HFMA Certified Revenue Cycle Representative Final
Exam: 200+ Practice Questions & Answers with
Detailed Rationales
The Certified Revenue Cycle Representative (CRCR) credential from the Healthcare
Financial Management Association (HFMA) is the only national certification that validates
expertise in the contemporary, patient-centric revenue cycle . Earning the CRCR
demonstrates a high level of current healthcare revenue cycle knowledge and helps set
performance standards for revenue cycle staff .
The CRCR program is divided into four core units :
Unit Title Focus Areas
Unit Revenue Cycle in Overview of revenue cycle, KPIs, regulatory
1 Health Care environment
Unit Pre-Service – Scheduling, pre-registration, insurance verification,
2 Financial Care medical necessity, financial assistance
Unit Time of Service – Patient identification, point-of-service collections,
3 Financial Care financial discussions
Unit Post-Service – Claims processing, denials management, appeals,
4 Financial Care payment posting, bad debt
, Unit 1: Revenue Cycle in Health Care
1. Through what document does a hospital establish compliance standards?
A) Employee handbook
B) Code of conduct
C) Billing manual
D) Mission statement
Answer: B) Code of conduct
Rationale: The code of conduct establishes organizational ethics and compliance
expectations, articulating the principles and standards by which the organization operates .
2. What is the primary purpose of a Corporate Compliance Program in a healthcare
organization?
A) To enhance marketing strategies
B) To increase patient volume
C) To ensure adherence to laws and regulations and prevent/detect fraudulent behavior
D) To reduce operational costs
Answer: C) To ensure adherence to laws and regulations and prevent/detect
fraudulent behavior
Rationale: Compliance programs help ensure strict compliance with all required laws and
regulations and help prevent and detect fraudulent behavior .
,3. What is the purpose of the OIG Work Plan?
A) To calculate Medicare reimbursement rates
B) To identify acceptable compliance programs in various provider settings
C) To approve new healthcare facilities
D) To certify revenue cycle staff
Answer: B) To identify acceptable compliance programs in various provider settings
Rationale: The OIG publishes an annual work plan identifying compliance focus areas for
different provider types .
4. Business ethics or organizational ethics represent:
A) Regulations that must be followed by law
B) The principles and standards by which organizations operate
C) Definitions of appropriate customer service
D) The code of acceptable conduct for employees only
Answer: B) The principles and standards by which organizations operate
Rationale: Business ethics guide organizational behavior beyond legal requirements and
represent the core principles of operation .
5. The soft cost of a dissatisfied customer is:
A) The cost of refunding their payment
B) The customer passing on information about negative experiences to potential patients via
word-of-mouth or social media
C) The cost of reprocessing their claim
D) The loss of their insurance contract
Answer: B) The customer passing on information about negative experiences to
potential patients or through social media channels
, Rationale: Negative word-of-mouth and social media posts can damage organizational
reputation and deter future patients .
6. What is the primary goal of an Accountable Care Organization (ACO) in relation to
patient care?
A) To provide financial incentives to physicians for reporting quality data
B) To eliminate duplicate services and ensure patient satisfaction
C) To ensure appropriateness of care, eliminate duplicate services, and prevent medical
errors for an identified group of patients
D) To create cost-containment provisions to reform healthcare delivery
Answer: C) To ensure appropriateness of care, eliminate duplicate services, and
prevent medical errors for an identified group of patients
Rationale: The ACO model focuses on care coordination, reducing duplication of services,
and improving patient safety for an attributed patient population .
7. The Affordable Care Act legislated the development of Health Insurance
Exchanges, where individuals and small businesses can:
A) Negotiate provider rates
B) Purchase qualified health benefit plans regardless of the insured's health status
C) Obtain free healthcare
D) Bypass insurance requirements
Answer: B) Purchase qualified health benefit plans regardless of the insured's health
status
Exam: 200+ Practice Questions & Answers with
Detailed Rationales
The Certified Revenue Cycle Representative (CRCR) credential from the Healthcare
Financial Management Association (HFMA) is the only national certification that validates
expertise in the contemporary, patient-centric revenue cycle . Earning the CRCR
demonstrates a high level of current healthcare revenue cycle knowledge and helps set
performance standards for revenue cycle staff .
The CRCR program is divided into four core units :
Unit Title Focus Areas
Unit Revenue Cycle in Overview of revenue cycle, KPIs, regulatory
1 Health Care environment
Unit Pre-Service – Scheduling, pre-registration, insurance verification,
2 Financial Care medical necessity, financial assistance
Unit Time of Service – Patient identification, point-of-service collections,
3 Financial Care financial discussions
Unit Post-Service – Claims processing, denials management, appeals,
4 Financial Care payment posting, bad debt
, Unit 1: Revenue Cycle in Health Care
1. Through what document does a hospital establish compliance standards?
A) Employee handbook
B) Code of conduct
C) Billing manual
D) Mission statement
Answer: B) Code of conduct
Rationale: The code of conduct establishes organizational ethics and compliance
expectations, articulating the principles and standards by which the organization operates .
2. What is the primary purpose of a Corporate Compliance Program in a healthcare
organization?
A) To enhance marketing strategies
B) To increase patient volume
C) To ensure adherence to laws and regulations and prevent/detect fraudulent behavior
D) To reduce operational costs
Answer: C) To ensure adherence to laws and regulations and prevent/detect
fraudulent behavior
Rationale: Compliance programs help ensure strict compliance with all required laws and
regulations and help prevent and detect fraudulent behavior .
,3. What is the purpose of the OIG Work Plan?
A) To calculate Medicare reimbursement rates
B) To identify acceptable compliance programs in various provider settings
C) To approve new healthcare facilities
D) To certify revenue cycle staff
Answer: B) To identify acceptable compliance programs in various provider settings
Rationale: The OIG publishes an annual work plan identifying compliance focus areas for
different provider types .
4. Business ethics or organizational ethics represent:
A) Regulations that must be followed by law
B) The principles and standards by which organizations operate
C) Definitions of appropriate customer service
D) The code of acceptable conduct for employees only
Answer: B) The principles and standards by which organizations operate
Rationale: Business ethics guide organizational behavior beyond legal requirements and
represent the core principles of operation .
5. The soft cost of a dissatisfied customer is:
A) The cost of refunding their payment
B) The customer passing on information about negative experiences to potential patients via
word-of-mouth or social media
C) The cost of reprocessing their claim
D) The loss of their insurance contract
Answer: B) The customer passing on information about negative experiences to
potential patients or through social media channels
, Rationale: Negative word-of-mouth and social media posts can damage organizational
reputation and deter future patients .
6. What is the primary goal of an Accountable Care Organization (ACO) in relation to
patient care?
A) To provide financial incentives to physicians for reporting quality data
B) To eliminate duplicate services and ensure patient satisfaction
C) To ensure appropriateness of care, eliminate duplicate services, and prevent medical
errors for an identified group of patients
D) To create cost-containment provisions to reform healthcare delivery
Answer: C) To ensure appropriateness of care, eliminate duplicate services, and
prevent medical errors for an identified group of patients
Rationale: The ACO model focuses on care coordination, reducing duplication of services,
and improving patient safety for an attributed patient population .
7. The Affordable Care Act legislated the development of Health Insurance
Exchanges, where individuals and small businesses can:
A) Negotiate provider rates
B) Purchase qualified health benefit plans regardless of the insured's health status
C) Obtain free healthcare
D) Bypass insurance requirements
Answer: B) Purchase qualified health benefit plans regardless of the insured's health
status
