CRCR FINAL EXAM QUESTIONS WITH
CORRECT SOLUTIONS||100%
GUARANTEED PASS||UPDATED
2026/2027 SYLLABUS||ALREADY A+
GRADED||<<LATEST VERSION>>
What option is an alternative to valid long-term payment plans? - ANSWER ✓
Bank loans
What is an advantage of using a collection agency to collect delinquent patient
accounts? - ANSWER ✓ Collection agencies collect accounts faster than hospital
does
What statement DOES NOT apply to revenue codes? - ANSWER ✓ revenue
codes identify the payer
When a patient's illness results in an unusually high amount of medical bills not
covered by insurance or other patient pay resources, what type of account is
created - ANSWER ✓ catastrophic charity
What happens when a patient receives non-emergent services from and out-of-
network provider? - ANSWER ✓ Patient payment responsibility is higher
Every patient who is new to the healthcare provider must be offered what? -
ANSWER ✓ A printed copy of the provider's privacy notice
How may a collection agency demonstrate its performance? - ANSWER ✓
Calculate the rate of recovery
What is true of the information the provider supplies to indicate that an
authorization for service has been received from the patient's primary payer? -
ANSWER ✓ It is posted on the remittance advice by the payer
, What standard claim forms are currently used by the healthcare industry to submit
claims to third-party payers? - ANSWER ✓ The UB-04 and the CMS 1500
Unless the patient encounter is an emergency, what is the efficient and effective
procedure for obtaining information? - ANSWER ✓ Obtain the required
demographic and insurance information before services are rendered
what protocol was developed through the Patient Friendly Billing Project? -
ANSWER ✓ Provide information using language that is easily understood by the
average reader
What technique is acceptable way to complete the MSP screening for a facility
situation? - ANSWER ✓ Ask if the patient's current services was accident related
What is a valid reason for a payer to delay a claim? - ANSWER ✓ Failure to
complete authorization requirements
IF outpatient diagnostic services are provided within three days of the admission
of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System)
hospital, what must happen to these charges - ANSWER ✓ They must be
combined with the inpatient bill and paid under the MS-DRG system
What do large adjustments require? - ANSWER ✓ Manager-level approval
What items are valid identifiers to establish a patient's identification? - ANSWER
✓ Photo identification, date of birth, and social security number
What must a provider do to qualify an account as a Medicare bad debts? -
ANSWER ✓ Pursue the account for 120 days and then refer it to an outside
collection agency
What restriction does a managed care plan place on locations that must be used if
the plan is to pay for the services provided? - ANSWER ✓ Site-of-service
limitation
What is an example of an outcome of the Patient Friendly Billing Project? -
ANSWER ✓ Redesigned patient billing statements using patient-friendly
language
,What statement describes the APC (Ambulatory payment classification) system? -
ANSWER ✓ APC rates are calculated on a national basis and are wage-adjusted
by geographic region
What is a benefit of insurance verification? - ANSWER ✓ Pre-certification or
pre-authorization requirements are confirmed
What is an effective tool to help staff collect payments at the time of service? -
ANSWER ✓ Develop scripts for the process of requesting payments
What is a benefit of electronic claims processing? - ANSWER ✓ Providers can
electronically view patient's eligibility
What does Medicare Part D provide coverage for? - ANSWER ✓ Prescription
drugs
What are some core elements of a board-approved financial policy - ANSWER ✓
Charity care, payment methods, and installment payment guidelines
What circumstance would result in an incorrect nightly room charge? - ANSWER
✓ If the patient's discharge, ordered for tomorrow, has not been charted
What is NOT a typical charge master problem that can result in a denial? -
ANSWER ✓ Does not include required modifiers
Access - ANSWER ✓ An individual's ability to obtain medical services on a
timely and financially acceptable level
Administrative Services Only (ASO) - ANSWER ✓ Usually contracted
administrative services to a self-insured health plan
Case management - ANSWER ✓ The process whereby all health-related
components of a case are managed by a designated health professional. Intended to
ensure continuity of healthcare accessibility and services
Claim - ANSWER ✓ A demand by an insured person for the benefits provided by
the group contract
, Coordination of benefits (COB) - ANSWER ✓ a typical insurance provision that
determines the responsibility for primary payment when the patient is covered by
more than one employer-sponsored health benefit program
Discounted fee-for-service - ANSWER ✓ A reimbursement methodology
whereby a provider agrees to provide service on a fee for service basis, but the fees
are discounted by certain packages
Eligibility - ANSWER ✓ Patient status regarding coverage for healthcare
insurance benefits
First dollar coverage - ANSWER ✓ A healthcare insurance policy that has no
deductible and covers the first dollar of an insured's expenses
Gatekeeping - ANSWER ✓ A concept wherein the primary care physician
provides all primary patient care and coordinates all diagnostic testing and
specialty referrals required for a patient's medical care
Health plan - ANSWER ✓ an insurance company that provides for the delivery or
payment of healthcare services
Indemnity insurance - ANSWER ✓ negotiated healthcare coverage within a
framework of fee schedules, limitations, and exclusions that is offered by insurance
companies or benevolent associations
Medically necessary - ANSWER ✓ Healthcare services that are required to
preserve or maintain a person's health status in accordance with medical practice
standards
Out-of-area benefits - ANSWER ✓ healthcare plan coverage allowed to covered
persons for emergency situations outside of the prescribed geographic area of the
HMO
Out-of-pocket payments - ANSWER ✓ Cash payments made by the insured for
services not covered by the health insurance plan
