CRCR Certification Exam Questions and
Answers
Question 1
What type of plan allows the subscriber to pay lower premium costs in return for a
higher deductible?
Correct Answer
Consumer directed health plan
Question 2
Across all care settings, if a patient consents to a financial discussion during a medical
encounter to expedite discharge, the HFMA best practice is to:
a) Make sure that the attending staff can answer questions and
assist in obtaining required patient financial data
b) Have a patient responsibilities kit ready for the patient,
containing all of the required registration forms and instructions
c) Support that choice, providing that the discussion does not
interfere with patient care or disrupt patient flow
d) Decline such request as finance discussions can disrupt patient care and patient
flow
Correct Answer
c) Support that choice, providing that the discussion does not interfere with patient
care or disrupt patient flow
Question 3
Local Coverage Determinations (LCD) and National Coverage Determinations (NCD)
are
Medicare established guideline(s) used to determine:
a) Medicare and Medicaid provider eligibility
b) Medicare outpatient reimbursement rates
c) Which diagnoses, signs, or symptoms are reimbursable
d) What Medicare reimburses and what should be referred to Medicaid
Correct Answer
c) Which diagnoses, signs, or symptoms are reimbursable
Page 1 of 92
,Question 4
If the patient cannot agree to payment arrangements, what is the next option?
Correct Answer
Warn the patient that unpaid accounts are placed with collection agencies for
further processing
Question 5
The Affordable Health Care Act legislated the development of Health Insurance
Exchange, where individuals and small businesses can:
Correct Answer
Purchase health benefits plans regardless of insured's health status
Question 6
This concept encompasses all activities required to send a request for payment to a
third-party health plan for payment of benefits
a) Third-party invoicing
b) Account resolution
c) Claims processing
d) Billing
Correct Answer
c) Claims processing
Question 7
Pricing transparency is defined as readily available information on the price of
healthcare
services, that together with other information, help define the value of those services
and
enable consumers to
a) Identify, compare, and choose providers that offer the desired level of value
b) Customize health care with a personally chosen mix of providers
c) Negotiate the cost of health plan premiums
d) Verify the cost of individual clinicians
Correct Answer
a) Identify, compare, and choose providers that offer the desired level of value
Page 2 of 92
,Question 8
Which of the following statements apply to the observation patient type?
Correct Answer
It is used to evaluate the need for an inpatient admission
Question 9
The important message from Medicare IM provides beneficiaries with information
concerning what?
Correct Answer
Right to appeal a discharge decision if patient disagrees with the plan
Question 10
The first thing a health plan does when processing a claim is:
Correct Answer
Check if the patient is a health plan beneficiary and what is the coverage
Question 11
Any healthcare insurance plan that provides or ensures comprehensive health
maintenance and
treatment services for an enrolled group of persons based on a monthly fee is known
as a
a) MSO
b) HMO
c) PPO
d) GPO
Correct Answer
b) HMO
Page 3 of 92
, Question 12
Recognizing that health coverage is complicated and not all patients are able to
navigate this terrain, HFMA best practices specify that
a) A representative of the health plan be included in the patient financial
responsibilities discussion
b) The patient accounts staff have someone assigned to research coverage on behalf
of patients
c) Patients should be given the opportunity to request a patient advocate, family
member or other designee to help them in these discussions
d) Patient coverage education may need to be provided by the health plan
Correct Answer
c) Patients should be given the opportunity to request a patient advocate, family
member or other designee to help them in these discussions
Question 13
In the pre-service stage, the requested service is screened for medical necessity,
health plan coverage and benefits are verified and:
Correct Answer
Pre-authorization are obtained
Question 14
For scheduled payments, important revenue cycle activities in the time-of-service
stage DO Not include:
Correct Answer
Obtaining or updating patient and guarantor information
Question 15
Appropriate training for patient financial counseling staff must cover all of the
following EXCEPT:
Correct Answer
Documenting the conversation in the medical records
Page 4 of 92
Answers
Question 1
What type of plan allows the subscriber to pay lower premium costs in return for a
higher deductible?
