CRCR Certification Exam 2025: Actual
Questions & Verified Answers | 100%
Guaranteed Pass
Question 1: Which of the following best defines the revenue cycle in healthcare? A. The
process of providing clinical care to patients B. The financial process that begins when a patient
schedules an appointment and ends when the provider receives full payment C. The process of
coding diagnoses and procedures for billing purposes D. The process of managing patient
medical records
Correct Answer: B Rationale: The revenue cycle in healthcare encompasses all administrative
and clinical functions that contribute to the capture, management, and collection of patient
service revenue. It starts with patient scheduling and continues until the provider receives full
payment for services rendered. A is incorrect because it only addresses clinical care, not
financial processes. C is incorrect because coding is just one component of the revenue cycle.
D is incorrect because medical records management is part of health information management,
not the revenue cycle.
Question 2: A patient presents with a new complaint. Which of the following is the correct
sequence for the revenue cycle process? A. Registration → Charge capture → Coding → Billing
→ Payment posting → Collections B. Coding → Registration → Billing → Charge capture →
Payment posting → Collections C. Registration → Coding → Charge capture → Billing →
Payment posting → Collections D. Billing → Registration → Coding → Charge capture →
Payment posting → Collections
Correct Answer: C Rationale: The correct sequence is: Registration (patient demographic and
insurance information is collected), Coding (diagnoses and procedures are coded), Charge
capture (services are recorded and charges are generated), Billing (claims are generated and
submitted), Payment posting (payments are recorded), and Collections (outstanding balances
are pursued). A, B, and D are incorrect because they do not follow the logical order of the
revenue cycle process.
,Question 3: Which code set is used to report medical diagnoses in the United States? A. CPT
B. HCPCS C. ICD-10-CM D. DRG
Correct Answer: C Rationale: ICD-10-CM (International Classification of Diseases, 10th
Revision, Clinical Modification) is the standard code set for reporting medical diagnoses in the
U.S. A is incorrect because CPT (Current Procedural Terminology) is used for reporting
procedures and services. B is incorrect because HCPCS (Healthcare Common Procedure
Coding System) is used for reporting supplies, equipment, and certain services. D is incorrect
because DRG (Diagnosis-Related Group) is used for inpatient hospital billing and classification,
not for reporting diagnoses.
Question 4: A patient’s insurance plan requires a referral for specialist visits. If the referral is not
obtained before the visit, what is the most likely outcome? A. The claim will be denied as not
medically necessary B. The claim will be paid at a reduced rate C. The claim will be denied as
missing authorization D. The claim will be paid in full
Correct Answer: C Rationale: Most insurance plans require referrals for specialist visits. If the
referral is not obtained, the claim will typically be denied as missing authorization. A is incorrect
because the denial would not be for medical necessity, but for lack of authorization. B is
incorrect because the claim would not be paid at all, not at a reduced rate. D is incorrect
because the claim would not be paid in full without the required referral.
Question 5: Which of the following is NOT a component of a clean claim? A. Accurate patient
demographic information B. Correct coding of diagnoses and procedures C. Provider’s
signature on the claim form D. Patient’s credit card information
Correct Answer: D Rationale: A clean claim is one that is complete, accurate, and submitted
with all required information. Patient’s credit card information is not required for claim
submission. A, B, and C are all components of a clean claim.
Question 6: What is the primary purpose of the 835 electronic transaction? A. To submit
healthcare claims B. To verify patient eligibility C. To receive electronic remittance advice (ERA)
D. To request prior authorization
Correct Answer: C Rationale: The 835 electronic transaction is used to receive electronic
remittance advice (ERA), which explains how a claim was processed and paid. A is incorrect
because the 837 transaction is used to submit claims. B is incorrect because the 270/271
transaction is used for eligibility verification. D is incorrect because prior authorization is typically
requested via phone, fax, or electronic forms, not the 835.
