HFMA CRCR Exam – Certified Revenue Cycle Representative
Study Guide (2025) with Practice Questions and Key Concepts
What results from a denied claim? - CORRECT -🅰️
🅰️☑️
☑️The provider incurs rework and
appeal costs
Why does the financial counselor need pricing for services? - CORRECT -🅰️
🅰️☑️
☑️To
calculate the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - CORRECT -
🅰️🅰️ ☑️ ☑️ Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? - CORRECT -🅰️
🅰️☑️
☑A
️ppeal
conditions specified in the individual payer's contract
What are collection agency fees based on? - CORRECT -🅰️
🅰️☑️
☑A
️percentage of dollars
collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what
other rule? - CORRECT -🅰️ 🅰️ ☑️ ☑️ Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated between
the payer and some or all providers? - CORRECT -🅰️🅰️ ☑️ ☑️ Case rates
What customer service improvements might improve the patient accounts department? -
CORRECT -🅰️ 🅰️ ☑️ ☑️ Holding staff accountable for customer service during performance
reviews
,What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - CORRECT -
🅰️🅰️ ☑️ ☑️ Inform a Medicare beneficiary that Medicare may not pay for the order or service
What type of account adjustment results from the patient's unwillingness to pay for a self-pay
balance? - CORRECT -🅰️ 🅰️ ☑️☑️ Bad debt adjustment
What is the initial hospice benefit? - CORRECT -🅰️
🅰️☑️
☑T️
wo 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - CORRECT -
🅰️🅰️☑️ ☑️ If the patient requires ambulance transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account is billed? - CORRECT
-🅰️🅰️ ☑️☑️ Post a late-charge adjustment to the account
an increase in the dollars aged greater than 90 days from date of service indicate what about
accounts - CORRECT -🅰️ 🅰️ ☑️ ☑T️ hey are not being processed in a timely manner
What is an advantage of a preregistration program? - CORRECT -🅰️
🅰️☑️
☑I️
t reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? - CORRECT -
🅰️🅰️ ☑️ ☑️ Medically unnecessary services and custodial care
What core financial activities are resolved within patient access? - CORRECT -
🅰️ 🅰️ ☑️ ☑️ Scheduling, insurance verification, discharge processing, and payment of point-of-
service receipts
What statement applies to the scheduled outpatient? - CORRECT -🅰️
🅰️☑️
☑️The services do
not involve an overnight stay
,How is a mis-posted contractual allowance resolved? - CORRECT -🅰️ 🅰️ ☑️ ☑️ Comparing the
contract reimbursement rates with the contract on the admittance advice to identify the correct
amount
What type of patient status is used to evaluate the patient's need for inpatient care? - CORRECT
-🅰️
🅰️ ☑️ ☑️ Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - CORRECT -🅰️ 🅰️ ☑️ ☑M ️edically necessary inpatient hospital
services for at least 3 consecutive days before the skilled nursing care admission
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - CORRECT -
🅰️🅰️☑️ ☑️ When the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - CORRECT -🅰️
🅰️ ☑️☑️ Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what is the
status of the subscriber's spouse? - CORRECT -🅰️ 🅰️ ☑️☑N ️either enrolled not entitled to
benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act,
establishes what? - CORRECT -🅰️ 🅰️ ☑️☑D ️isclosure rules for consumer credit sales and
consumer loans
What is a principal diagnosis? - CORRECT -🅰️
🅰️☑️
☑️Primary reason for the patient's
admission
, Collecting patient liability dollars after service leads to what? - CORRECT -🅰️
🅰️☑️
☑️Lower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - CORRECT -
🅰️🅰️ ☑️ ☑️ 50% of the current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as
an RHC services? - CORRECT -🅰️ 🅰️ ☑️ ☑️ Inpatient care
What code indicates the disposition of the patient at the conclusion of service? - CORRECT -
🅰️🅰️ ☑️ ☑️ Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - CORRECT -
🅰️🅰️ ☑️ ☑️ They result in lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient and the third
party payer, who is responsible for payment? - CORRECT -🅰️🅰️☑️ ☑️ Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: - CORRECT -🅰️ 🅰️ ☑️ ☑️ A valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are expanding to
allow patients to do what? - CORRECT -🅰️ 🅰️ ☑️ ☑A ️ccess their information and perform
functions on-line
What date is required on all CMS 1500 claim forms? - CORRECT -🅰️
🅰️☑️
☑o
️nset date of
current illness
What does scheduling allow provider staff to do - CORRECT -🅰️
🅰️☑️
☑R
️eview
appropriateness of the service request
Study Guide (2025) with Practice Questions and Key Concepts
What results from a denied claim? - CORRECT -🅰️
🅰️☑️
☑️The provider incurs rework and
appeal costs
Why does the financial counselor need pricing for services? - CORRECT -🅰️
