HFMA CRCR Review Exam Questions
and Answers32
What does the Revenue Cycle encompass? - ANSWERS-All major steps required to process a
patient account from service request to account closure.
What are the three segments of the Revenue Cycle? - ANSWERS-Pre-Service, Time-of-Service,
and Post-Service.
What is the focus of the Pre-Service segment? - ANSWERS-Effective patient communication and
data collection before the service.
What activities are involved in the Pre-Service segment? - ANSWERS-Screening for medical
necessity, verifying health plan coverage, obtaining pre-authorizations, and generating cost
estimates.
What must be communicated to the patient during Pre-Service? - ANSWERS-Financial
responsibility, including copayments and deductibles.
Why is the Pre-Service segment critical? - ANSWERS-Failures in this segment can affect
healthcare compliance and collection performance later.
What is the first step in the Pre-Service example? - ANSWERS-Dr. West electronically orders a
chest MRI for Mary Smith.
What happens during the second step of Pre-Service? - ANSWERS-Central scheduling staff
assess medical necessity and notify the patient of costs.
,What is required for scheduling a service? - ANSWERS-Patient consent and notification of costs
must be secured.
What is the purpose of online verification in Pre-Service? - ANSWERS-To update the patient's
account status and confirm medical necessity screening.
What occurs during Time-of-Service processing? - ANSWERS-Final account review, consent
signing, and collection of co-payments.
What is the role of positive patient identification? - ANSWERS-To ensure the patient is correctly
matched to their activated account.
What happens if a patient is unscheduled at Time-of-Service? - ANSWERS-Comprehensive
registration and financial processing are completed at that time.
What is involved in the Time-of-Service example for inpatient admission? - ANSWERS-Case
management, order entry, reporting results, generating charges, and coding.
What is the significance of monitoring charges during Time-of-Service? - ANSWERS-To ensure
accurate billing and compliance with managed care requirements.
What happens when Mary arrives for her service? - ANSWERS-She checks in at the Rapid check-
in desk, confirms her identity, and pays her deductible.
What occurs after Mary receives her MRI? - ANSWERS-Her patient type is updated to
observation status, and notifications are sent for monitoring.
What is the final step in processing after the MRI? - ANSWERS-The MRI charge is posted to
Mary's account and additional services are entered.
,What is the role of financial communication in Pre-Service? - ANSWERS-To explain the patient's
financial responsibilities and assess eligibility for assistance.
What must be done if a patient does not contact the scheduling center? - ANSWERS-Staff will
initiate contact with the patient to schedule the service.
What is the purpose of pre-authorization in the Revenue Cycle? - ANSWERS-To ensure that
services are covered by the patient's health plan before they are provided.
What happens during the financial resolution documentation? - ANSWERS-The account is
flagged for payment collection on the day of service.
What is the importance of adequate training in the Revenue Cycle? - ANSWERS-To ensure that
staff can effectively manage processes and improve patient experiences.
What is the significance of establishing clear procedures in Pre-Service? - ANSWERS-To prevent
process failures that can impact the entire Revenue Cycle.
What does the term 'managed care resolution' refer to? - ANSWERS-The process of addressing
and resolving patient liabilities and managed care requirements.
What is the outcome of successful Pre-Service processing? - ANSWERS-A smooth transition to
Time-of-Service and improved patient satisfaction.
How does the Revenue Cycle impact overall healthcare delivery? - ANSWERS-It affects patient
access, financial outcomes, and the efficiency of healthcare services.
, What is the role of case management during Time-of-Service? - ANSWERS-To ensure
appropriate care planning and resource allocation for patients.
What is the first step in Time-of-Service Processing for unscheduled services? - ANSWERS-Bill
Jones is directed to the registration desk within the Patient Access department.
What is done in Step 6 of Time-of-Service Processing? - ANSWERS-Identification of all charges
related to the ordered service(s) and application of verified health plan benefits to calculate the
amount due from the patient.
What happens if a patient owes a co-payment during Time-of-Service Processing? - ANSWERS-A
financial conversation is initiated to resolve the account.
What is the purpose of the Post-Service segment in the revenue cycle? - ANSWERS-It includes
account activities that occur after the patient is discharged until the account reaches a zero
balance.
What information is updated in Step One of Post-Service Activities? - ANSWERS-The account is
updated with discharge information, including the disposition code indicating that the patient is
discharged home.
What is the role of Medical Records in Post-Service Activities? - ANSWERS-They review the
patient's chart and enter all required procedure codes and diagnosis codes into the medical
record.
What is the outcome once all billing edits are resolved in Post-Service Activities? - ANSWERS-
The account qualifies for bill submission.