, Question 7: Which federal law requires healthcare providers to protect the privacy and security
of patient health information? A. HIPAA B. ACA C. CMS D. OSHA
Correct Answer: A Rationale: HIPAA (Health Insurance Portability and Accountability Act) is the
federal law that mandates the protection of patient health information. B is incorrect because the
ACA (Affordable Care Act) focuses on health insurance reform. C is incorrect because CMS
(Centers for Medicare & Medicaid Services) is a federal agency, not a law. D is incorrect
because OSHA (Occupational Safety and Health Administration) focuses on workplace safety.
Question 8: A patient’s claim is denied for “lack of medical necessity.” What is the best first step
in the appeals process? A. Resubmit the claim with corrected patient information B. Obtain
additional documentation from the provider to support medical necessity C. Write off the balance
as bad debt D. Contact the patient to request payment in full
Correct Answer: B Rationale: When a claim is denied for lack of medical necessity, the best
first step is to obtain additional documentation from the provider to support the medical necessity
of the services rendered. A is incorrect because resubmitting with corrected patient information
will not address the medical necessity issue. C is incorrect because writing off the balance
should only be done after all appeals are exhausted. D is incorrect because contacting the
patient for payment should only occur after insurance appeals are completed.
Question 9: Which of the following is an example of a primary payer? A. Medicaid B. Medicare
C. Blue Cross Blue Shield D. All of the above
Correct Answer: D Rationale: A primary payer is the insurance plan that pays first on a claim.
Medicaid, Medicare, and Blue Cross Blue Shield can all be primary payers, depending on the
patient’s coverage. A, B, and C are all correct individually, but D is the most comprehensive
answer.
Question 10: What is the purpose of a “write-off” in the revenue cycle? A. To adjust the patient’s
balance to zero B. To record the difference between the provider’s charge and the allowed
amount by the payer C. To transfer the balance to a collections agency D. To correct a coding
error
Correct Answer: B Rationale: A write-off is the process of recording the difference between the
provider’s charge and the amount allowed by the payer, which is typically the contracted rate. A
is incorrect because a write-off does not necessarily adjust the patient’s balance to zero. C is
Questions & Verified Answers | 100%
Guaranteed Pass
Question 1: Which of the following best defines the revenue cycle in healthcare? A. The
process of providing clinical care to patients B. The financial process that begins when a patient
schedules an appointment and ends when the provider receives full payment C. The process of
coding diagnoses and procedures for billing purposes D. The process of managing patient
medical records
Correct Answer: B Rationale: The revenue cycle in healthcare encompasses all administrative
and clinical functions that contribute to the capture, management, and collection of patient
service revenue. It starts with patient scheduling and continues until the provider receives full
payment for services rendered. A is incorrect because it only addresses clinical care, not
financial processes. C is incorrect because coding is just one component of the revenue cycle.
D is incorrect because medical records management is part of health information management,
not the revenue cycle.
Question 2: A patient presents with a new complaint. Which of the following is the correct
sequence for the revenue cycle process? A. Registration → Charge capture → Coding → Billing
→ Payment posting → Collections B. Coding → Registration → Billing → Charge capture →
Payment posting → Collections C. Registration → Coding → Charge capture → Billing →
Payment posting → Collections D. Billing → Registration → Coding → Charge capture →
Payment posting → Collections
Correct Answer: C Rationale: The correct sequence is: Registration (patient demographic and
insurance information is collected), Coding (diagnoses and procedures are coded), Charge
capture (services are recorded and charges are generated), Billing (claims are generated and
submitted), Payment posting (payments are recorded), and Collections (outstanding balances
are pursued). A, B, and D are incorrect because they do not follow the logical order of the
revenue cycle process.
,Question 3: Which code set is used to report medical diagnoses in the United States? A. CPT
B. HCPCS C. ICD-10-CM D. DRG
Correct Answer: C Rationale: ICD-10-CM (International Classification of Diseases, 10th
Revision, Clinical Modification) is the standard code set for reporting medical diagnoses in the
U.S. A is incorrect because CPT (Current Procedural Terminology) is used for reporting
procedures and services. B is incorrect because HCPCS (Healthcare Common Procedure
Coding System) is used for reporting supplies, equipment, and certain services. D is incorrect
because DRG (Diagnosis-Related Group) is used for inpatient hospital billing and classification,
not for reporting diagnoses.