🅰️☑️
☑️To
calculate the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form - CORRECT -
🅰️🅰️ ☑️ ☑️ Hospital-based mammography centers
How are disputes with nongovernmental payers resolved? - CORRECT -🅰️
🅰️☑️
☑A
️ppeal
conditions specified in the individual payer's contract
What are collection agency fees based on? - CORRECT -🅰️
🅰️☑️
☑A
️percentage of dollars
collected
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what
other rule? - CORRECT -🅰️ 🅰️ ☑️ ☑️ Birthday
In what type of payment methodology is a lump sum or bundled payment negotiated between
the payer and some or all providers? - CORRECT -🅰️🅰️ ☑️ ☑️ Case rates
What customer service improvements might improve the patient accounts department? -
CORRECT -🅰️ 🅰️ ☑️ ☑️ Holding staff accountable for customer service during performance
reviews
,What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do? - CORRECT -
🅰️🅰️ ☑️ ☑️ Inform a Medicare beneficiary that Medicare may not pay for the order or service
What type of account adjustment results from the patient's unwillingness to pay for a self-pay
balance? - CORRECT -🅰️ 🅰️ ☑️☑️ Bad debt adjustment
What is the initial hospice benefit? - CORRECT -🅰️
🅰️☑️
☑T️
wo 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim? - CORRECT -
🅰️🅰️☑️ ☑️ If the patient requires ambulance transportation to a skilled nursing facility
How should a provider resolve a late-charge credit posted after an account is billed? - CORRECT
-🅰️🅰️ ☑️☑️ Post a late-charge adjustment to the account
an increase in the dollars aged greater than 90 days from date of service indicate what about
accounts - CORRECT -🅰️ 🅰️ ☑️ ☑T️ hey are not being processed in a timely manner
What is an advantage of a preregistration program? - CORRECT -🅰️
🅰️☑️
☑I️
t reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? - CORRECT -
🅰️🅰️ ☑️ ☑️ Medically unnecessary services and custodial care
What core financial activities are resolved within patient access? - CORRECT -
🅰️ 🅰️ ☑️ ☑️ Scheduling, insurance verification, discharge processing, and payment of point-of-
service receipts
What statement applies to the scheduled outpatient? - CORRECT -🅰️
🅰️☑️
☑️The services do
not involve an overnight stay
,How is a mis-posted contractual allowance resolved? - CORRECT -🅰️ 🅰️ ☑️ ☑️ Comparing the
contract reimbursement rates with the contract on the admittance advice to identify the correct
amount
What type of patient status is used to evaluate the patient's need for inpatient care? - CORRECT
-🅰️
🅰️ ☑️ ☑️ Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - CORRECT -🅰️ 🅰️ ☑️ ☑M ️edically necessary inpatient hospital
services for at least 3 consecutive days before the skilled nursing care admission
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$? - CORRECT -
🅰️🅰️☑️ ☑️ When the patient is the insured
What are non-emergency patients who come for service without prior notification to the
provider called? - CORRECT -🅰️
🅰️ ☑️☑️ Unscheduled patients
If the insurance verification response reports that a subscriber has a single policy, what is the
status of the subscriber's spouse? - CORRECT -🅰️ 🅰️ ☑️☑N ️either enrolled not entitled to
benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth in Lending Act,
establishes what? - CORRECT -🅰️ 🅰️ ☑️☑D ️isclosure rules for consumer credit sales and
consumer loans
What is a principal diagnosis? - CORRECT -🅰️
🅰️☑️
☑️Primary reason for the patient's
admission
, Collecting patient liability dollars after service leads to what? - CORRECT -🅰️
🅰️☑️
☑️Lower
accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day used? - CORRECT -
🅰️🅰️ ☑️ ☑️ 50% of the current deductible amount
What service provided to a Medicare beneficiary in a rural health clinic (RHC) is not billable as
an RHC services? - CORRECT -🅰️ 🅰️ ☑️ ☑️ Inpatient care
What code indicates the disposition of the patient at the conclusion of service? - CORRECT -
🅰️🅰️ ☑️ ☑️ Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts? - CORRECT -
🅰️🅰️ ☑️ ☑️ They result in lost reimbursement and additional cost to collect
When an undue delay of payment results from a dispute between the patient and the third
party payer, who is responsible for payment? - CORRECT -🅰️🅰️☑️ ☑️ Patient
Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information
provided on the order must include: - CORRECT -🅰️ 🅰️ ☑️ ☑️ A valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle processes are expanding to
allow patients to do what? - CORRECT -🅰️ 🅰️ ☑️ ☑A ️ccess their information and perform
functions on-line
What date is required on all CMS 1500 claim forms? - CORRECT -🅰️
🅰️☑️
☑o
️nset date of
current illness
What does scheduling allow provider staff to do - CORRECT -🅰️
🅰️☑️
☑R
️eview
appropriateness of the service request