CORRECT SOLUTIONS||100%
GUARANTEED PASS||UPDATED
2026/2027 SYLLABUS||ALREADY A+
GRADED||<<LATEST VERSION>>
What option is an alternative to valid long-term payment plans? - ANSWER ✓
Bank loans
What is an advantage of using a collection agency to collect delinquent patient
accounts? - ANSWER ✓ Collection agencies collect accounts faster than hospital
does
What statement DOES NOT apply to revenue codes? - ANSWER ✓ revenue
codes identify the payer
When a patient's illness results in an unusually high amount of medical bills not
covered by insurance or other patient pay resources, what type of account is
created - ANSWER ✓ catastrophic charity
What happens when a patient receives non-emergent services from and out-of-
network provider? - ANSWER ✓ Patient payment responsibility is higher
Every patient who is new to the healthcare provider must be offered what? -
ANSWER ✓ A printed copy of the provider's privacy notice
How may a collection agency demonstrate its performance? - ANSWER ✓
Calculate the rate of recovery
What is true of the information the provider supplies to indicate that an
authorization for service has been received from the patient's primary payer? -
ANSWER ✓ It is posted on the remittance advice by the payer
, What standard claim forms are currently used by the healthcare industry to submit
claims to third-party payers? - ANSWER ✓ The UB-04 and the CMS 1500
Unless the patient encounter is an emergency, what is the efficient and effective
procedure for obtaining information? - ANSWER ✓ Obtain the required
demographic and insurance information before services are rendered
what protocol was developed through the Patient Friendly Billing Project? -
ANSWER ✓ Provide information using language that is easily understood by the
average reader
What technique is acceptable way to complete the MSP screening for a facility
situation? - ANSWER ✓ Ask if the patient's current services was accident related
What is a valid reason for a payer to delay a claim? - ANSWER ✓ Failure to
complete authorization requirements
IF outpatient diagnostic services are provided within three days of the admission
of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System)
hospital, what must happen to these charges - ANSWER ✓ They must be
combined with the inpatient bill and paid under the MS-DRG system
What do large adjustments require? - ANSWER ✓ Manager-level approval
What items are valid identifiers to establish a patient's identification? - ANSWER
✓ Photo identification, date of birth, and social security number
What must a provider do to qualify an account as a Medicare bad debts? -
ANSWER ✓ Pursue the account for 120 days and then refer it to an outside
collection agency
What restriction does a managed care plan place on locations that must be used if
the plan is to pay for the services provided? - ANSWER ✓ Site-of-service
limitation
What is an example of an outcome of the Patient Friendly Billing Project? -
ANSWER ✓ Redesigned patient billing statements using patient-friendly
language
,What statement describes the APC (Ambulatory payment classification) system? -
ANSWER ✓ APC rates are calculated on a national basis and are wage-adjusted
by geographic region
What is a benefit of insurance verification? - ANSWER ✓ Pre-certification or
pre-authorization requirements are confirmed
What is an effective tool to help staff collect payments at the time of service? -
ANSWER ✓ Develop scripts for the process of requesting payments
What is a benefit of electronic claims processing? - ANSWER ✓ Providers can
electronically view patient's eligibility
What does Medicare Part D provide coverage for? - ANSWER ✓ Prescription
drugs
What are some core elements of a board-approved financial policy - ANSWER ✓
Charity care, payment methods, and installment payment guidelines
What circumstance would result in an incorrect nightly room charge? - ANSWER
✓ If the patient's discharge, ordered for tomorrow, has not been charted
What is NOT a typical charge master problem that can result in a denial? -
ANSWER ✓ Does not include required modifiers
Access - ANSWER ✓ An individual's ability to obtain medical services on a
timely and financially acceptable level
Administrative Services Only (ASO) - ANSWER ✓ Usually contracted
administrative services to a self-insured health plan
Case management - ANSWER ✓ The process whereby all health-related
components of a case are managed by a designated health professional. Intended to
ensure continuity of healthcare accessibility and services
Claim - ANSWER ✓ A demand by an insured person for the benefits provided by
the group contract
, Coordination of benefits (COB) - ANSWER ✓ a typical insurance provision that
determines the responsibility for primary payment when the patient is covered by
more than one employer-sponsored health benefit program
Discounted fee-for-service - ANSWER ✓ A reimbursement methodology
whereby a provider agrees to provide service on a fee for service basis, but the fees
are discounted by certain packages
Eligibility - ANSWER ✓ Patient status regarding coverage for healthcare
insurance benefits
First dollar coverage - ANSWER ✓ A healthcare insurance policy that has no
deductible and covers the first dollar of an insured's expenses
Gatekeeping - ANSWER ✓ A concept wherein the primary care physician
provides all primary patient care and coordinates all diagnostic testing and
specialty referrals required for a patient's medical care
Health plan - ANSWER ✓ an insurance company that provides for the delivery or
payment of healthcare services
Indemnity insurance - ANSWER ✓ negotiated healthcare coverage within a
framework of fee schedules, limitations, and exclusions that is offered by insurance
companies or benevolent associations
Medically necessary - ANSWER ✓ Healthcare services that are required to
preserve or maintain a person's health status in accordance with medical practice
standards
Out-of-area benefits - ANSWER ✓ healthcare plan coverage allowed to covered
persons for emergency situations outside of the prescribed geographic area of the
HMO
Out-of-pocket payments - ANSWER ✓ Cash payments made by the insured for
services not covered by the health insurance plan
