1|Page
CRCR ACTUAL EXAM TESTBANK 2026
ALL QUESTIONS AND CORRECT
DETAILED ANSWERS ALREADY A
GRADED WITH EXPERT FEEDBACK |
NEW AND REVISED
What type of patient status is used to evaluate the patient's need for
inpatient care? - ANSWER- Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care
require that the beneficiary has received what? - ANSWER- Medically
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$? - ANSWER- When the patient is the insured
What are non-emergency patients who come for service without prior
notification to the provider called? - ANSWER- Unscheduled patients
If the insurance verification response reports that a subscriber has a
single policy, what is the status of the subscriber's spouse? - ANSWER-
Neither enrolled not entitled to benefits
,2|Page
Regulation Z of the Consumer Credit Protection Act, also known as the
Truth in Lending Act, establishes what? - ANSWER- Disclosure rules
for consumer credit sales and consumer loans
What is a principal diagnosis? - ANSWER- Primary reason for the
patient's admission
Collecting patient liability dollars after service leads to what? -
ANSWER- Lower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day
used? - ANSWER- 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? - ANSWER- Inpatient care
What code indicates the disposition of the patient at the conclusion of
service? - ANSWER- Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts?
- ANSWER- 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? -
ANSWER- Patient
,3|Page
Medicare guidelines require that when a test is ordered for a LCD or
NCD exists, the information provided on the order must include: -
ANSWER- A valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle
processes are expanding to allow patients to do what? - ANSWER-
Access their information and perform functions on-line
What date is required on all CMS 1500 claim forms? - ANSWER- onset
date of current illness
What does scheduling allow provider staff to do - ANSWER- Review
appropriateness of the service request
What code is used to report the provider's most common semiprivate
room rate? - ANSWER- Condition code
Regulations and requirements for coding accountable care organizations,
which allows providers to begin creating these organizations, were
finalized in: - ANSWER- 2012
What is a primary responsibility of the Recover Audit Contractor? -
ANSWER- To correctly identify proper payments for Medicare Part A
& B claims
, 4|Page
How must providers handle credit balances? - ANSWER- Comply with
state statutes concerning reporting credit balance
Insurance verification results in what? - ANSWER- The accurate
identification of the patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - ANSWER-
CMS 1500
What activities are completed when a scheduled pre-registered patient
arrives for service? - ANSWER- Registering the patient and directing
the patient to the service area
In addition to being supported by information found in the patient's
chart, a CMS 1500 claim must be coded using what? - ANSWER-
HCPCS (Healthcare Common Procedure Coding system)
What results from a denied claim? - ANSWER- The provider incurs
rework and appeal costs
Why does the financial counselor need pricing for services? -
ANSWER- To calculate the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form -
ANSWER- Hospital-based mammography centers
CRCR ACTUAL EXAM TESTBANK 2026
ALL QUESTIONS AND CORRECT
DETAILED ANSWERS ALREADY A
GRADED WITH EXPERT FEEDBACK |
NEW AND REVISED
What type of patient status is used to evaluate the patient's need for
inpatient care? - ANSWER- Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care
require that the beneficiary has received what? - ANSWER- Medically
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$? - ANSWER- When the patient is the insured
What are non-emergency patients who come for service without prior
notification to the provider called? - ANSWER- Unscheduled patients
If the insurance verification response reports that a subscriber has a
single policy, what is the status of the subscriber's spouse? - ANSWER-
Neither enrolled not entitled to benefits
,2|Page
Regulation Z of the Consumer Credit Protection Act, also known as the
Truth in Lending Act, establishes what? - ANSWER- Disclosure rules
for consumer credit sales and consumer loans
What is a principal diagnosis? - ANSWER- Primary reason for the
patient's admission
Collecting patient liability dollars after service leads to what? -
ANSWER- Lower accounts receivable levels
What is the daily out-of-pocket amount for each lifetime reserve day
used? - ANSWER- 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? - ANSWER- Inpatient care
What code indicates the disposition of the patient at the conclusion of
service? - ANSWER- Patient discharge status code
What are hospitals required to do for Medicare credit balance accounts?
- ANSWER- 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? -
ANSWER- Patient
,3|Page
Medicare guidelines require that when a test is ordered for a LCD or
NCD exists, the information provided on the order must include: -
ANSWER- A valid CPT or HCPCS code
With advances in internet security and encryption, revenue-cycle
processes are expanding to allow patients to do what? - ANSWER-
Access their information and perform functions on-line
What date is required on all CMS 1500 claim forms? - ANSWER- onset
date of current illness
What does scheduling allow provider staff to do - ANSWER- Review
appropriateness of the service request
What code is used to report the provider's most common semiprivate
room rate? - ANSWER- Condition code
Regulations and requirements for coding accountable care organizations,
which allows providers to begin creating these organizations, were
finalized in: - ANSWER- 2012
What is a primary responsibility of the Recover Audit Contractor? -
ANSWER- To correctly identify proper payments for Medicare Part A
& B claims
, 4|Page
How must providers handle credit balances? - ANSWER- Comply with
state statutes concerning reporting credit balance
Insurance verification results in what? - ANSWER- The accurate
identification of the patient's eligibility and benefits
What form is used to bill Medicare for rural health clinics? - ANSWER-
CMS 1500
What activities are completed when a scheduled pre-registered patient
arrives for service? - ANSWER- Registering the patient and directing
the patient to the service area
In addition to being supported by information found in the patient's
chart, a CMS 1500 claim must be coded using what? - ANSWER-
HCPCS (Healthcare Common Procedure Coding system)
What results from a denied claim? - ANSWER- The provider incurs
rework and appeal costs
Why does the financial counselor need pricing for services? -
ANSWER- To calculate the patient's financial responsibility
What type of provider bills third-party payers using CMS 1500 form -
ANSWER- Hospital-based mammography centers