What is the significance of patient experience in the revenue cycle? - ANSWERS-Patients
demand information and choices about services, prices, and payment options.
and Answers32
What does the Revenue Cycle encompass? - ANSWERS-All major steps required to process a
patient account from service request to account closure.
What are the three segments of the Revenue Cycle? - ANSWERS-Pre-Service, Time-of-Service,
and Post-Service.
What is the focus of the Pre-Service segment? - ANSWERS-Effective patient communication and
data collection before the service.
What activities are involved in the Pre-Service segment? - ANSWERS-Screening for medical
necessity, verifying health plan coverage, obtaining pre-authorizations, and generating cost
estimates.
What must be communicated to the patient during Pre-Service? - ANSWERS-Financial
responsibility, including copayments and deductibles.
Why is the Pre-Service segment critical? - ANSWERS-Failures in this segment can affect
healthcare compliance and collection performance later.
What is the first step in the Pre-Service example? - ANSWERS-Dr. West electronically orders a
chest MRI for Mary Smith.
What happens during the second step of Pre-Service? - ANSWERS-Central scheduling staff
assess medical necessity and notify the patient of costs.
,What is required for scheduling a service? - ANSWERS-Patient consent and notification of costs
must be secured.
What is the purpose of online verification in Pre-Service? - ANSWERS-To update the patient's
account status and confirm medical necessity screening.
What occurs during Time-of-Service processing? - ANSWERS-Final account review, consent
signing, and collection of co-payments.
What is the role of positive patient identification? - ANSWERS-To ensure the patient is correctly
matched to their activated account.
What happens if a patient is unscheduled at Time-of-Service? - ANSWERS-Comprehensive
registration and financial processing are completed at that time.
What is involved in the Time-of-Service example for inpatient admission? - ANSWERS-Case
management, order entry, reporting results, generating charges, and coding.
What is the significance of monitoring charges during Time-of-Service? - ANSWERS-To ensure
accurate billing and compliance with managed care requirements.
What happens when Mary arrives for her service? - ANSWERS-She checks in at the Rapid check-
in desk, confirms her identity, and pays her deductible.
What occurs after Mary receives her MRI? - ANSWERS-Her patient type is updated to
observation status, and notifications are sent for monitoring.
What is the final step in processing after the MRI? - ANSWERS-The MRI charge is posted to
Mary's account and additional services are entered.
,What is the role of financial communication in Pre-Service? - ANSWERS-To explain the patient's
financial responsibilities and assess eligibility for assistance.
What must be done if a patient does not contact the scheduling center? - ANSWERS-Staff will
initiate contact with the patient to schedule the service.
What is the purpose of pre-authorization in the Revenue Cycle? - ANSWERS-To ensure that
services are covered by the patient's health plan before they are provided.
What happens during the financial resolution documentation? - ANSWERS-The account is
flagged for payment collection on the day of service.
What is the importance of adequate training in the Revenue Cycle? - ANSWERS-To ensure that
staff can effectively manage processes and improve patient experiences.
What is the significance of establishing clear procedures in Pre-Service? - ANSWERS-To prevent
process failures that can impact the entire Revenue Cycle.
What does the term 'managed care resolution' refer to? - ANSWERS-The process of addressing
and resolving patient liabilities and managed care requirements.
What is the outcome of successful Pre-Service processing? - ANSWERS-A smooth transition to
Time-of-Service and improved patient satisfaction.
How does the Revenue Cycle impact overall healthcare delivery? - ANSWERS-It affects patient
access, financial outcomes, and the efficiency of healthcare services.
, What is the role of case management during Time-of-Service? - ANSWERS-To ensure
appropriate care planning and resource allocation for patients.
What is the first step in Time-of-Service Processing for unscheduled services? - ANSWERS-Bill
Jones is directed to the registration desk within the Patient Access department.
What is done in Step 6 of Time-of-Service Processing? - ANSWERS-Identification of all charges
related to the ordered service(s) and application of verified health plan benefits to calculate the
amount due from the patient.
What happens if a patient owes a co-payment during Time-of-Service Processing? - ANSWERS-A
financial conversation is initiated to resolve the account.
What is the purpose of the Post-Service segment in the revenue cycle? - ANSWERS-It includes
account activities that occur after the patient is discharged until the account reaches a zero
balance.
What information is updated in Step One of Post-Service Activities? - ANSWERS-The account is
updated with discharge information, including the disposition code indicating that the patient is
discharged home.
What is the role of Medical Records in Post-Service Activities? - ANSWERS-They review the
patient's chart and enter all required procedure codes and diagnosis codes into the medical
record.
What is the outcome once all billing edits are resolved in Post-Service Activities? - ANSWERS-
The account qualifies for bill submission.
What is the significance of patient experience in the revenue cycle? - ANSWERS-Patients
demand information and choices about services, prices, and payment options.
