"Mastering the CRCR Exam: Your Ultimate
Guide to Success in 2025 - Navigate the
Path to Becoming a Certified Revenue
Cycle Representative!
A Top-Rated Exam Study Guide Latest
Updated 2025/2026
What are collection agency fees based on? - ansA percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what
other rule? - ansBirthday
In what type of payment methodology is a lump sum or bundled payment negotiated between
the payer and some or all providers? - ansCase rates
What customer service improvements might improve the patient accounts department? -
ansHolding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - ansInform
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? - ansBad debt adjustment
What is the initial hospice benefit? - ansTwo 90-day periods and an unlimited number of
subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - ansIf 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? - ansPost
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 - ansThey are not being processed in a timely manner
What is an advantage of a preregistration program? - ansIt reduces processing times at the
time of service
What are the two statutory exclusions from hospice coverage? - ansMedically unnecessary
services and custodial care
What core financial activities are resolved within patient access? - ansScheduling, insurance
verification, discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - ansThe services do not involve an
overnight stay
How is a mis-posted contractual allowance resolved? - ansComparing 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? -
ansObservation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - ansMedically 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$? - ansWhen the
patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - ansUnscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what is the
status of the subscriber's spouse? - ansNeither enrolled not entitled to benefits
,"Mastering the CRCR Exam: Your Ultimate
Guide to Success in 2025 - Navigate the
Path to Becoming a Certified Revenue
Cycle Representative!
A Top-Rated Exam Study Guide Latest
Updated 2025/2026
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - ansDisclosure rules for consumer credit sales and consumer loans
What is a principal diagnosis? - ansPrimary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - ansLower accounts receivable
levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - ans50% of the
current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable
as an RHC services? - ansInpatient care
What code indicates the disposition of the patient at the conclusion of service? - ansPatient
discharge status code
What are hospitals required to do for Medicare credit balance accounts? - ansThey result in
lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient and the third
party payer, who is responsible for payment? - ansPatient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - ansA valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are expanding to
allow patients to do what? - ansAccess their information and perform functions on-line
What date is required on all CMS 1500 claim forms? - ansonset date of current illness
What does scheduling allow provider staff to do - ansReview appropriateness of the service
request
What code is used to report the provider's most common semiprivate room rate? -
ansCondition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: - ans2012
What is a primary responsibility of the Recover Audit Contractor? - ansTo correctly identify
proper payments for Medicare Part A & B claims
How must providers handle credit balances? - ansComply with state statutes concerning
reporting credit balance
Insurance verification results in what? - ansThe accurate identification of the patient's
eligibility and benefits
What form is used to bill Medicare for rural health clinics? - ansCMS 1500
What activities are completed when a scheduled pre-registered patient arrives for service? -
ansRegistering the patient and directing the patient to the service area
In addition to being supported by information found in the patient's chart, a CMS 1500 claim
must be coded using what? - ansHCPCS (Healthcare Common Procedure Coding system)
What results from a denied claim? - ansThe provider incurs rework and appeal costs
Why does the financial counselor need pricing for services? - ansTo calculate the patient's
financial responsibility
,"Mastering the CRCR Exam: Your Ultimate
Guide to Success in 2025 - Navigate the
Path to Becoming a Certified Revenue
Cycle Representative!
