1|Page
NEWEST 2025 HFMA CRCR (CERTIFIED REVENUE CYCLE
REPRESENTATIVE) EXAM WITH 200 ACCURATE AND VERIFIED
QUESTIONS COVERING REVENUE CYCLE OPERATIONS, PATIENT
ACCESS, BILLING, COMPLIANCE, AND REIMBURSEMENT.
What Restriction does a managed care plan place on locations that must be used if the plan is to
pay for the service provided? - ANSWER-Site of service limitation
Which of the following statements applies to private rooms? - ANSWER-If the medical necessity
for a private room is documented in the chart. The patients insurance will be billed for the
differential
Which of the following is true about screening a beneficiary of possible MSP(Medicare
secondary payer) situations? - ANSWER-It is necessary to ask the patient each of the MSP
questions
Which of the following is not true of Medicare Advantage Plans? - ANSWER-A patient must have
both Medicare Part A and B benefits to be eligible for a Medicare Advantage plan
Which of the following is a valid reason for a payer to deny a claim? - ANSWER-Failure to
complete authorization
Which of the following statements is NOT a possible consequence of selecting the wrong
patient in the MPI(master patient index) - ANSWER-Claim is paid in full
Which of the following statements is true of a Medicare Advantage Plan? - ANSWER-This plan
supplements Part A and Part B benefits
,2|Page
Which is the following is not a characteristic of Medicaid HMO plan? - ANSWER-Medicaid-
eligible patients are never required to join a Medicaid HMO plan
Which of the following is violation of the EMTALA ? - ANSWER-Registration staff members
routinely contact managed care plans for prior authorizations before the patients is seen by the
on duty physician
Which of the following statements is true of the important message from Medicare notification
requirements? - ANSWER-Notification can be issued no earlier than 7 days before admission
and no more than 2 days before discharge.
What is the self pay balance after insurance - ANSWER-The portion of the adjudicated claim that
is due from the patient
Which of the following options is an alternative to valid long term payment plans - ANSWER-
Bank loans
The patient has the following benefit plan $400 per family member deductible, to a maximum
of $1200 per year and $2000 per family member co insurance, to a family maximum of $6000
per year excluding the deductible . Five family members are enrolled in this benefit plan. What
is the maximum out of pocket expense that that family could incur during the calendar year? -
ANSWER-$6000
What type of plan restricts benefits for non-emergency care to approve providers only? -
ANSWER-A POS (point of service )plan
What does scheduling allow provider staff to do? - ANSWER-Review the appropriateness of the
service requested
,3|Page
When an adult patient is covered by both his own and his spouse health insurance plan, which
of the statements is true? - ANSWER-The patients insurance plan is primary
Mrs. Jones , a Medicare beneficiary was admitted to the hospital on June 20,2010. As of the
admission date, she had only used 8 inpatient days in the current benefit period. If she is not
discharge on what date will Mr jones exhaust her full coverage days. - ANSWER-August 9, 2010
In order to meet eligibility guidelines for healthcare benefits, Medicaid beneficiaries must fall
into a specified need category and meet what other types of requirements - ANSWER-Income
and assets
Fee for service plans pay claims based on a percentage of charges. How are patients out of
pocket cost calculated? - ANSWER-They are calculated quarterly
Indemnity plans usually reimburse what? - ANSWER-A certain percentage of charges after
patient meets policy's annual deductible.
Departments that need to be included in Charge master maintenance include all EXCEPT -
ANSWER-Quality Assurance
Using HIPPA standardized transaction sets allow providers to: - ANSWER-Submit a standardized
transaction to any of the health plans with which it conducts business.
Which of the following is NOT included in the standardized quality measures? - ANSWER-Cost of
services
The ACO investment model will test the use of pre-paid shared savings to: - ANSWER-Encourage
new ACOs to form in rural and underserved areas.
, 4|Page
Any healthcare insurance plan that provides or ensures comprehensive health maintenance and
treatment services for an enrolled group of persons on a monthly fee is known as: - ANSWER-
HMO
Ambulance services are billed directly to the health plan for: - ANSWER-Services provided
before a patient is admitted and for ambulance rides arranged to pick up the patient from the
hospital after discharge to take him/her home or to another facility.
Any provider that has filed a timely cost report may appeal in an adverse final decision received
from the Medicare Administrative Contractor (MAC), the appeal may be filed with: - ANSWER-
The Provider Reimbursement Review Board.
For scheduled payments, important revenue cycle activities in the time-of-service stage DO Not
include: - ANSWER-Obtaining or updating patient and guarantor information
Hospital can only convert an inpatient case to observation if: - ANSWER-The hospital utilization
review committee determines before the patient is discharged and prior to billing that an
observation setting would be more appropriate.
Hospital need which of the following information sets to assess a patient's financial status? -
ANSWER-Demographic, Income, Assets and Expenses.
HIPAA privacy rules require covered entities to take all, of the following actions EXCEPT: -
ANSWER-Use only designated software platforms to secure patient date.
When Recovery Audit Contractors (RAC) identify improper payments as overpayment. the
claims processing contractor must: - ANSWER-Send a demand letter to the provider to recover
the over payment amount.
