CRCR (Certified Revenue Cycle Representative)
TESTBANK 2025-2026 QUESTIONS AND
CORRECT ANSWERS GRADED A+
What are the two statutory exclusions from hospice coverage?
Medically unnecessary services and custodial care
What core financial activities are resolved within patient access?
Scheduling, insurance verification, discharge processing, and payment of point-of-
service receipts
What statement applies to the scheduled outpatient?
The services do not involve an overnight stay
How is a mis-posted contractual allowance resolved?
Comparing 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?
Observation
,Coverage rules for Medicare beneficiaries receiving skilled nursing care require
that the beneficiary has received what?
Medically 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$?
When the patient is the insured
What are non-emergency patients who come for service without prior notification
to the provider called?
Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse?
Neither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
Lending Act, establishes what?
Disclosure rules for consumer credit sales and consumer loans
What is a principal diagnosis?
Primary reason for the patient's admission
,Collecting patient liability dollars after service leads to what?
Lower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used?
50% 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?
Inpatient care
What code indicates the disposition of the patient at the conclusion of service?
Patient discharge status code
What are collection agency fees based on?
A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule
or what other rule?
Birthday
, In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers?
Case rates
What customer service improvements might improve the patient accounts
department?
Holding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do?
Inform 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?
Bad debt adjustment
What is the initial hospice benefit?
Two 90-day periods and an unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim?
If the patient requires ambulance transportation to a skilled nursing facility
TESTBANK 2025-2026 QUESTIONS AND
CORRECT ANSWERS GRADED A+
What are the two statutory exclusions from hospice coverage?
Medically unnecessary services and custodial care
What core financial activities are resolved within patient access?
Scheduling, insurance verification, discharge processing, and payment of point-of-
service receipts
What statement applies to the scheduled outpatient?
The services do not involve an overnight stay
How is a mis-posted contractual allowance resolved?
Comparing 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?
Observation
,Coverage rules for Medicare beneficiaries receiving skilled nursing care require
that the beneficiary has received what?
Medically 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$?
When the patient is the insured
What are non-emergency patients who come for service without prior notification
to the provider called?
Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy,
what is the status of the subscriber's spouse?
Neither enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in
Lending Act, establishes what?
Disclosure rules for consumer credit sales and consumer loans
What is a principal diagnosis?
Primary reason for the patient's admission
,Collecting patient liability dollars after service leads to what?
Lower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used?
50% 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?
Inpatient care
What code indicates the disposition of the patient at the conclusion of service?
Patient discharge status code
What are collection agency fees based on?
A percentage of dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule
or what other rule?
Birthday
, In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers?
Case rates
What customer service improvements might improve the patient accounts
department?
Holding staff accountable for customer service during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do?
Inform 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?
Bad debt adjustment
What is the initial hospice benefit?
Two 90-day periods and an unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim?
If the patient requires ambulance transportation to a skilled nursing facility
