CRCR CORE MAIN EXAMINATION SET 2026
QUESTIONS AND ANSWERS SURE A+
✔✔A claim is denied for the following reasons, EXCEPT:
a) The health plan cannot identify the subscriber
b) The frequency of service was outside the coverage timeline
c) The submitted claim does not have the physicians signature
d) The subscriber was not enrolled at the time of service - ✔✔C
✔✔Any provider that has filed a timely cost report may appeal an adverse final decision
received from the Medicare Administrative Contractor (MAC). This appeal may be filed
with
a) A court appointed federal mediator
b) The Department of Health and Human Services Provider Relations
Division
c) The Office of the Inspector General
d) The Provider Reimbursement Review Board - ✔✔D
✔✔Charges, as the most appropriate measurement of utilization, enables
a) Generation of timely and accurate billing
b) Managing of expense budgets
,c) Accuracy of expense and cost capture
d) Effective HIM planning - ✔✔???Number 24???
✔✔Ambulance services are billed directly to the health plan for
a) All pre-admission emergency transports
b) Services provided before a patient is admitted and for ambulance
rides arranged to pick up the patient from the hospital after
discharge to take him/her home or to another facility
c) The portion of the bill outside of the patient's self-pay
d) Transports deemed medically necessary by the attending
paramedic-ambulance crew - ✔✔C
✔✔An individual enrolled in Medicare who is dissatisfied with the government's claim
determination is entitled to reconsideration of the decision. This type of appeal is
known as
a) A beneficiary appeal
b) A Medicare supplemental review
c) A payment review
d) A Medicare determination appeal - ✔✔A
✔✔The nuanced data resulting from detailed ICD-10 coding allows senior leadership to
work with physicians to do all of the following EXCEPT:
a) Drive significant improvements in the areas of quality and the
patient experience
b) Embrace new reimbursement models
c) Improve outcomes
d) Obtain higher compensation for physicians - ✔✔D
✔✔Duplicate payments occur:
a) When providers re-bill claims based on nonpayment from the
initial bill submission
b) When service departments do not process charges with the
organization's suspense days
c) When the payer's coordination of benefits is not captured
correctly at the time of patient registration
d) When there are other healthcare claims in process and the
anticipated deductibles and co-insurance amounts still show open
but will be met by the in-process claims - ✔✔a
✔✔The Affordable Care Act legislated the development of Health Insurance Exchanges,
where individuals and small businesses can
,a) Purchase qualified health benefit plans regardless of insured's
health status
b) Obtain price estimates for medical services
c) Negotiate the price of medical services with providers
d) Meet federal mandates for insurance coverage and obtain the
corresponding tax deduction - ✔✔A
✔✔The most common resolution methods for credit balances include all of the following
EXCEPT:
a) Designate the overpayment for charity care
b) Submit the corrected claim to the payer incorporating credits
c) Either send a refund or complete a takeback form as directed by
the payer
d) Determine the correct primary payer and notify incorrect payer of
overpayment - ✔✔A
✔✔EFT (electronic funds transfer) is
a) An electronic claim submission
b) The record of payments in the hospital's accounting system
c) An electronic confirmation that a payment is due
d) An electronic transfer of funds from payer to payee - ✔✔D
✔✔Revenue cycle activities occurring at the point-of-service include all of the following
EXCEPT:
a) The monitoring of charges
b) The provision of case management and discharge planning
services
c) Providing charges to the third-party payer as they are incurred
d) The generation of charges - ✔✔C
✔✔Medicare beneficiaries remain in the same "benefit period"
a) Up to hospitalization discharge
b) Until the beneficiary is "hospitalization and/or skilled nursing
facility-free" for 60 consecutive days
c) Each calendar year
d) Up to 60 days - ✔✔B
✔✔Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and
a) Provide evidence of financial status
b) Provide a method of measuring the collection and control of A/R
, c) Establish productivity targets
d) Make allowance for accurate revenue forecasting - ✔✔B
✔✔Recognizing that health coverage is complicated and not all patients are able to
navigate
this terrain, HFMA best practices specify that
a) The patient accounts staff have someone assigned to research
coverage on behalf of patients
b) Patients should be given the opportunity to request a patient
advocate, family member, or other designee to help them in these
discussions
c) Patient coverage education may need to be provided by the
health plan
d) A representative of the health plan be included in the patient
financial responsibilities discussion - ✔✔B
✔✔When there is a request for service, the scheduling staff member must confirm the
patient's unique identification information to
a) Check if there is any patient balance due
b) Verify the patient's insurance coverage if the patient is a returning
customer
c) Confirm that physician orders have been received
d) Ensure that she/he accesses the correct information in the
historical database - ✔✔D
✔✔Once the price is estimated in the pre-service stage, a provider's financial best
practice
is to
a) Explain to the patient their financial responsibility and to
determine the plan for payment
b) Allow the patient time to compare prices with other providers
c) Lock-in the prices
d) Have another employee double check the price estimate - ✔✔A
✔✔What type of account adjustment results from the patient's unwillingness to pay a
self-
pay balance?
