The 835 file communicates adjudication, payments,
and denials.
