REVENUE CYCLE MANAGEMENT
PRACTICE TEST (2026/2027
UPDATES) QUESTIONS AND
ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Section 1: Patient Access & Registration (Questions 1–10)
1. Which of the following is the MOST critical step in preventing claim denials
related to patient identity?
a) Collecting copayment at check-in
b) Verifying insurance eligibility and benefits prior to service
c) Scanning the patient’s driver’s license
d) Obtaining a credit card on file
Rationale: Eligibility verification ensures the patient’s insurance is active and covers
the planned service, directly preventing denials.
2. Under the 2026 CMS price transparency final rule, hospitals must:
a) Post chargemaster prices only
b) Provide machine-readable files with payer-specific negotiated rates and a
consumer-friendly shoppable services display
c) Mail price estimates within 30 days of discharge
d) Only disclose prices if the patient asks in writing
Rationale: The rule requires both machine-readable files and a consumer-friendly
display of 300 shoppable services.
,3. A patient presents for an emergency visit but is unconscious. What is the
appropriate registration action?
a) Refuse treatment until a guardian arrives
b) Treat under EMTALA, then perform retrospective eligibility verification
c) Transfer to a different hospital
d) Bill the patient’s next of kin immediately
Rationale: EMTALA mandates stabilizing treatment regardless of ability to pay;
registration occurs after.
4. Which patient data element is MOST likely to cause a clean claim rejection if
incorrect?
a) Preferred pharmacy
b) Health insurance claim number (HICN) or member ID
c) Patient’s email address
d) Employer name
Rationale: An incorrect member ID leads to payer rejection before medical review.
5. The process of estimating a patient’s out-of-pocket cost before service is
called:
a) Precertification
b) Price estimation or patient financial clearance
c) Retrospective audit
d) Claims scrubbing
Rationale: Price estimation tools combine benefit data and contracted rates to
inform patients.
6. A patient has two active insurances. How is coordination of benefits (COB)
determined for a dependent child?
a) Always father’s plan first
b) Birthday rule – plan of parent whose birthday occurs first in calendar year
c) Whichever plan was purchased more recently
d) Patient chooses primary
Rationale: The birthday rule is standard for dependents unless court order states
otherwise.
7. Which action is NOT allowed during patient registration under the No
Surprises Act?
a) Asking for insurance card
b) Requiring a waiver of surprise billing protections as a condition of treatment
c) Providing a good faith estimate
d) Collecting previous balance
, Rationale: Providers cannot force patients to waive balance billing protections for
emergencies or certain non-emergencies.
8. Demographic error rate in RCM is best reduced by:
a) Relying on patient recall
b) Real-time eligibility and address verification using third-party tools
c) Manual entry only
d) Billing first, verifying later
Rationale: Automated verification reduces human error and improves first-pass
yield.
9. A Medicare patient asks for an Advance Beneficiary Notice (ABN). When is it
correctly used?
a) For all routine annual physicals
b) When the provider believes Medicare will likely deny a specific service for
lack of medical necessity
c) Only for inpatient stays
d) For every lab test ordered
Rationale: ABN shifts liability to patient if Medicare denies; used only when denial is
reasonably expected.
10. Which registration document is required for HIPAA compliance?
a) Financial responsibility waiver
b) Notice of Privacy Practices (NPP) acknowledgment
c) Living will
d) Power of attorney
Rationale: Patients must acknowledge receipt of NPP; this is a HIPAA requirement.
Section 2: Medical Coding & Charge Capture (Questions 11–25)
11. What is the correct ICD-11 coding convention for a “code also” instruction?
a) List the manifestation first
b) The two codes must be reported together, with the underlying disease listed
first
c) Never code both conditions
d) Only code the secondary condition
Rationale: “Code also” requires both codes; primary is the underlying etiology.
PRACTICE TEST (2026/2027
UPDATES) QUESTIONS AND
ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Section 1: Patient Access & Registration (Questions 1–10)
1. Which of the following is the MOST critical step in preventing claim denials
related to patient identity?
a) Collecting copayment at check-in
b) Verifying insurance eligibility and benefits prior to service
c) Scanning the patient’s driver’s license
d) Obtaining a credit card on file
Rationale: Eligibility verification ensures the patient’s insurance is active and covers
the planned service, directly preventing denials.
2. Under the 2026 CMS price transparency final rule, hospitals must:
a) Post chargemaster prices only
b) Provide machine-readable files with payer-specific negotiated rates and a
consumer-friendly shoppable services display
c) Mail price estimates within 30 days of discharge
d) Only disclose prices if the patient asks in writing
Rationale: The rule requires both machine-readable files and a consumer-friendly
display of 300 shoppable services.
,3. A patient presents for an emergency visit but is unconscious. What is the
appropriate registration action?
a) Refuse treatment until a guardian arrives
b) Treat under EMTALA, then perform retrospective eligibility verification
c) Transfer to a different hospital
d) Bill the patient’s next of kin immediately
Rationale: EMTALA mandates stabilizing treatment regardless of ability to pay;
registration occurs after.
4. Which patient data element is MOST likely to cause a clean claim rejection if
incorrect?
a) Preferred pharmacy
b) Health insurance claim number (HICN) or member ID
c) Patient’s email address
d) Employer name
Rationale: An incorrect member ID leads to payer rejection before medical review.
5. The process of estimating a patient’s out-of-pocket cost before service is
called:
a) Precertification
b) Price estimation or patient financial clearance
c) Retrospective audit
d) Claims scrubbing
Rationale: Price estimation tools combine benefit data and contracted rates to
inform patients.
6. A patient has two active insurances. How is coordination of benefits (COB)
determined for a dependent child?
a) Always father’s plan first
b) Birthday rule – plan of parent whose birthday occurs first in calendar year
c) Whichever plan was purchased more recently
d) Patient chooses primary
Rationale: The birthday rule is standard for dependents unless court order states
otherwise.
7. Which action is NOT allowed during patient registration under the No
Surprises Act?
a) Asking for insurance card
b) Requiring a waiver of surprise billing protections as a condition of treatment
c) Providing a good faith estimate
d) Collecting previous balance
, Rationale: Providers cannot force patients to waive balance billing protections for
emergencies or certain non-emergencies.
8. Demographic error rate in RCM is best reduced by:
a) Relying on patient recall
b) Real-time eligibility and address verification using third-party tools
c) Manual entry only
d) Billing first, verifying later
Rationale: Automated verification reduces human error and improves first-pass
yield.
9. A Medicare patient asks for an Advance Beneficiary Notice (ABN). When is it
correctly used?
a) For all routine annual physicals
b) When the provider believes Medicare will likely deny a specific service for
lack of medical necessity
c) Only for inpatient stays
d) For every lab test ordered
Rationale: ABN shifts liability to patient if Medicare denies; used only when denial is
reasonably expected.
10. Which registration document is required for HIPAA compliance?
a) Financial responsibility waiver
b) Notice of Privacy Practices (NPP) acknowledgment
c) Living will
d) Power of attorney
Rationale: Patients must acknowledge receipt of NPP; this is a HIPAA requirement.
Section 2: Medical Coding & Charge Capture (Questions 11–25)
11. What is the correct ICD-11 coding convention for a “code also” instruction?
a) List the manifestation first
b) The two codes must be reported together, with the underlying disease listed
first
c) Never code both conditions
d) Only code the secondary condition
Rationale: “Code also” requires both codes; primary is the underlying etiology.