a) Charity adjustment
b) Bad debt adjustment
c) Contractual adjustment
d) Administrative adjustment - ✔✔B
QUESTIONS AND ANSWERS SURE A+
✔✔A claim is denied for the following reasons, EXCEPT:
a) The health plan cannot identify the subscriber
b) The frequency of service was outside the coverage timeline
c) The submitted claim does not have the physicians signature
d) The subscriber was not enrolled at the time of service - ✔✔C
✔✔Any provider that has filed a timely cost report may appeal an adverse final decision
received from the Medicare Administrative Contractor (MAC). This appeal may be filed
with
a) A court appointed federal mediator
b) The Department of Health and Human Services Provider Relations
Division
c) The Office of the Inspector General
d) The Provider Reimbursement Review Board - ✔✔D
✔✔Charges, as the most appropriate measurement of utilization, enables
a) Generation of timely and accurate billing
b) Managing of expense budgets
,c) Accuracy of expense and cost capture
d) Effective HIM planning - ✔✔???Number 24???
✔✔Ambulance services are billed directly to the health plan for
a) All pre-admission emergency transports
b) Services provided before a patient is admitted and for ambulance
rides arranged to pick up the patient from the hospital after
discharge to take him/her home or to another facility
c) The portion of the bill outside of the patient's self-pay
d) Transports deemed medically necessary by the attending
paramedic-ambulance crew - ✔✔C
✔✔An individual enrolled in Medicare who is dissatisfied with the government's claim
determination is entitled to reconsideration of the decision. This type of appeal is
known as
a) A beneficiary appeal
b) A Medicare supplemental review
c) A payment review
d) A Medicare determination appeal - ✔✔A
✔✔The nuanced data resulting from detailed ICD-10 coding allows senior leadership to
work with physicians to do all of the following EXCEPT:
a) Drive significant improvements in the areas of quality and the
patient experience
b) Embrace new reimbursement models
c) Improve outcomes
d) Obtain higher compensation for physicians - ✔✔D
✔✔Duplicate payments occur:
a) When providers re-bill claims based on nonpayment from the
initial bill submission
b) When service departments do not process charges with the
organization's suspense days
c) When the payer's coordination of benefits is not captured
correctly at the time of patient registration
d) When there are other healthcare claims in process and the
anticipated deductibles and co-insurance amounts still show open
but will be met by the in-process claims - ✔✔a
✔✔The Affordable Care Act legislated the development of Health Insurance Exchanges,
where individuals and small businesses can
,a) Purchase qualified health benefit plans regardless of insured's
health status
b) Obtain price estimates for medical services
c) Negotiate the price of medical services with providers
d) Meet federal mandates for insurance coverage and obtain the
corresponding tax deduction - ✔✔A
✔✔The most common resolution methods for credit balances include all of the following
EXCEPT:
a) Designate the overpayment for charity care
b) Submit the corrected claim to the payer incorporating credits
c) Either send a refund or complete a takeback form as directed by
the payer
d) Determine the correct primary payer and notify incorrect payer of
overpayment - ✔✔A
✔✔EFT (electronic funds transfer) is
a) An electronic claim submission
b) The record of payments in the hospital's accounting system
c) An electronic confirmation that a payment is due
d) An electronic transfer of funds from payer to payee - ✔✔D
✔✔Revenue cycle activities occurring at the point-of-service include all of the following
EXCEPT:
a) The monitoring of charges
b) The provision of case management and discharge planning
services
c) Providing charges to the third-party payer as they are incurred
d) The generation of charges - ✔✔C
✔✔Medicare beneficiaries remain in the same "benefit period"
a) Up to hospitalization discharge
b) Until the beneficiary is "hospitalization and/or skilled nursing
facility-free" for 60 consecutive days
c) Each calendar year
d) Up to 60 days - ✔✔B
✔✔Key Performance Indicators (KPIs) set standards for accounts receivables (A/R) and
a) Provide evidence of financial status
b) Provide a method of measuring the collection and control of A/R
, c) Establish productivity targets
d) Make allowance for accurate revenue forecasting - ✔✔B
✔✔Recognizing that health coverage is complicated and not all patients are able to
navigate
this terrain, HFMA best practices specify that
a) The patient accounts staff have someone assigned to research
coverage on behalf of patients
b) Patients should be given the opportunity to request a patient
advocate, family member, or other designee to help them in these
discussions
c) Patient coverage education may need to be provided by the
health plan
d) A representative of the health plan be included in the patient
financial responsibilities discussion - ✔✔B
✔✔When there is a request for service, the scheduling staff member must confirm the
patient's unique identification information to
a) Check if there is any patient balance due
b) Verify the patient's insurance coverage if the patient is a returning
customer
c) Confirm that physician orders have been received
d) Ensure that she/he accesses the correct information in the
historical database - ✔✔D
✔✔Once the price is estimated in the pre-service stage, a provider's financial best
practice
is to
a) Explain to the patient their financial responsibility and to
determine the plan for payment
b) Allow the patient time to compare prices with other providers
c) Lock-in the prices
d) Have another employee double check the price estimate - ✔✔A
✔✔What type of account adjustment results from the patient's unwillingness to pay a
self-
pay balance?
a) Charity adjustment
b) Bad debt adjustment
c) Contractual adjustment
d) Administrative adjustment - ✔✔B
