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HFMA Certified Revenue Cycle Representative CRCR
ACTUAL EXAM QUESTIONS AND ANSWERS
2026/2027 | Comprehensive Assessment | Pass
Guaranteed - A+ Graded
Domain 1: Pre-Service/Patient Access (31 Questions)
Q1: During pre-registration for an elective surgery, the financial counselor confirms the patient
has a high-deductible health plan (HDHP) with a $3,000 deductible, of which $0 has been met.
The facility's estimated charge for the surgery is $18,000, and the payer's contracted rate is
$12,000. What is the most accurate statement to provide the patient regarding their financial
responsibility?
A. "You will owe the full $12,000 contracted rate at the time of service."
B. "Your estimated portion is $3,000, as that is your remaining deductible."
C. "Your portion is $3,000, but we cannot collect it until after the claim is processed."
D. "Your estimated portion is $3,000, and we can offer a payment plan or discuss financial
assistance options." [CORRECT]
Correct Answer: D
Rationale: Under an HDHP, the patient is responsible for 100% of the contracted rate until the
deductible is met. The estimated patient portion is the remaining deductible ($3,000). Best
practice in patient financial counseling is to provide a good faith estimate, offer payment options,
and inform them about financial assistance if applicable. Collecting the estimated deductible at
or before the time of service (when possible) is standard to reduce bad debt, but options must be
presented (D). A is incorrect (confuses charge with contracted rate). B is accurate but incomplete
as it doesn't address collections or assistance. C is incorrect; facilities can and do collect
estimates upfront.
Q2: [Select ALL That Apply] Which of the following are required elements to verify during the
insurance eligibility verification process for a scheduled outpatient procedure?
A. Patient's name, date of birth, and insurance ID number match the insurance card exactly
[CORRECT]
B. Whether the procedure requires prior authorization or pre-certification [CORRECT]
C. The patient's current deductible balance and out-of-pocket maximum status [CORRECT]
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D. The name of the patient's primary care physician
E. Whether the facility is in-network for the specific plan [CORRECT]
F. The patient's marital status
Correct Answers: A, B, C, E
Rationale: Accurate eligibility verification (A) prevents claim denials for member mismatch.
Determining if authorization is required (B) is critical to prevent "no auth" denials.
Understanding the patient's financial responsibility (C) enables proper financial counseling.
Confirming network status (E) affects reimbursement rates and patient liability. D is not required
for eligibility verification (though it may be needed for referral requirements). F is irrelevant to
insurance verification.
Q3: A patient presents to the emergency department with chest pain. The registration clerk is
unable to verify insurance coverage because the payer's eligibility system is down. According to
EMTALA regulations, what is the appropriate action?
A. Stabilize the patient and delay registration until insurance can be verified [CORRECT]
B. Transfer the patient to another facility that can verify insurance
C. Ask the patient to pay a deposit before treatment can begin
D. Refuse treatment until the insurance issue is resolved
Correct Answer: A
Rationale: EMTALA requires hospitals to provide a medical screening examination and
stabilizing treatment regardless of insurance status or ability to pay. The hospital cannot delay
screening or treatment to inquire about insurance (A). B violates EMTALA if the patient is not
stabilized. C and D are illegal under EMTALA and can result in significant penalties.
Q4: [Select ALL That Apply] A patient is scheduled for a CT scan with contrast at an outpatient
imaging center. Which steps should be completed during the pre-service phase to ensure proper
reimbursement?
A. Verify that the ordering physician's NPI is valid and active [CORRECT]
B. Confirm the ICD-10-CM diagnosis code on the order supports medical necessity for the
procedure [CORRECT]
C. Check if prior authorization is required by the specific payer for this CPT code [CORRECT]
D. Ensure the patient has fasted for 12 hours before the procedure
E. Verify the patient's copay or coinsurance for radiology services [CORRECT]
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F. Obtain the patient's credit score to determine payment likelihood
Correct Answers: A, B, C, E
Rationale: Valid ordering provider NPI (A) is required for Medicare and most payers. Medical
necessity (B) prevents denials for "not medically necessary." Prior authorization (C) is critical for
many advanced imaging procedures under Medicare and commercial plans. Financial
responsibility verification (E) supports patient collections. D is a clinical preparation step, not a
revenue cycle requirement. F is discriminatory and not a standard practice.
Q5: A financial counselor is preparing a good faith estimate for a patient with commercial
insurance undergoing a total knee replacement. The patient's plan has a $1,500 deductible (met),
20% coinsurance, and $5,000 out-of-pocket maximum ($3,500 remaining). The estimated
allowed amount is $25,000. What is the patient's estimated financial responsibility?
A. $1,500
B. $3,500 [CORRECT]
C. $5,000
D. $6,500
Correct Answer: B
Rationale: Since the deductible is met, the patient owes 20% coinsurance on $25,000 = $5,000.
However, the patient only has $3,500 remaining before hitting the out-of-pocket maximum.
Therefore, the estimated responsibility is capped at $3,500 (B). This calculation is required under
the No Surprises Act for good faith estimates.
