1
HFMA CRCR Exam Prep 2025/2026 | 180+ Practice
Questions & Answers | Expert Verified A+ Study Guide |
Guarantee Pass
1.
A hospital’s revenue integrity team discovers a consistent pattern of underbilling
due to missed charge capture. Which of the following is the best first step to
address this issue?
A. Hire additional coding staff
B. Conduct a root cause analysis of the missed charges
C. Increase prices to offset the lost revenue
D. Notify the payer of potential claim changes
Answer: B
Rationale: A root cause analysis identifies the underlying reasons for missed
, 2
charge capture (e.g., workflow gaps, staff training, technology issues). Without
addressing the cause, other measures would be ineffective or unsustainable.
2.
In the revenue cycle, “clean claim rate” refers to:
A. The percentage of claims paid without denials or rework
B. The number of claims submitted within 24 hours of discharge
C. The percentage of claims audited internally
D. The total charges billed to insurance payers
Answer: A
Rationale: Clean claim rate measures claims accepted and processed by payers
without additional information requests or rework, directly impacting cash flow.
3.
Which patient access function most directly impacts point-of-service collections?
A. Pre-authorization verification
B. Scheduling
C. Eligibility verification
D. Price estimation
, 3
Answer: D
Rationale: Accurate price estimation enables upfront discussions about costs,
increasing the likelihood of point-of-service payment and reducing bad debt.
4.
A hospital receives a Recovery Audit Contractor (RAC) letter requesting records
for a suspected overpayment. What is the most appropriate response?
A. Ignore the request until a follow-up letter arrives
B. Send only partial documentation to protect patient data
C. Submit all requested records within the stated timeline
D. Refund the amount immediately without review
Answer: C
Rationale: The provider must comply with RAC requests by submitting the
complete documentation on time to support the original claim and avoid automatic
recoupment.
5.
, 4
Which KPI best measures how quickly an organization turns charges into cash?
A. Days in Accounts Receivable (AR)
B. Net Revenue per Adjusted Discharge
C. Collection Rate
D. Bad Debt Percentage
Answer: A
Rationale: Days in AR measures the average number of days it takes to collect
payment after a service is provided, indicating revenue cycle efficiency.
6.
The No Surprises Act primarily protects patients from:
A. Higher copayments for preventive services
B. Surprise medical bills from out-of-network providers at in-network facilities
C. Increases in health insurance premiums
D. Automatic claim denials for non-covered services
Answer: B
Rationale: The No Surprises Act prevents patients from receiving unexpected bills
for emergency services or certain non-emergency services at in-network facilities
when provided by out-of-network clinicians.
HFMA CRCR Exam Prep 2025/2026 | 180+ Practice
Questions & Answers | Expert Verified A+ Study Guide |
Guarantee Pass
1.
A hospital’s revenue integrity team discovers a consistent pattern of underbilling
due to missed charge capture. Which of the following is the best first step to
address this issue?
A. Hire additional coding staff
B. Conduct a root cause analysis of the missed charges
C. Increase prices to offset the lost revenue
D. Notify the payer of potential claim changes
Answer: B
Rationale: A root cause analysis identifies the underlying reasons for missed
, 2
charge capture (e.g., workflow gaps, staff training, technology issues). Without
addressing the cause, other measures would be ineffective or unsustainable.
2.
In the revenue cycle, “clean claim rate” refers to:
A. The percentage of claims paid without denials or rework
B. The number of claims submitted within 24 hours of discharge
C. The percentage of claims audited internally
D. The total charges billed to insurance payers
Answer: A
Rationale: Clean claim rate measures claims accepted and processed by payers
without additional information requests or rework, directly impacting cash flow.
3.
Which patient access function most directly impacts point-of-service collections?
A. Pre-authorization verification
B. Scheduling
C. Eligibility verification
D. Price estimation
, 3
Answer: D
Rationale: Accurate price estimation enables upfront discussions about costs,
increasing the likelihood of point-of-service payment and reducing bad debt.
4.
A hospital receives a Recovery Audit Contractor (RAC) letter requesting records
for a suspected overpayment. What is the most appropriate response?
A. Ignore the request until a follow-up letter arrives
B. Send only partial documentation to protect patient data
C. Submit all requested records within the stated timeline
D. Refund the amount immediately without review
Answer: C
Rationale: The provider must comply with RAC requests by submitting the
complete documentation on time to support the original claim and avoid automatic
recoupment.
5.
, 4
Which KPI best measures how quickly an organization turns charges into cash?
A. Days in Accounts Receivable (AR)
B. Net Revenue per Adjusted Discharge
C. Collection Rate
D. Bad Debt Percentage
Answer: A
Rationale: Days in AR measures the average number of days it takes to collect
payment after a service is provided, indicating revenue cycle efficiency.
6.
The No Surprises Act primarily protects patients from:
A. Higher copayments for preventive services
B. Surprise medical bills from out-of-network providers at in-network facilities
C. Increases in health insurance premiums
D. Automatic claim denials for non-covered services
Answer: B
Rationale: The No Surprises Act prevents patients from receiving unexpected bills
for emergency services or certain non-emergency services at in-network facilities
when provided by out-of-network clinicians.