Correct Answer
Consumer directed health plan
Question 2
Across all care settings, if a patient consents to a financial discussion during a medical
encounter to expedite discharge, the HFMA best practice is to:
a) Make sure that the attending staff can answer questions and
assist in obtaining required patient financial data
b) Have a patient responsibilities kit ready for the patient,
containing all of the required registration forms and instructions
c) Support that choice, providing that the discussion does not
interfere with patient care or disrupt patient flow
d) Decline such request as finance discussions can disrupt patient care and patient
flow
Correct Answer
c) Support that choice, providing that the discussion does not interfere with patient
care or disrupt patient flow
Question 3
Local Coverage Determinations (LCD) and National Coverage Determinations (NCD)
are
Medicare established guideline(s) used to determine:
a) Medicare and Medicaid provider eligibility
b) Medicare outpatient reimbursement rates
c) Which diagnoses, signs, or symptoms are reimbursable
d) What Medicare reimburses and what should be referred to Medicaid
Correct Answer
c) Which diagnoses, signs, or symptoms are reimbursable
Page 1 of 92
,Question 4
If the patient cannot agree to payment arrangements, what is the next option?
Correct Answer
Warn the patient that unpaid accounts are placed with collection agencies for
further processing
Question 5
The Affordable Health Care Act legislated the development of Health Insurance
Exchange, where individuals and small businesses can:
Correct Answer
Purchase health benefits plans regardless of insured's health status
Question 6
This concept encompasses all activities required to send a request for payment to a
third-party health plan for payment of benefits
a) Third-party invoicing
b) Account resolution
c) Claims processing
d) Billing
Correct Answer
c) Claims processing
Question 7
Pricing transparency is defined as readily available information on the price of
healthcare
services, that together with other information, help define the value of those services
and
enable consumers to
a) Identify, compare, and choose providers that offer the desired level of value
b) Customize health care with a personally chosen mix of providers
c) Negotiate the cost of health plan premiums
d) Verify the cost of individual clinicians
Correct Answer
a) Identify, compare, and choose providers that offer the desired level of value
Page 2 of 92
,Question 8
Which of the following statements apply to the observation patient type?
Correct Answer
It is used to evaluate the need for an inpatient admission
Question 9
The important message from Medicare IM provides beneficiaries with information
concerning what?
Correct Answer
Right to appeal a discharge decision if patient disagrees with the plan
Question 10
The first thing a health plan does when processing a claim is:
Correct Answer
Check if the patient is a health plan beneficiary and what is the coverage
Question 11
Any healthcare insurance plan that provides or ensures comprehensive health
maintenance and
treatment services for an enrolled group of persons based on a monthly fee is known
as a
a) MSO
b) HMO
c) PPO
d) GPO
Correct Answer
b) HMO
Page 3 of 92
, Question 12
Recognizing that health coverage is complicated and not all patients are able to
navigate this terrain, HFMA best practices specify that
a) A representative of the health plan be included in the patient financial
responsibilities discussion
b) The patient accounts staff have someone assigned to research coverage on behalf
of patients
c) Patients should be given the opportunity to request a patient advocate, family
member or other designee to help them in these discussions
d) Patient coverage education may need to be provided by the health plan
Correct Answer
c) Patients should be given the opportunity to request a patient advocate, family
member or other designee to help them in these discussions
Question 13
In the pre-service stage, the requested service is screened for medical necessity,
health plan coverage and benefits are verified and:
Correct Answer
Pre-authorization are obtained
Question 14
For scheduled payments, important revenue cycle activities in the time-of-service
stage DO Not include:
Correct Answer
Obtaining or updating patient and guarantor information
Question 15
Appropriate training for patient financial counseling staff must cover all of the
following EXCEPT:
Correct Answer
Documenting the conversation in the medical records
Page 4 of 92