A Top-Rated Exam Study Guide Latest
Updated 2025/2026
What type of provider bills third-party payers using CMS 1500 form - ansHospital-based
mammography centers
How are disputes with nongovernmental payers resolved? - ansAppeal conditions specified in
the individual payer's contract
The important message from Medicare provides beneficiaries with information concerning
what? - ansRight to appeal a discharge decision if the patient disagrees with the services
Why do managed care plans have agreements with hospitals, physicians, and other healthcare
providers to offer a range of services to plan members? - ansTo improve access to quality
healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days,
what is the SNF permitted to do? - ansSubmit interim bills to the Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - ans120 days passes, but the claim then be withdrawn from the
liability carrier
What data are required to establish a new MPI entry? - ansThe patient's full legal name, date
of birth, and sex
What should the provider do if both of the patient's insurance plans pay as primary? -
ansDetermine the correct payer and notify the incorrect payer of the processing error
What do EMTALA regulations require on-call physicians to do? - ansPersonally appear in
the emergency department and attend to the patient within a reasonable time
At the end of each shift, what must happen to cash, checks, and credit card transaction
documents? - ansThey must be balanced
What will cause a CMS 1500 claim to be rejected? - ansThe provider is billing with a future
date of service
Under Medicare regulations, which of the following is not included on a valid physician's
order for services? - ansThe cost of the test
how are HCPCS codes and the appropriate modifiers used? - ansTo report the level 1, 2, or 3
code that correctly describes the service provided
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG
window rule? - ansDiagnostic and clinically-related non-diagnostic charges provided on the
Tuesday, Wednesday, Thursday, and Friday before admission
What is a benefit of pre-registering patient's for service? - ansPatient arrival processing is
expedited, reducing wait times and delays
What is a characteristic of a managed contracting methodology? - ansProspectively set rates
for inpatient and outpatient services
What do the MSP disability rules require? - ansThat the patient's spouse's employer must
have less than 20 employees in the group health plan
what organization originated the concept of insuring prepaid health care services? - ansBlue
Cross and blue Shield
, "Mastering the CRCR Exam: Your Ultimate
Guide to Success in 2025 - Navigate the
Path to Becoming a Certified Revenue
Cycle Representative!
A Top-Rated Exam Study Guide Latest
Updated 2025/2026
What is true about screening a beneficiary for possible MSP situations? - ansIt is acceptable
to complete the screening form after the patient has completed the registration process and
been sent to the service department
If the patient cannot agree to payment arrangements, what is the next option? - ansWarn the
patient that unpaid accounts are placed with collection agencies for further processing
In services lines such as cardiology or orthopedics, what does the case-rate payment
methodology allow providers to do? - ansReceive a fixed for specific procedures
What will comprehensive patient access processing accomplish? - ansMinimize the need for
follow-up on insurance accounts
Through what document does a hospital establish compliance standards? - ansCode of
conduct
How does utilization review staff use correct insurance information? - ansTo obtain approval
for inpatient days and coordinate services
When is it not appropriate to use observation status? - ansAs a substitute for an inpatient
admission
What is a serious consequence of misidentifying a patient in the MPI? - ansThe services will
be documented in the wrong record
When a patient reports directly to a clinical department for service, what will the clinical
department staff do? - ansRedirect the patient to the patient access department for registration
What process can be used to shorten claim turnaround time? - ansSend high-dollar hard-copy
claims with required attachments by overnight mail or registered mail
How are patient reminder calls used? - ansTo make sure the patient follows the prep
instructions and arrives at the scheduled time for service
If a patient declares a straight bankruptcy, what must the provider do? - ansWrite off the
account to the contractual adjustment account
According to the Department of Health and Human Services guidelines, what is NOT
considered income? - ansSale of property, house, or car
The situation where neither the patient nor spouse is employed is described to the patient
using: - ansA condition code
What option is an alternative to valid long-term payment plans? - ansBank loans
What is an advantage of using a collection agency to collect delinquent patient accounts? -
ansCollection agencies collect accounts faster than hospital does
What statement DOES NOT apply to revenue codes? - ansrevenue codes identify the payer
When a patient's illness results in an unusually high amount of medical bills not covered by
insurance or other patient pay resources, what type of account is created - anscatastrophic
charity
What happens when a patient receives non-emergent services from and out-of-network
provider? - ansPatient payment responsibility is higher
Every patient who is new to the healthcare provider must be offered what? - ansA printed
copy of the provider's privacy notice
Guide to Success in 2025 - Navigate the
Path to Becoming a Certified Revenue
Cycle Representative!
