CRCR EXAM FINAL PAPER 2026 TESTED
QUESTIONS WITH FULL SOLUTION GRADED
A+
◉ How does utilization review staff use correct insurance
information? Answer: To obtain approval for inpatient days and
coordinate services
◉ When is it not appropriate to use observation status? Answer: As
a substitute for an inpatient admission
◉ What is a serious consequence of misidentifying a patient in the
MPI? Answer: The 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? Answer: Redirect
the patient to the patient access department for registration
◉ What process can be used to shorten claim turnaround time?
Answer: Send high-dollar hard-copy claims with required
attachments by overnight mail or registered mail
,◉ How are patient reminder calls used? Answer: To 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? Answer: Write off the account to the contractual adjustment
account
◉ According to the Department of Health and Human Services
guidelines, what is NOT considered income? Answer: Sale of
property, house, or car
◉ The situation where neither the patient nor spouse is employed is
described to the patient using: Answer: A condition code
◉ What option is an alternative to valid long-term payment plans?
Answer: Bank loans
◉ What is an advantage of using a collection agency to collect
delinquent patient accounts? Answer: Collection agencies collect
accounts faster than hospital does
◉ What statement DOES NOT apply to revenue codes? Answer:
revenue 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 Answer: catastrophic
charity
◉ What happens when a patient receives non-emergent services
from and out-of-network provider? Answer: Patient payment
responsibility is higher
◉ Every patient who is new to the healthcare provider must be
offered what? Answer: A printed copy of the provider's privacy
notice
◉ How may a collection agency demonstrate its performance?
Answer: Calculate the rate of recovery
◉ What is true of the information the provider supplies to indicate
that an authorization for service has been received from the
patient's primary payer? Answer: It is posted on the remittance
advice by the payer
◉ What standard claim forms are currently used by the healthcare
industry to submit claims to third-party payers? Answer: The UB-04
and the CMS 1500
, ◉ Unless the patient encounter is an emergency, what is the efficient
and effective procedure for obtaining information? Answer: Obtain
the required demographic and insurance information before
services are rendered
◉ what protocol was developed through the Patient Friendly Billing
Project? Answer: Provide information using language that is easily
understood by the average reader
◉ What technique is acceptable way to complete the MSP screening
for a facility situation? Answer: Ask if the patient's current services
was accident related
◉ 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
QUESTIONS WITH FULL SOLUTION GRADED
A+
◉ How does utilization review staff use correct insurance
information? Answer: To obtain approval for inpatient days and
coordinate services
◉ When is it not appropriate to use observation status? Answer: As
a substitute for an inpatient admission
◉ What is a serious consequence of misidentifying a patient in the
MPI? Answer: The 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? Answer: Redirect
the patient to the patient access department for registration
◉ What process can be used to shorten claim turnaround time?
Answer: Send high-dollar hard-copy claims with required
attachments by overnight mail or registered mail
,◉ How are patient reminder calls used? Answer: To 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? Answer: Write off the account to the contractual adjustment
account
◉ According to the Department of Health and Human Services
guidelines, what is NOT considered income? Answer: Sale of
property, house, or car
◉ The situation where neither the patient nor spouse is employed is
described to the patient using: Answer: A condition code
◉ What option is an alternative to valid long-term payment plans?
Answer: Bank loans
◉ What is an advantage of using a collection agency to collect
delinquent patient accounts? Answer: Collection agencies collect
accounts faster than hospital does
◉ What statement DOES NOT apply to revenue codes? Answer:
revenue 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 Answer: catastrophic
charity
◉ What happens when a patient receives non-emergent services
from and out-of-network provider? Answer: Patient payment
responsibility is higher
◉ Every patient who is new to the healthcare provider must be
offered what? Answer: A printed copy of the provider's privacy
notice
◉ How may a collection agency demonstrate its performance?
Answer: Calculate the rate of recovery
◉ What is true of the information the provider supplies to indicate
that an authorization for service has been received from the
patient's primary payer? Answer: It is posted on the remittance
advice by the payer
◉ What standard claim forms are currently used by the healthcare
industry to submit claims to third-party payers? Answer: The UB-04
and the CMS 1500
, ◉ Unless the patient encounter is an emergency, what is the efficient
and effective procedure for obtaining information? Answer: Obtain
the required demographic and insurance information before
services are rendered
◉ what protocol was developed through the Patient Friendly Billing
Project? Answer: Provide information using language that is easily
understood by the average reader
◉ What technique is acceptable way to complete the MSP screening
for a facility situation? Answer: Ask if the patient's current services
was accident related
◉ 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