Q6: [Select ALL That Apply] Which of the following scenarios would require the facility to
provide the patient with a written good faith estimate under the No Surprises Act?
A. A self-pay patient scheduling an elective colonoscopy [CORRECT]
B. An insured patient requesting an estimate for an out-of-network service at an in-network
facility [CORRECT]
C. An insured patient with in-network coverage for a routine screening mammogram
D. A patient with insurance who requests an estimate for services not covered by their plan
[CORRECT]
E. An emergency department visit for acute appendicitis
Correct Answers: A, B, D
Rationale: The No Surprises Act requires good faith estimates for uninsured/self-pay individuals
(A) and insured patients when they request estimates for out-of-network services (B) or non-
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covered services (D). Routine in-network preventive services (C) do not require estimates.
Emergency services (E) are exempt from the advance estimate requirement due to the urgent
nature of care.
Q7: A patient arrives for a scheduled MRI and presents an insurance card that expired two weeks
ago. The patient states they have new coverage but cannot provide the card. What is the best
immediate action?
A. Reschedule the appointment until new insurance can be verified
B. Proceed with the service and bill the patient as self-pay
C. Attempt to verify coverage through the payer's automated system or contact the employer's
HR department [CORRECT]
D. Accept the expired card and submit the claim to the old payer
Correct Answer: C
Rationale: The best practice is to attempt real-time verification through alternative methods (C)
to prevent delays in patient care while ensuring proper billing. Many payers allow verification
with SSN and date of birth. A may delay medically necessary care. B creates patient
dissatisfaction and potential bad debt. D will result in a denial and delayed reimbursement.
Q8: [Ordering Question - Drag and Drop] Place the following steps in the correct chronological
order for processing a prior authorization request for a scheduled surgery:
Submit authorization request to payer with clinical documentation
Verify medical necessity and clinical indications
Receive approval/denial decision from payer
Obtain completed order from physician with diagnosis codes
Schedule patient for surgery
Notify patient of authorization status and financial responsibility
Correct Order: 4, 2, 1, 3, 6, 5
Rationale: The proper sequence is: Obtain physician order (4) → Verify medical necessity (2) →
Submit request with documentation (1) → Receive payer decision (3) → Counsel patient on
status and costs (6) → Schedule surgery (5). Scheduling (5) should only occur after authorization
is confirmed to prevent cancellations.
Q9: A registration clerk notices that a patient's insurance card indicates "Medicare Advantage
Plan" rather than traditional Medicare. What is the critical difference in processing this account?
HFMA Certified Revenue Cycle Representative CRCR
ACTUAL EXAM QUESTIONS AND ANSWERS
2026/2027 | Comprehensive Assessment | Pass
Guaranteed - A+ Graded
Domain 1: Pre-Service/Patient Access (31 Questions)
Q1: During pre-registration for an elective surgery, the financial counselor confirms the patient
has a high-deductible health plan (HDHP) with a $3,000 deductible, of which $0 has been met.
The facility's estimated charge for the surgery is $18,000, and the payer's contracted rate is
$12,000. What is the most accurate statement to provide the patient regarding their financial
responsibility?
A. "You will owe the full $12,000 contracted rate at the time of service."
B. "Your estimated portion is $3,000, as that is your remaining deductible."
C. "Your portion is $3,000, but we cannot collect it until after the claim is processed."
D. "Your estimated portion is $3,000, and we can offer a payment plan or discuss financial
assistance options." [CORRECT]
Correct Answer: D
Rationale: Under an HDHP, the patient is responsible for 100% of the contracted rate until the
deductible is met. The estimated patient portion is the remaining deductible ($3,000). Best
practice in patient financial counseling is to provide a good faith estimate, offer payment options,
and inform them about financial assistance if applicable. Collecting the estimated deductible at
or before the time of service (when possible) is standard to reduce bad debt, but options must be
presented (D). A is incorrect (confuses charge with contracted rate). B is accurate but incomplete
as it doesn't address collections or assistance. C is incorrect; facilities can and do collect
estimates upfront.
Q2: [Select ALL That Apply] Which of the following are required elements to verify during the
insurance eligibility verification process for a scheduled outpatient procedure?
A. Patient's name, date of birth, and insurance ID number match the insurance card exactly
[CORRECT]
B. Whether the procedure requires prior authorization or pre-certification [CORRECT]
C. The patient's current deductible balance and out-of-pocket maximum status [CORRECT]
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D. The name of the patient's primary care physician
E. Whether the facility is in-network for the specific plan [CORRECT]
F. The patient's marital status
Correct Answers: A, B, C, E
Rationale: Accurate eligibility verification (A) prevents claim denials for member mismatch.
Determining if authorization is required (B) is critical to prevent "no auth" denials.
Understanding the patient's financial responsibility (C) enables proper financial counseling.
Confirming network status (E) affects reimbursement rates and patient liability. D is not required
for eligibility verification (though it may be needed for referral requirements). F is irrelevant to
insurance verification.