A Top-Rated Exam Study Guide Latest
Updated 2025/2026
What are collection agency fees based on? - ansA percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what
other rule? - ansBirthday
In what type of payment methodology is a lump sum or bundled payment negotiated between
the payer and some or all providers? - ansCase rates
What customer service improvements might improve the patient accounts department? -
ansHolding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - ansInform
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? - ansBad debt adjustment
What is the initial hospice benefit? - ansTwo 90-day periods and an unlimited number of
subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - ansIf 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? - ansPost
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 - ansThey are not being processed in a timely manner
What is an advantage of a preregistration program? - ansIt reduces processing times at the
time of service
What are the two statutory exclusions from hospice coverage? - ansMedically unnecessary
services and custodial care
What core financial activities are resolved within patient access? - ansScheduling, insurance
verification, discharge processing, and payment of point-of-service receipts
What statement applies to the scheduled outpatient? - ansThe services do not involve an
overnight stay
How is a mis-posted contractual allowance resolved? - ansComparing 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? -
ansObservation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - ansMedically 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$? - ansWhen the
patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - ansUnscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what is the
status of the subscriber's spouse? - ansNeither enrolled not entitled to benefits
,"Mastering the CRCR Exam: Your Ultimate
Guide to Success in 2025 - Navigate the
Path to Becoming a Certified Revenue
Cycle Representative!
A Top-Rated Exam Study Guide Latest
Updated 2025/2026
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending
Act, establishes what? - ansDisclosure rules for consumer credit sales and consumer loans
What is a principal diagnosis? - ansPrimary reason for the patient's admission
Collecting patient liability dollars after service leads to what? - ansLower accounts receivable
levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - ans50% of the
current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable
as an RHC services? - ansInpatient care
What code indicates the disposition of the patient at the conclusion of service? - ansPatient
discharge status code
What are hospitals required to do for Medicare credit balance accounts? - ansThey result in
lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient and the third
party payer, who is responsible for payment? - ansPatient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the
information provided on the order must include: - ansA valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are expanding to
allow patients to do what? - ansAccess their information and perform functions on-line
What date is required on all CMS 1500 claim forms? - ansonset date of current illness
What does scheduling allow provider staff to do - ansReview appropriateness of the service
request
What code is used to report the provider's most common semiprivate room rate? -
ansCondition code
Regulations and requirements for coding accountable care organizations, which allows
providers to begin creating these organizations, were finalized in: - ans2012
What is a primary responsibility of the Recover Audit Contractor? - ansTo correctly identify
proper payments for Medicare Part A & B claims
How must providers handle credit balances? - ansComply with state statutes concerning
reporting credit balance
Insurance verification results in what? - ansThe accurate identification of the patient's
eligibility and benefits
What form is used to bill Medicare for rural health clinics? - ansCMS 1500
What activities are completed when a scheduled pre-registered patient arrives for service? -
ansRegistering the patient and directing the patient to the service area
In addition to being supported by information found in the patient's chart, a CMS 1500 claim
must be coded using what? - ansHCPCS (Healthcare Common Procedure Coding system)
What results from a denied claim? - ansThe provider incurs rework and appeal costs
Why does the financial counselor need pricing for services? - ansTo calculate the patient's
financial responsibility
,"Mastering the CRCR Exam: Your Ultimate
Guide to Success in 2025 - Navigate the
Path to Becoming a Certified Revenue
Cycle Representative!
A Top-Rated Exam Study Guide Latest
Updated 2025/2026
What type of provider bills third-party payers using CMS 1500 form - ansHospital-based
mammography centers
How are disputes with nongovernmental payers resolved? - ansAppeal conditions specified in
the individual payer's contract
The important message from Medicare provides beneficiaries with information concerning
what? - ansRight to appeal a discharge decision if the patient disagrees with the services
Why do managed care plans have agreements with hospitals, physicians, and other healthcare
providers to offer a range of services to plan members? - ansTo improve access to quality
healthcare
If a patient remains an inpatient of an SNF (skilled nursing facility for more than 30 days,
what is the SNF permitted to do? - ansSubmit interim bills to the Medicare program.
