CRCR CERTIFICATION HFMA CURRENTLY
TESTING MOST EXAM QUESTIONS WILL
COME FROM HERE UPDATED THIS YEAR
/ALREADY GRADED A+
HFMA CRCR EXAM COVERAGE (FULL CONTENT
BREAKDOWN)
The CRCR exam focuses on U.S. healthcare revenue cycle
operations, compliance, and patient financial services. It
evaluates knowledge across the entire patient financial
journey.
A. Revenue Cycle Fundamentals
Healthcare revenue cycle definition and flow
Patient access through accounts receivable
Key performance indicators (KPIs)
Revenue integrity concepts
B. Patient Access & Pre-Service
Scheduling and registration
Eligibility verification (insurance coverage validation)
Prior authorization requirements
Medical necessity checks
, Patient identity management
Point-of-service collections
C. Health Insurance Basics
Commercial insurance structures (HMO, PPO, EPO, POS)
Government programs:
o Medicare (Parts A, B, C, D)
o Medicaid
Coordination of Benefits (COB)
Deductibles, copays, coinsurance
Explanation of Benefits (EOB)
D. Medical Billing & Coding Fundamentals
ICD-10-CM diagnosis coding
CPT/HCPCS procedural coding basics
Modifiers and bundling/unbundling rules
Claim form requirements (CMS-1500, UB-04)
E. Claims Management
Clean claim definition
Claim submission workflows (electronic/manual)
Claim scrubbing
Denials and rejections
Appeal processes
Timely filing limits
,F. Payment Posting & Reconciliation
ERA/EOB interpretation
Payment posting workflows
Adjustments and contractual allowances
Reconciliation of accounts
G. Patient Financial Services
Self-pay management
Financial assistance policies
Charity care screening
Payment plans and collections ethics
H. Compliance & Regulations
HIPAA Privacy and Security Rules
False Claims Act
Stark Law & Anti-Kickback Statute
Fair Debt Collection Practices Act (FDCPA)
No Surprises Act (balance billing rules)
I. Revenue Cycle Performance Improvement
Denial prevention strategies
Root cause analysis
Lean process improvement basics
Key financial metrics (DNFB, AR days, clean claim rate)
, Q1
A registrar enters a patient’s insurance information, but
the eligibility system shows inactive coverage after the
patient has already received non-emergency services.
What is the MOST appropriate next step?
A. Write off the entire encounter
B. Bill insurance anyway without correction
C. Notify patient and initiate self-pay collection process
D. Cancel the claim and do not bill anyone
Answer: C
Rationale: Once eligibility is confirmed inactive post-
service, patient responsibility process must begin; billing
insurance knowingly inactive coverage is incorrect.
Q2
A claim is rejected because the patient’s date of birth does
not match payer records, but all other clinical data is
correct. What type of issue is this MOST accurately
classified as?
A. Clinical denial
B. Administrative rejection
TESTING MOST EXAM QUESTIONS WILL
COME FROM HERE UPDATED THIS YEAR
/ALREADY GRADED A+
HFMA CRCR EXAM COVERAGE (FULL CONTENT
BREAKDOWN)
The CRCR exam focuses on U.S. healthcare revenue cycle
operations, compliance, and patient financial services. It
evaluates knowledge across the entire patient financial
journey.
A. Revenue Cycle Fundamentals
Healthcare revenue cycle definition and flow
Patient access through accounts receivable
Key performance indicators (KPIs)
Revenue integrity concepts
B. Patient Access & Pre-Service
Scheduling and registration
Eligibility verification (insurance coverage validation)
Prior authorization requirements
Medical necessity checks
, Patient identity management
Point-of-service collections
C. Health Insurance Basics
Commercial insurance structures (HMO, PPO, EPO, POS)
Government programs:
o Medicare (Parts A, B, C, D)
o Medicaid
Coordination of Benefits (COB)
Deductibles, copays, coinsurance
Explanation of Benefits (EOB)
D. Medical Billing & Coding Fundamentals
ICD-10-CM diagnosis coding
CPT/HCPCS procedural coding basics
Modifiers and bundling/unbundling rules
Claim form requirements (CMS-1500, UB-04)
E. Claims Management
Clean claim definition
Claim submission workflows (electronic/manual)
Claim scrubbing
Denials and rejections
Appeal processes
Timely filing limits
,F. Payment Posting & Reconciliation
ERA/EOB interpretation
Payment posting workflows
Adjustments and contractual allowances
Reconciliation of accounts
G. Patient Financial Services
Self-pay management
Financial assistance policies
Charity care screening
Payment plans and collections ethics
H. Compliance & Regulations
HIPAA Privacy and Security Rules
False Claims Act
Stark Law & Anti-Kickback Statute
Fair Debt Collection Practices Act (FDCPA)
No Surprises Act (balance billing rules)
I. Revenue Cycle Performance Improvement
Denial prevention strategies
Root cause analysis
Lean process improvement basics
Key financial metrics (DNFB, AR days, clean claim rate)
, Q1
A registrar enters a patient’s insurance information, but
the eligibility system shows inactive coverage after the
patient has already received non-emergency services.
What is the MOST appropriate next step?
A. Write off the entire encounter
B. Bill insurance anyway without correction
C. Notify patient and initiate self-pay collection process
D. Cancel the claim and do not bill anyone
Answer: C
Rationale: Once eligibility is confirmed inactive post-
service, patient responsibility process must begin; billing
insurance knowingly inactive coverage is incorrect.
Q2
A claim is rejected because the patient’s date of birth does
not match payer records, but all other clinical data is
correct. What type of issue is this MOST accurately
classified as?
A. Clinical denial
B. Administrative rejection
