CRCR COMPREHENSIVE CERTIFICATION EXAM
2026 QUESTIONS WITH SOLUTIONS GRADED
A+
◉ What is a valid reason for a payer to delay a claim? Answer:
Failure to complete authorization requirements
◉ IF outpatient diagnostic services are provided within three days
of the admission of a Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to these
charges Answer: They must be combined with the inpatient bill and
paid under the MS-DRG system
◉ What do large adjustments require? Answer: Manager-level
approval
◉ What items are valid identifiers to establish a patient's
identification? Answer: Photo identification, date of birth, and social
security number
◉ What must a provider do to qualify an account as a Medicare bad
debts? Answer: Pursue the account for 120 days and then refer it to
an outside collection agency
,◉ What restriction does a managed care plan place on locations that
must be used if the plan is to pay for the services provided? Answer:
Site-of-service limitation
◉ What is an example of an outcome of the Patient Friendly Billing
Project? Answer: Redesigned patient billing statements using
patient-friendly language
◉ What statement describes the APC (Ambulatory payment
classification) system? Answer: APC rates are calculated on a
national basis and are wage-adjusted by geographic region
◉ What is a benefit of insurance verification? Answer: Pre-
certification or pre-authorization requirements are confirmed
◉ What is an effective tool to help staff collect payments at the time
of service? Answer: Develop scripts for the process of requesting
payments
◉ What is a benefit of electronic claims processing? Answer:
Providers can electronically view patient's eligibility
◉ What does Medicare Part D provide coverage for? Answer:
Prescription drugs
,◉ What are some core elements of a board-approved financial policy
Answer: Charity care, payment methods, and installment payment
guidelines
◉ What circumstance would result in an incorrect nightly room
charge? Answer: If the patient's discharge, ordered for tomorrow,
has not been charted
◉ What is NOT a typical charge master problem that can result in a
denial? Answer: Does not include required modifiers
◉ Access Answer: An individual's ability to obtain medical services
on a timely and financially acceptable level
◉ Administrative Services Only (ASO) Answer: Usually contracted
administrative services to a self-insured health plan
◉ Case management Answer: The process whereby all health-
related components of a case are managed by a designated health
professional. Intended to ensure continuity of healthcare
accessibility and services
◉ Claim Answer: A demand by an insured person for the benefits
provided by the group contract
, ◉ Coordination of benefits (COB) Answer: a typical insurance
provision that determines the responsibility for primary payment
when the patient is covered by more than one employer-sponsored
health benefit program
◉ Discounted fee-for-service Answer: A reimbursement
methodology whereby a provider agrees to provide service on a fee
for service basis, but the fees are discounted by certain packages
◉ Eligibility Answer: Patient status regarding coverage for
healthcare insurance benefits
◉ First dollar coverage Answer: A healthcare insurance policy that
has no deductible and covers the first dollar of an insured's
expenses
◉ Gatekeeping Answer: A concept wherein the primary care
physician provides all primary patient care and coordinates all
diagnostic testing and specialty referrals required for a patient's
medical care
◉ Health plan Answer: an insurance company that provides for the
delivery or payment of healthcare services
2026 QUESTIONS WITH SOLUTIONS GRADED
A+
◉ What is a valid reason for a payer to delay a claim? Answer:
Failure to complete authorization requirements
◉ IF outpatient diagnostic services are provided within three days
of the admission of a Medicare beneficiary to an IPPS (Inpatient
Prospective Payment System) hospital, what must happen to these
charges Answer: They must be combined with the inpatient bill and
paid under the MS-DRG system
◉ What do large adjustments require? Answer: Manager-level
approval
◉ What items are valid identifiers to establish a patient's
identification? Answer: Photo identification, date of birth, and social
security number
◉ What must a provider do to qualify an account as a Medicare bad
debts? Answer: Pursue the account for 120 days and then refer it to
an outside collection agency
,◉ What restriction does a managed care plan place on locations that
must be used if the plan is to pay for the services provided? Answer:
Site-of-service limitation
◉ What is an example of an outcome of the Patient Friendly Billing
Project? Answer: Redesigned patient billing statements using
patient-friendly language
◉ What statement describes the APC (Ambulatory payment
classification) system? Answer: APC rates are calculated on a
national basis and are wage-adjusted by geographic region
◉ What is a benefit of insurance verification? Answer: Pre-
certification or pre-authorization requirements are confirmed
◉ What is an effective tool to help staff collect payments at the time
of service? Answer: Develop scripts for the process of requesting
payments
◉ What is a benefit of electronic claims processing? Answer:
Providers can electronically view patient's eligibility
◉ What does Medicare Part D provide coverage for? Answer:
Prescription drugs
,◉ What are some core elements of a board-approved financial policy
Answer: Charity care, payment methods, and installment payment
guidelines
◉ What circumstance would result in an incorrect nightly room
charge? Answer: If the patient's discharge, ordered for tomorrow,
has not been charted
◉ What is NOT a typical charge master problem that can result in a
denial? Answer: Does not include required modifiers
◉ Access Answer: An individual's ability to obtain medical services
on a timely and financially acceptable level
◉ Administrative Services Only (ASO) Answer: Usually contracted
administrative services to a self-insured health plan
◉ Case management Answer: The process whereby all health-
related components of a case are managed by a designated health
professional. Intended to ensure continuity of healthcare
accessibility and services
◉ Claim Answer: A demand by an insured person for the benefits
provided by the group contract
, ◉ Coordination of benefits (COB) Answer: a typical insurance
provision that determines the responsibility for primary payment
when the patient is covered by more than one employer-sponsored
health benefit program
◉ Discounted fee-for-service Answer: A reimbursement
methodology whereby a provider agrees to provide service on a fee
for service basis, but the fees are discounted by certain packages
◉ Eligibility Answer: Patient status regarding coverage for
healthcare insurance benefits
◉ First dollar coverage Answer: A healthcare insurance policy that
has no deductible and covers the first dollar of an insured's
expenses
◉ Gatekeeping Answer: A concept wherein the primary care
physician provides all primary patient care and coordinates all
diagnostic testing and specialty referrals required for a patient's
medical care
◉ Health plan Answer: an insurance company that provides for the
delivery or payment of healthcare services