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - ans120 days passes, but the claim then be withdrawn from the
liability carrier
What data are required to establish a new MPI entry? - ansThe patient's full legal name, date
of birth, and sex
What should the provider do if both of the patient's insurance plans pay as primary? -
ansDetermine the correct payer and notify the incorrect payer of the processing error
What do EMTALA regulations require on-call physicians to do? - ansPersonally appear in
the emergency department and attend to the patient within a reasonable time
At the end of each shift, what must happen to cash, checks, and credit card transaction
documents? - ansThey must be balanced
What will cause a CMS 1500 claim to be rejected? - ansThe provider is billing with a future
date of service
Under Medicare regulations, which of the following is not included on a valid physician's
order for services? - ansThe cost of the test
how are HCPCS codes and the appropriate modifiers used? - ansTo report the level 1, 2, or 3
code that correctly describes the service provided
If a Medicare patient is admitted on Friday, what services fall within the three-day DRG
window rule? - ansDiagnostic and clinically-related non-diagnostic charges provided on the
Tuesday, Wednesday, Thursday, and Friday before admission
What is a benefit of pre-registering patient's for service? - ansPatient arrival processing is
expedited, reducing wait times and delays
What is a characteristic of a managed contracting methodology? - ansProspectively set rates
for inpatient and outpatient services
What do the MSP disability rules require? - ansThat the patient's spouse's employer must
have less than 20 employees in the group health plan
what organization originated the concept of insuring prepaid health care services? - ansBlue
Cross and blue Shield
, "Mastering the CRCR Exam: Your Ultimate
Guide to Success in 2025 - Navigate the
Path to Becoming a Certified Revenue
Cycle Representative!
A Top-Rated Exam Study Guide Latest
Updated 2025/2026
What is true about screening a beneficiary for possible MSP situations? - ansIt is acceptable
to complete the screening form after the patient has completed the registration process and
been sent to the service department
If the patient cannot agree to payment arrangements, what is the next option? - ansWarn the
patient that unpaid accounts are placed with collection agencies for further processing
In services lines such as cardiology or orthopedics, what does the case-rate payment
methodology allow providers to do? - ansReceive a fixed for specific procedures
What will comprehensive patient access processing accomplish? - ansMinimize the need for
follow-up on insurance accounts
Through what document does a hospital establish compliance standards? - ansCode of
conduct
How does utilization review staff use correct insurance information? - ansTo obtain approval
for inpatient days and coordinate services
When is it not appropriate to use observation status? - ansAs a substitute for an inpatient
admission
What is a serious consequence of misidentifying a patient in the MPI? - ansThe services will
be documented in the wrong record
When a patient reports directly to a clinical department for service, what will the clinical
department staff do? - ansRedirect the patient to the patient access department for registration
What process can be used to shorten claim turnaround time? - ansSend high-dollar hard-copy
claims with required attachments by overnight mail or registered mail
How are patient reminder calls used? - ansTo make sure the patient follows the prep
instructions and arrives at the scheduled time for service
If a patient declares a straight bankruptcy, what must the provider do? - ansWrite off the
account to the contractual adjustment account
According to the Department of Health and Human Services guidelines, what is NOT
considered income? - ansSale of property, house, or car
The situation where neither the patient nor spouse is employed is described to the patient
using: - ansA condition code
What option is an alternative to valid long-term payment plans? - ansBank loans
What is an advantage of using a collection agency to collect delinquent patient accounts? -
ansCollection agencies collect accounts faster than hospital does
What statement DOES NOT apply to revenue codes? - ansrevenue codes identify the payer
When a patient's illness results in an unusually high amount of medical bills not covered by
insurance or other patient pay resources, what type of account is created - anscatastrophic
charity
What happens when a patient receives non-emergent services from and out-of-network
provider? - ansPatient payment responsibility is higher
Every patient who is new to the healthcare provider must be offered what? - ansA printed
copy of the provider's privacy notice
