CRCR Cheat Sheet 2026

The 30 highest-yield CRCR facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. A guarantor is BEST defined as: → The individual financially responsible for the patient's account
2. What does the term 'clean claim' mean in the context of revenue cycle management? → A claim that passes all edits and is accepted for adjudication without corrections
3. On the CMS-1500 form, Box 21 is used to report which of the following? → Diagnosis codes in ICD format
4. Which of the following is a common reason a patient balance fails to collect? → The patient's address on file is outdated
5. A provider receives a payment for $1,500 but the EOB lists two claims totaling $1,400. How should the $100 difference be handled? → Apply $1,400 to the claims and hold $100 as unapplied cash pending research
6. Which key performance indicator (KPI) measures the percentage of claims that are accepted and paid on the first submission without requiring rework? → First-pass resolution rate (FPRR)
7. Which revenue code on a UB-04 is used to bill for routine daily room and board charges in a semi-private room? → 0120
8. A financial counselor is helping an uninsured patient who is scheduled for a non-emergency procedure. What is the BEST first step the counselor should take? → Screen the patient for insurance coverage options and financial assistance eligibility
9. Which metric BEST measures the effectiveness of a hospital's pre-registration process? → Percentage of claims denied for missing or incorrect patient demographic information
10. The Deficit Reduction Act of 2005 requires states to educate employees of Medicaid providers about which federal law? → False Claims Act
11. Under the Affordable Care Act, non-profit hospitals must have a financial assistance policy (FAP) that includes all of the following EXCEPT: → A requirement that patients purchase supplemental insurance
12. Under the No Surprises Act, which type of service is most commonly subject to its protections regarding out-of-network charges? → Emergency services and surprise out-of-network bills at in-network facilities
13. What action should be taken when a duplicate claim denial is received? → Verify whether the original claim was paid or is still pending
14. Which type of payer model requires members to select a primary care physician (PCP) who coordinates all care? → Health Maintenance Organization (HMO)
15. Which type of denial requires the provider to submit additional clinical documentation to support medical necessity? → Medical necessity denial
16. A provider receives a Remittance Advice (RA) showing claim adjustment reason code (CARC) 97. What does this indicate? → The benefit for this service is included in the payment/allowance for another service
17. A claim includes CPT code 45378 (colonoscopy) and 45380 (colonoscopy with biopsy) for the same date. A payer denies the 45378. Why? → CPT 45378 is bundled into 45380 since 45380 includes the diagnostic colonoscopy
18. A claim is denied because the procedure code is inconsistent with the patient's age. What type of denial is this? → Clinical edit denial
19. Under the Affordable Care Act, what is the maximum period a commercial payer has to pay or deny a clean electronic claim? → 30 calendar days
20. A patient undergoes a bilateral knee arthroscopy. How should CPT coding typically reflect this? → Report the unilateral arthroscopy code twice with modifier -50 (Bilateral Procedure)
21. What is the significance of the CARC (Claim Adjustment Reason Code) on an ERA? → It explains why a payment was adjusted or denied on a specific service line
22. What does the modifier -59 indicate when appended to a CPT code? → The procedure is distinct and separate from other services on the same date
23. Why is accurate patient demographic information critical to the revenue cycle? → Demographic errors are the leading cause of claim rejections and payment delays
24. What is a point-of-service collection at patient registration and why is it important? → Collecting copayments, deductibles, or deposits from the patient at the time of service
25. A collection letter is returned as undeliverable. What should the revenue cycle team do? → Use skip tracing to locate updated patient contact information
26. When a patient has both Medicare Part A and a Medigap (supplemental) policy, the financial counselor should understand that Medigap typically covers: → Medicare Part A deductibles and coinsurance
27. What does 'unapplied cash' refer to in payment posting? → Funds received but not yet matched to a specific claim or account
28. Under the Medicare Conditions of Participation, how long must hospitals generally retain medical records for adult patients? → 5 years from date of discharge
29. A patient presents with a Medicaid card and a secondary commercial insurance. What is the correct POS collection approach? → Collect no copay since Medicaid is primary and prohibits balance billing
30. Which national standard transaction set is used for electronic submission of professional healthcare claims? → ASC X12 837P