Q3: A patient presents to the emergency department with chest pain. The registration clerk is
unable to verify insurance coverage because the payer's eligibility system is down. According to
EMTALA regulations, what is the appropriate action?
A. Stabilize the patient and delay registration until insurance can be verified [CORRECT]
B. Transfer the patient to another facility that can verify insurance
C. Ask the patient to pay a deposit before treatment can begin
D. Refuse treatment until the insurance issue is resolved
Correct Answer: A
Rationale: EMTALA requires hospitals to provide a medical screening examination and
stabilizing treatment regardless of insurance status or ability to pay. The hospital cannot delay
screening or treatment to inquire about insurance (A). B violates EMTALA if the patient is not
stabilized. C and D are illegal under EMTALA and can result in significant penalties.
Q4: [Select ALL That Apply] A patient is scheduled for a CT scan with contrast at an outpatient
imaging center. Which steps should be completed during the pre-service phase to ensure proper
reimbursement?
A. Verify that the ordering physician's NPI is valid and active [CORRECT]
B. Confirm the ICD-10-CM diagnosis code on the order supports medical necessity for the
procedure [CORRECT]
C. Check if prior authorization is required by the specific payer for this CPT code [CORRECT]
D. Ensure the patient has fasted for 12 hours before the procedure
E. Verify the patient's copay or coinsurance for radiology services [CORRECT]
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F. Obtain the patient's credit score to determine payment likelihood
Correct Answers: A, B, C, E
Rationale: Valid ordering provider NPI (A) is required for Medicare and most payers. Medical
necessity (B) prevents denials for "not medically necessary." Prior authorization (C) is critical for
many advanced imaging procedures under Medicare and commercial plans. Financial
responsibility verification (E) supports patient collections. D is a clinical preparation step, not a
revenue cycle requirement. F is discriminatory and not a standard practice.
Q5: A financial counselor is preparing a good faith estimate for a patient with commercial
insurance undergoing a total knee replacement. The patient's plan has a $1,500 deductible (met),
20% coinsurance, and $5,000 out-of-pocket maximum ($3,500 remaining). The estimated
allowed amount is $25,000. What is the patient's estimated financial responsibility?
A. $1,500
B. $3,500 [CORRECT]
C. $5,000
D. $6,500
Correct Answer: B
Rationale: Since the deductible is met, the patient owes 20% coinsurance on $25,000 = $5,000.
However, the patient only has $3,500 remaining before hitting the out-of-pocket maximum.
Therefore, the estimated responsibility is capped at $3,500 (B). This calculation is required under
the No Surprises Act for good faith estimates.
Q6: [Select ALL That Apply] Which of the following scenarios would require the facility to
provide the patient with a written good faith estimate under the No Surprises Act?
A. A self-pay patient scheduling an elective colonoscopy [CORRECT]
B. An insured patient requesting an estimate for an out-of-network service at an in-network
facility [CORRECT]
C. An insured patient with in-network coverage for a routine screening mammogram
D. A patient with insurance who requests an estimate for services not covered by their plan
[CORRECT]
E. An emergency department visit for acute appendicitis
Correct Answers: A, B, D
Rationale: The No Surprises Act requires good faith estimates for uninsured/self-pay individuals
(A) and insured patients when they request estimates for out-of-network services (B) or non-
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covered services (D). Routine in-network preventive services (C) do not require estimates.
Emergency services (E) are exempt from the advance estimate requirement due to the urgent
nature of care.
Q7: A patient arrives for a scheduled MRI and presents an insurance card that expired two weeks
ago. The patient states they have new coverage but cannot provide the card. What is the best
immediate action?
A. Reschedule the appointment until new insurance can be verified
B. Proceed with the service and bill the patient as self-pay
C. Attempt to verify coverage through the payer's automated system or contact the employer's
HR department [CORRECT]
D. Accept the expired card and submit the claim to the old payer
Correct Answer: C
Rationale: The best practice is to attempt real-time verification through alternative methods (C)
to prevent delays in patient care while ensuring proper billing. Many payers allow verification
with SSN and date of birth. A may delay medically necessary care. B creates patient
dissatisfaction and potential bad debt. D will result in a denial and delayed reimbursement.
Q8: [Ordering Question - Drag and Drop] Place the following steps in the correct chronological
order for processing a prior authorization request for a scheduled surgery:
Submit authorization request to payer with clinical documentation
Verify medical necessity and clinical indications
Receive approval/denial decision from payer
Obtain completed order from physician with diagnosis codes
Schedule patient for surgery
Notify patient of authorization status and financial responsibility
Correct Order: 4, 2, 1, 3, 6, 5
Rationale: The proper sequence is: Obtain physician order (4) → Verify medical necessity (2) →
Submit request with documentation (1) → Receive payer decision (3) → Counsel patient on
status and costs (6) → Schedule surgery (5). Scheduling (5) should only occur after authorization
is confirmed to prevent cancellations.
Q9: A registration clerk notices that a patient's insurance card indicates "Medicare Advantage
Plan" rather than traditional Medicare. What is the critical difference in processing this account?