NEWEST 2025 HFMA CRCR (CERTIFIED REVENUE CYCLE
REPRESENTATIVE) EXAM WITH 200 ACCURATE AND VERIFIED
QUESTIONS COVERING REVENUE CYCLE OPERATIONS, PATIENT
ACCESS, BILLING, COMPLIANCE, AND REIMBURSEMENT.
What Restriction does a managed care plan place on locations that must be used if the plan is to
pay for the service provided? - ANSWER-Site of service limitation
Which of the following statements applies to private rooms? - ANSWER-If the medical necessity
for a private room is documented in the chart. The patients insurance will be billed for the
differential
Which of the following is true about screening a beneficiary of possible MSP(Medicare
secondary payer) situations? - ANSWER-It is necessary to ask the patient each of the MSP
questions
Which of the following is not true of Medicare Advantage Plans? - ANSWER-A patient must have
both Medicare Part A and B benefits to be eligible for a Medicare Advantage plan
Which of the following is a valid reason for a payer to deny a claim? - ANSWER-Failure to
complete authorization
Which of the following statements is NOT a possible consequence of selecting the wrong
patient in the MPI(master patient index) - ANSWER-Claim is paid in full
Which of the following statements is true of a Medicare Advantage Plan? - ANSWER-This plan
supplements Part A and Part B benefits
,2|Page
Which is the following is not a characteristic of Medicaid HMO plan? - ANSWER-Medicaid-
eligible patients are never required to join a Medicaid HMO plan
Which of the following is violation of the EMTALA ? - ANSWER-Registration staff members
routinely contact managed care plans for prior authorizations before the patients is seen by the
on duty physician
Which of the following statements is true of the important message from Medicare notification
requirements? - ANSWER-Notification can be issued no earlier than 7 days before admission
and no more than 2 days before discharge.
What is the self pay balance after insurance - ANSWER-The portion of the adjudicated claim that
is due from the patient
Which of the following options is an alternative to valid long term payment plans - ANSWER-
Bank loans
The patient has the following benefit plan $400 per family member deductible, to a maximum
of $1200 per year and $2000 per family member co insurance, to a family maximum of $6000
per year excluding the deductible . Five family members are enrolled in this benefit plan. What
is the maximum out of pocket expense that that family could incur during the calendar year? -
ANSWER-$6000
What type of plan restricts benefits for non-emergency care to approve providers only? -
ANSWER-A POS (point of service )plan
What does scheduling allow provider staff to do? - ANSWER-Review the appropriateness of the
service requested
,3|Page
When an adult patient is covered by both his own and his spouse health insurance plan, which
of the statements is true? - ANSWER-The patients insurance plan is primary
Mrs. Jones , a Medicare beneficiary was admitted to the hospital on June 20,2010. As of the
admission date, she had only used 8 inpatient days in the current benefit period. If she is not
discharge on what date will Mr jones exhaust her full coverage days. - ANSWER-August 9, 2010
In order to meet eligibility guidelines for healthcare benefits, Medicaid beneficiaries must fall
into a specified need category and meet what other types of requirements - ANSWER-Income
and assets
Fee for service plans pay claims based on a percentage of charges. How are patients out of
pocket cost calculated? - ANSWER-They are calculated quarterly
Indemnity plans usually reimburse what? - ANSWER-A certain percentage of charges after
patient meets policy's annual deductible.
Departments that need to be included in Charge master maintenance include all EXCEPT -
ANSWER-Quality Assurance
Using HIPPA standardized transaction sets allow providers to: - ANSWER-Submit a standardized
transaction to any of the health plans with which it conducts business.
Which of the following is NOT included in the standardized quality measures? - ANSWER-Cost of
services
The ACO investment model will test the use of pre-paid shared savings to: - ANSWER-Encourage
new ACOs to form in rural and underserved areas.
, 4|Page
Any healthcare insurance plan that provides or ensures comprehensive health maintenance and
treatment services for an enrolled group of persons on a monthly fee is known as: - ANSWER-
HMO
Ambulance services are billed directly to the health plan for: - ANSWER-Services provided
before a patient is admitted and for ambulance rides arranged to pick up the patient from the
hospital after discharge to take him/her home or to another facility.
Any provider that has filed a timely cost report may appeal in an adverse final decision received
from the Medicare Administrative Contractor (MAC), the appeal may be filed with: - ANSWER-
The Provider Reimbursement Review Board.
For scheduled payments, important revenue cycle activities in the time-of-service stage DO Not
include: - ANSWER-Obtaining or updating patient and guarantor information
Hospital can only convert an inpatient case to observation if: - ANSWER-The hospital utilization
review committee determines before the patient is discharged and prior to billing that an
observation setting would be more appropriate.
Hospital need which of the following information sets to assess a patient's financial status? -
ANSWER-Demographic, Income, Assets and Expenses.
HIPAA privacy rules require covered entities to take all, of the following actions EXCEPT: -
ANSWER-Use only designated software platforms to secure patient date.
When Recovery Audit Contractors (RAC) identify improper payments as overpayment. the
claims processing contractor must: - ANSWER-Send a demand letter to the provider to recover
the over payment amount.