Question 4: A patient’s insurance plan requires a referral for specialist visits. If the referral is not
obtained before the visit, what is the most likely outcome? A. The claim will be denied as not
medically necessary B. The claim will be paid at a reduced rate C. The claim will be denied as
missing authorization D. The claim will be paid in full
Correct Answer: C Rationale: Most insurance plans require referrals for specialist visits. If the
referral is not obtained, the claim will typically be denied as missing authorization. A is incorrect
because the denial would not be for medical necessity, but for lack of authorization. B is
incorrect because the claim would not be paid at all, not at a reduced rate. D is incorrect
because the claim would not be paid in full without the required referral.
Question 5: Which of the following is NOT a component of a clean claim? A. Accurate patient
demographic information B. Correct coding of diagnoses and procedures C. Provider’s
signature on the claim form D. Patient’s credit card information
Correct Answer: D Rationale: A clean claim is one that is complete, accurate, and submitted
with all required information. Patient’s credit card information is not required for claim
submission. A, B, and C are all components of a clean claim.
Question 6: What is the primary purpose of the 835 electronic transaction? A. To submit
healthcare claims B. To verify patient eligibility C. To receive electronic remittance advice (ERA)
D. To request prior authorization
Correct Answer: C Rationale: The 835 electronic transaction is used to receive electronic
remittance advice (ERA), which explains how a claim was processed and paid. A is incorrect
because the 837 transaction is used to submit claims. B is incorrect because the 270/271
transaction is used for eligibility verification. D is incorrect because prior authorization is typically
requested via phone, fax, or electronic forms, not the 835.
, Question 7: Which federal law requires healthcare providers to protect the privacy and security
of patient health information? A. HIPAA B. ACA C. CMS D. OSHA
Correct Answer: A Rationale: HIPAA (Health Insurance Portability and Accountability Act) is the
federal law that mandates the protection of patient health information. B is incorrect because the
ACA (Affordable Care Act) focuses on health insurance reform. C is incorrect because CMS
(Centers for Medicare & Medicaid Services) is a federal agency, not a law. D is incorrect
because OSHA (Occupational Safety and Health Administration) focuses on workplace safety.
Question 8: A patient’s claim is denied for “lack of medical necessity.” What is the best first step
in the appeals process? A. Resubmit the claim with corrected patient information B. Obtain
additional documentation from the provider to support medical necessity C. Write off the balance
as bad debt D. Contact the patient to request payment in full
Correct Answer: B Rationale: When a claim is denied for lack of medical necessity, the best
first step is to obtain additional documentation from the provider to support the medical necessity
of the services rendered. A is incorrect because resubmitting with corrected patient information
will not address the medical necessity issue. C is incorrect because writing off the balance
should only be done after all appeals are exhausted. D is incorrect because contacting the
patient for payment should only occur after insurance appeals are completed.
Question 9: Which of the following is an example of a primary payer? A. Medicaid B. Medicare
C. Blue Cross Blue Shield D. All of the above
Correct Answer: D Rationale: A primary payer is the insurance plan that pays first on a claim.
Medicaid, Medicare, and Blue Cross Blue Shield can all be primary payers, depending on the
patient’s coverage. A, B, and C are all correct individually, but D is the most comprehensive
answer.
Question 10: What is the purpose of a “write-off” in the revenue cycle? A. To adjust the patient’s
balance to zero B. To record the difference between the provider’s charge and the allowed
amount by the payer C. To transfer the balance to a collections agency D. To correct a coding
error
Correct Answer: B Rationale: A write-off is the process of recording the difference between the
provider’s charge and the amount allowed by the payer, which is typically the contracted rate. A
is incorrect because a write-off does not necessarily adjust the patient’s balance to zero. C is
