CRCR Certification Exam Questions and Answers 2025

1. Overall aggregate payments made to a hospice are subject to a computed "cap amount" calculated by: The Medicare Administrative Contractor (MAC) at the end of the hospice cap period 2. Which of the following is required for participation in Medicaid: Meet In- come and Assets Requirements 3. In choosing a setting for patient financial discussions, organizations should first and foremost: Respect the patients privacy 4. A nightly room charge will be incorrect if the patient's: Transfer from ICU (intensive care unit) to the Medical/Surgical floor is not reflected in the registration system 5. The Affordable Care Act legislated the development of Health Insurance Exchanges, where individuals and small businesses can: Purchase qualified health benefit plans regardless of insured's 1 / 15 health status 6. A portion of the accounts receivable inventory which has NOT qualified for billing includes:: Charitable pledges 7. What is required for the UB-04/837-I, used by Rural Health Clinics to generate payment from Medicare?: Revenue codes 8. This directive was developed to promote and ensure healthcare quality and value and also to protect consumers and workers in the healthcare system. This directive is called: Patient bill of rights 9. The activity which results in the accurate recording of patient bed and level of care assessment, patient transfer and patient discharge status on a real-time basis is known as: Case management 10. Which statement is an EMTALA (Emergency Medical Treatment and Ac- tive Labor Act) violation?: Registration staff may routinely contact managed are plans for prior authorizations before the patient is seen by the on-duty physician 2 / 15 11. HIPAA had adopted Employer Identification Numbers (EIN) to be used in standard transactions to identify the employer of an individual described in a transaction EIN's are assigned by: The Internal Revenue Service 12. Checks received through mail, cash received through mail, and lock box are all examples of: Control points for cash posting 13. What are some core elements if a board-approved financial assistance policy?: Eligibility, application process, and nonpayment collection activities 3 / 15 14. A recurring/series registration is characterized by: The creation of one registration record for multiple days of service 15. With the advent of the Affordable Care Act Health Insurance Marketplaces and the expansion of Medicaid in some states, it is more important than ever for hospitals to: Assist patients in understanding their insurance coverage and their financial obligation 16. The purpose of a financial report is to:: Present financial information to decision makers 17. Patient financial communications best practices produce communica- tions that are: Consistent, clear and transparent 18. Medicare has established guidelines called the Local Coverage Determi- nations (LCD) and National Coverage Determinations (NCD) that establish: - What services or healthcare items are covered under Medicare 19. 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: The Provider Reimbursement Review Board 20. Concurrent review and discharge planning: Occurs during service 21. Duplicate payments occur:: When providers re-bill claims based on nonpay- ment from the initial bill submission 22. An individual enrolled in Medicare who is dissatisfied with the govern- ment's claim determination is entitled to reconsideration of the decision. This type of appeal is known as: A beneficiary appeal 23. Insurance verification results in which of the following: The accurate identification of the patient's eligibility and benefits 24. The Medicare fee-for service appeal process for both beneficiaries and providers includes all of the following levels EXCEPT:: Judicial review by a federal district court 25. Under EMTALA (Emergency Medical Treatment and Labor Act) regula- tions, the providermay not ask about a patient's insurance information if it would delay what?: Medical screening and stabilizing treatment 26. Ambulance services are billed directly to the health plan for: 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 27. Key performance indicators (KPIs) set standards for accounts receiv- ables (A/R) and: Provide a method of measuring the collection and control of A/R 28. he patient discharge process begins when: The physician writes the dis- charge orders 29. The nightly room charge will be incorrect if the patient's: Transfer from ICU to the Medical/Surgical floor is not reflected in the registration system. 30. The soft cost of a dissatisfied customer is: The customer passing on info about their negative experience to potential pts or through social media channels 31. An advantage of a pre-registration program is: The opportunity to reduce the corporate compliance failures within the registration process 32. It is important to have high registration quality standards because: Inac- curate or incomplete patient data will delay payment or cause denials 33. Telemed seeks to improve a patient's health by: Permitting 2-way real time interactive communication between the patient and the clinical professional 34. Any healthcare insurance plan that provides or ensures comprehensive health maintenance and treatment services for an enrolled group of persons based on a monthly fee is known as a: HMO 35. Identifying the patient, in the MPI, creating the registration record, com- pleting medical necessity screening, determining insurance eligibility and benefits resolving managed care, requirements and completing financial ed- ucation/resolution are all: The data collection steps for scheduling and pre-reg- istering a patient 36. Medicare Part B has an annual deductible, and the beneficiary is respon- sible for: A co-insurance payment for all Part B covered services 37. The standard claim form used for billing by hospitals, nursing facilities, and other inpatient: UB-04 38. Charges are the basis for: Separation of fiscal responsibilities between the patient and the health plan 39. All of the following are forms of hospital payment contracting EXCEPT: - Contracted Rebating 40. The most common resolution methods for credit balances include all of the following EXCEPT:: Designate the overpayment for charity care 41. Ambulance services are billed directly to the health plan for: The portion of the bill outside of the patient's self-pay 42. A claim for reimbursement submitted to a third-party payer that has all the information and documentation required for the payer to make a decision on it is known as: A clean claim 43. The healthcare industry is vulnerable to compliance issues, in large part due to the complexity of the statutes and regulations pertaining to: Medicare and Medicaid payments 44. The Correct Coding Initiative Program consists of: Edits that are imple- mented within providers' claim processing systems 45. To provide a patient with information that is meaningful to them, all of the following factors must be included EXCEPT: The actual physician reimburse- ment 46. Which department supports/collaborates with the revenue cycle?: Infor- mation Technology 47. Medicare Part B has an annual deductible and the beneficiary is respon- sible for: a co-insurance payment for all Part B covered services 48. The two types of claims denial appeals are: Beneficiary and Provider 49. Which of the following is a violation of the EMTALA (Emergency Medical Treatment and Labor Act?): Registration staff members routinely contact man- aged care plans for prior authorizations before the patient is seen by the on duty physician 50. Rural Health Clinics (RHC) personnel can provide services in all of the following locations, EXCEPT: Providing inpatient services in the RHC 51. The patient discharge process begins when: The physician writes the dis- charge order 52. Departments that need to be included in charge master maintenance include all of the following EXCEPT: Quality Assurance 53. The first thing a health plan does when processing a claim is: Check if the patient is a health plan beneficiary and what is the coverage 54. Vital to accurate calculations of a patient's self-pay amount is: 55. The most accurate way to validate patient information is to: require clinical staff to verify information at each treatment encounter 56. In order for Regulation Z to apply, a hospital must: 57. All of the following are minimum requirements for new patients with no MPI number EXCEPT: Address 58. A typical routine patient financial discussion would include: Explaining the benefits identified through verifying the patients insurance 59. Components of financial education include informing the patient of the hospital's financial policies, assessing the patient's ability to pay and: Re- viewing payment alternatives with the patient so appropriate resolution of the health care financial obligation is achieved 60. HFMA best practices indicate that the technology evaluation is conduct- ed to: Continually align technology with processes rather than technology dictating processes